Saint Joseph Martin – Community Health Needs Assessment

Community Health Needs
Assessment
FY 2013
Contents
Introduction........................................................................................................................1
Executive Summary .......................................................................................................................1
Organization Description ............................................................................................................. 3
How the Assessment was Conducted...............................................................................4
Community Served by the Hospital ................................................................................6
Identification and Description of Geographical Community..............................................7
Defined Community or Service Area......................................................................................... .8
Community Population and Demographics.............................................................................. 10
Socioeconomic Characteristics of the Community.................... ...................................... 10
Economic & Demographic Profile…................................................................................ 11
Community Health Care Resources ...........................................................................................12
Health Status of the Community ...................................................................................12
Community Health Profile................................................................................................ 14
Leading Causes of Death…………………………………………………… …………15
Primary Health Conditions Responsible for Inpatient Hospitalization .............................16
Health Outcomes and Factors.........................................................................................16
Health Statistics and Rankings…………………….………………………………..........16
County Health Rankings....................................................................................................18
Health Outcomes…………………………………………………………………………19
Health Factors…………………………………………………………………...……….20
Primary Data....................................................................................................................21
Community Engagement and Input…………………………………………...…21
Supplemental Data…………………………………………………..………………….24
Priority Community Health Needs Identified ..............................................................28
Violence in the Community........................................................................................................ 31
Adoption/Approval..........................................................................................................32
Appendix A: Community Health Needs Assessment………………………...………33
Introduction
During 2012, a community health needs assessment was conducted by Saint Joseph Martin to
support its mission to enhance the health of people in the communities it serves, to comply with
the Patient Protection and Affordable Care Act of 2010 and federal tax-exemption requirements,
and to identify health needs of the community to help prioritize the allocation of hospital
resources to meet those needs. Based on current literature and other guidance from the Treasury
and IRS, the following steps were completed as part of the community health needs assessment:
•
The “community” served by was defined utilizing inpatient and outpatient data on patient
origin. This process is further described in Community Served by the Hospital.
•
Population demographics and socioeconomic characteristics of the community were
gathered and reported using various sources. The health status of the community was then
reviewed. Information on the leading causes of death and morbidity information was
analyzed in conjunction with health outcomes and factors reported for the community by
County-Healthrankings.org. Health factors with significant opportunity for improvement
were noted.
•
An inventory of health care facilities and resources was prepared.
•
Four focus groups were conducted in the late summer and early fall of 2012. The focus
groups conducted included a senior support group, HANDS (Health Access Nurturing
Development Services) participants, and general community members.
Executive Summary
Saint Joseph Martin and Highlands Regional Medical Center joined together to conduct the
Community Health Needs Assessment that complies with the Patient Protection and Affordable
Care Act enacted in 2010. In addition to the Community Health Needs Assessment that must be
conducted at least every three years, the following are also required for tax-exempt hospitals:



adopt and implement written financial assistance and
emergency medical care policies,
limit charges for emergency or other medically necessary care,
comply with new billing and collection restrictions.
McDowell Appalachian Regional Hospital, a member of the Appalachian Regional Healthcare,
decided to complete their Community Health Needs Assessment by working within their system
that is heavily represented in the eastern part of Kentucky.
Saint Joseph Martin and Highlands Regional Medical Center contracted with the Community and
Economic Development Initiative of Kentucky (CEDIK) to assist in the process. Also input was
solicited from the following organizations to assure that “all” people were represented
particularly the most vulnerable: Big Sandy Area Development District; Martin County Health
Department; Floyd County Health Department; Johnson County Health Department; Magoffin
County Health Department; Sandy Valley Abuse Shelter; Big Sandy Health Care – a federally
1
qualified health center; Operation UNITE; Salyersville Nursing and Rehab Center; Mountain
Comprehensive Care Center; Floyd County Senior Citizens’ Centers; and, community members.
Primary data, secondary data, surveys, focus groups and supplemental data was gathered to assure
the Community Health Needs Assessment was extensive and included input from the voices of
the most vulnerable.
To facilitate prioritization of identified health needs, a ranking and prioritization process was used
based on six factors:
1) The ability of Saint Joseph Martin to evaluate and measure outcomes.
2) How many people are affected by the issue or size of the issue?
3) What are the consequences of not addressing this problem?
4) Prevalence of common themes.
5) How closely does the need align with KentuckyOne Health strategies?
6) Does the hospital have existing programs which respond to the identified need?
Upon completion of the prioritization process, Heart Disease, Cancer and Diabetes were
identified by the Implementation Strategy Team as the top priorities for Saint Joseph Martin.
Also, because of their ranking and their integral relationship to the major identified needs, adult
smoking and adult obesity, will be woven into the strategies of the top priorities.
Saint Joseph Martin will continue to work with the community to execute the implementation
plan and realize the goals that have been positioned to build a healthier community – a healthier
Kentucky.
2
Organization Description
In September 1947, three courageous Sisters of Divine Providence of
Melbourne, Kentucky assumed ownership of a 30 bed hospital named
Martin General Hospital. The hospital’s name was changed to Our Lady
of the Way Hospital. In January 2008, Our Lady of the Way Hospital
became part of Saint Joseph Health System and is presently named
Saint Joseph Martin (SJM). Saint Joseph Martin is a non-profit
Critical Access Hospital (CAH) located in Martin, Kentucky.
Saint Joseph Martin is part of KentuckyOne Health, the largest health system in Kentucky with
more than 200 locations including hospitals, outpatient facilities and physician offices, and more
than 3,100 licensed beds. An 18-member volunteer board of directors governs KentuckyOne
Health, its facilities and operations, including Saint Joseph Martin, with this mission:
Our Purpose
To bring wellness, healing and hope to all, including the underserved.
Our Future
To transform the health of communities, care delivery and health care professions so that
individuals and families can enjoy the best of health and wellbeing.
Our Values
Reverence: Respecting those we serve and those who serve.
Integrity: Doing the right things in the right way for the right reason.
Compassion: Sharing in others’ joys and sorrows.
Excellence: Living up to the highest standards.
3
Saint Joseph Martin is one of three hospitals operating in Floyd County. As a rural CAH, Saint
Joseph Martin has 25 Medicare certified beds. In addition to the hospital, SJM operates four rural
health clinics. Saint Joseph Martin employs 140 individuals.
Saint Joseph Martin is committed to excellence in all aspects of their care. SJM is accredited by
The Joint Commission which means complying with the highest national standards for safety and
quality of care.
Saint Joseph – Martin’s diligence in striving for excellence as they fulfill their mission has
garnered them many achievements on a local, state and national level.
•
October 2012 – Kentucky Family Resource Youth Services Centers presented Saint
Joseph Martin the not-for-profit Bridges Over Barriers Award.
•
May 2011 – Kentucky Hospital Association (KHA) presented Saint Joseph Martin the
Quality Award in the category of Critical Access Hospitals. Saint Joseph Martin was the
only hospital in eastern Kentucky to receive this award.
•
February 2011 – Saint Joseph – Martin received the JD Power distinction for Service
excellence (all seven Saint Joseph Health System hospitals received this distinction.)
•
May 2010 – Saint Joseph – Martin earned Quality Respiratory Care Recognition (QRCR)
under a national program aimed at helping patients and families make informed decisions
about the quality of the respiratory care services available in hospitals. Saint Joseph –
Martin also earned this recognition in 2009.
How the Assessment was Conducted
Saint Joseph Martin contracted with the Community and Economic Development Initiative of
Kentucky (CEDIK) in the spring of 2012 to conduct this community health needs assessment
(CHNA). Saint Joseph Martin also partnered with the Highlands Regional Medical Center to
conduct the CHNA because of a shared common service area. CEDIK is a Cooperative
Extension-based center at the University of Kentucky that provides technical assistance to rural
hospitals and health providers in Kentucky.
4
Figure 1 provides a brief overview of CEDIK's CHNA
process.
The Community Steering Committee is a vital part to the CHNA process. These individuals
represent organizations and agencies from the service area. In particular, the individuals who
were willing to volunteer enabled the hospital to get input from populations that were often not
engaged in conversations about their health needs. CEDIK provided a list of potential agencies
and organizations that would facilitate broad input. Specifically, the list included individuals
serving the local health department, the school system, Cooperative Extension, public housing,
senior citizens, local government, other healthcare provider (EMS, clinics, etc), social work, Area
Development Districts, and small businesses, among others.
Saint Joseph Martin and Highlands Regional Medical Center (Prestonsburg, KY) chose to
combine the process for their CHNA because both hospitals are located in the same county. As a
result, there was one Community Steering Committee. Highlands Regional Medical Center is a
larger hospital (120 beds) and serves a larger region than just Floyd County. However, there was
ample representation from Floyd County and surrounding counties to allow for this combined
steering committee.
Table 1 provides an overview of those individuals who were willing to serve on the Community
Steering Committee and the organizations they represent. There was tremendous representation
by the local health departments, the regional planning districts (Big Sandy Area Development
District), other healthcare providers, senior citizen center, and local government.
Table 1 Saint Joseph Martin Community Steering Committee Members
Name
Organization
Title/Position
5
Denise Thomas
Deborah Ramey
Thursa Slone
Russell Briggs
Connie Little
Toby Music
Ancil Lewis
Judy Salyer
Debbie Trusty
Megan Mainous
Big Sandy Area Development
District
Big Sandy Area Development
District
Martin County Health Department
Floyd County Health Dept.
Johnson County Health Dept.
Sandy Valley Abuse Shelter
Highlands Regional Medical Center
Big Sandy Health Care
Saint Joseph Martin Hospital
Operation Unite
Salyersville Nursing and Rehab
Tonya Ward
Sharon Green
Linda Spurlock
Vickie Boyd
Donna Gray
Community Member
Magoffin County Health Department
MCCC
Floyd County Senior Center
Community Volunteer
Terry Trimble
Community & Economic Dev.
Associate
Executive Assistant
Martin County Health Department
Public Health Director
Director
Director
Director of Social Work
CEO
Director of Social Work
Education Director
Regional Director of Sales &
Marketing
Magoffin County Circuit Clerk
Region 9 HDC coordinator
Volunteer coordinator/advocate
Director
The Community Steering Committee met as a group at Jenny Wiley State Park in June 2012 and
then in September 2012. Each time a hospital representative from each hospital welcomed and
thanked the individuals for assisting in the process and then excused themselves. CEDIK asked
that hospital representatives not be present during any focus group discussions or debriefing with
the Community Steering Committee.
Community Served by the Hospital
Identification and Description of Geographical Community
Floyd County is located in Eastern Kentucky, in the heart of Appalachia. Pikeville, KY is the
closest larger city in Kentucky. Lexington, KY and Charleston, WV are roughly equidistant, as
the crow flies. There is limited road access to the region.
Figure 2 provides an overview of the location of Saint Joseph Martin.
Figure 2 Saint Joseph Martin Location
6
Defined Community or Service Area
Saint Joseph Martin’s community was defined as the geographical area from which a significant
number of the patients utilizing hospital services reside. While the community health needs
assessment considers other types of health care providers, hospitals are the single largest provider
of acute care services. For this reason, the utilization of hospital services provides the clearest
definition of the community.
Saint Joseph Martin serves primarily the residents of Floyd County. Eighty-two percent of the
inpatient discharges at Saint Joseph Martin originate from Floyd County.
Tables 2 through 7 provide a description of Saint Joseph Martin’s patients in particular where
they come from, how they pay, and why they visited. Table 2 details the patient origin of all of
Saint Joseph Martin’s patients (inpatient visits only) during the 2011 calendar year. Roughly
82% of the patients reside in Floyd County and 12.5% originate from Knott County.
Table 2 Saint Joseph Martin Inpatient Origin Discharges 1/1/11 – 12/31/11
County of Origin
Discharges
Patient Days
Average LOS
Total Charges
Average Charges
3.8
$
6,628,982
$
9,894
Floyd, KY
670
2,570
Knott, KY
102
412
4
$
1,048,023
$
10,275
Pike, KY
19
53
2.8
$
155,456
$
8,182
Johnson, KY
12
45
3.8
$
147,475
$
12,290
Magoffin, KY
7
21
3
$
71,195
$
10,171
Perry, KY
3
6
2
$
14,170
$
4,723
7
Martin, KY
1
12
12
$
34,304
$
34,304
Pulaski, KY
1
2
2
$
2,695
$
2,695
Dickensen, VA
1
3
3
$
25,272
$
25,272
Mingo, WV
1
1
1
$
4,046
$
4,046
The inpatient market share is provided in Table 3. The data suggest that 8.1% of Floyd County
residents utilize Saint Joseph Martin whereas the remaining 91.9% of Floyd County residents
(who utilized inpatient care) used Highlands Regional Medical Center (34.1%), Pikeville Medical
Center (22.9%) and McDowell ARH (8.9%) among other less utilized hospitals. Less than 1% of
other patients from other surrounding counties used Saint Joseph Martin.
Table 3 Inpatient Market Share
Originating
County
Floyd
Johnson
Magoffin
Martin
Highlands
Pikeville
McDowell
ARH
Saint
Joseph
Martin
Hazard
ARH
Kings
Daughter
34.1%
27.0%
28.4%
27.6%
22.9%
4.2%
4.0%
2.4%
8.9%
0.1%
0.0%
0.0%
8.1%
0.2%
0.4%
0.1%
6.0%
2.1%
2.2%
1.6%
5.8%
13.1%
7.7%
21.9%
UK
3.5%
2.5%
3.4%
2.2%
Central
Baptist
Paul B
Hall
Three
Rivers
1.8%
1.1%
3.4%
0.7%
1.6%
40.8%
37.7%
7.3%
1.4%
3.9%
1.3%
27.6%
Saint
Joseph
East
Saint
Joseph
Hospital
Other
1.3%
1.7%
2.9%
0.7%
1.1%
0.6%
1.0%
0.1%
3.5%
2.8%
7.7%
7.7%
Table 4 Saint Joseph Martin Inpatient Payer Mix 1/1/11 - 12/31/11
Payer
Discharges
Average LOS
Total Charges
Average Charges
Medicare
402
4.4
$
4,314,186
$
10,732
Medicaid
143
3.6
$
1,306,303
$
9,135
Charity
125
2.9
$
960,476
$
7,684
Commercial - Mix
70
3.2
$
871,942
$
12,456
Self-Pay
23
3
$
175,197
$
7,617
Medicare Managed Care
22
3.7
$
179,317
$
8,151
Coventry Cares
8
1.5
$
52,474
$
6,559
Workers Compensation
7
2.3
$
46,304
$
6,615
Other Federal Programs
7
7.1
$
116,073
$
16,582
Kentucky Spirit
5
2.6
$
46,673
$
9,335
WellCare
4
2.3
$
36,597
$
9,149
Champus
1
3
$
26,071
$
26,071
Table 4 suggests that approximately 50% of the total inpatient visits were paid for by Medicare,
17.4% by Medicaid, 15.2% were classified as charitable care and 8.5% were paid by commercial
insurance. The average charges were highest for commercial insurance and other federal
programs and the lowest charges for one of the new Medicaid Care Organizations
(CoventyCares), self-pay, workers compensation, and charitable pay.
8
Table 5 Saint Joseph Martin Outpatient Origin Report 1
County
Discharges
Total Charges
Average Charges
Floyd, KY
12,851
$
25,463,794
$
1,981
Knott, KY
2,032
$
3,954,301
$
1,946
Pike, KY
344
$
821,079
$
2,387
Johnson, KY
294
$
701,496
$
2,386
Magoffin, KY
239
$
503,457
$
2,107
Perry, KY
64
$
118,729
$
1,855
Martin, KY
33
$
49,692
$
1,506
Lawrence, KY
21
$
47,780
$
2,275
Letcher, KY
17
$
32,639
$
1,920
Breathitt, KY
14
$
26,639
$
1,903
Fayette, KY
11
$
19,868
$
1,806
Boyd, KY
9
$
16,927
$
1,881
Montgomery, KY
8
$
6,603
$
825
Leslie, KY
7
$
28,184
$
4,026
Table 6 Saint Joseph Martin Outpatient Payer Mix 1/1/11 - 12/31/11
Payer
Discharges
Total Charges
Average Charges
Medicaid
4,418
$
5,978,053
$
1,353
Charity
4,191
$
7,753,255
$
1,850
Medicare
3,333
$
10,148,178
$
3,045
Commercial - Mix
2,021
$
3,913,019
$
1,936
Self-Pay
1,096
$
2,410,693
$
2,200
Coventry Cares
278
$
411,605
$
1,481
Kentucky Spirit
226
$
330,449
$
1,462
Medicare Managed Care
213
$
624,153
$
2,930
WellCare
172
$
217,335
$
1,264
Workers Comp
98
$
192,539
$
1,965
Other Federal Programs
22
$
66,266
$
3,012
Auto Insurance
13
$
56,964
$
4,382
Champus
10
$
12,094
$
1,209
Passport Medicaid Managed Care
10
$
4,245
$
425
3
$
3,771
$
1,257
VA
Tables 5 and 6 provide an overview of who uses the hospital for outpatient purposes. Again,
roughly 81% of the visitors who used Saint Joseph Martin’s outpatient services resided in Floyd
County and 12.7% lived in Knott County. The vast majority of the visits were paid through
Medicaid, Charitable care, or Medicare.
1
Did not report for counties where there were fewer than 5 patients.
9
Community Population and Demographics
Saint Joseph Martin’s primary service area is Floyd County. In 2010, the population of Floyd
County was 39,451 and there are roughly 634 individuals residing in the city of Martin.
Socioeconomic Characteristics of the Community
Table 7 provides an overview of the basic social and economic factors in Floyd County. Of the
39,451 individuals living in Floyd County, 98.7% of them are white. Roughly 69% of those over
the age of 24 have graduated from high school compared to a state average of 81% and a national
average of 92%. More than one-third of the population rates themselves as having fair or poor
health and 36.9% of children are members of a single-parent household. These statistics are
consistent with many of Kentucky’s Appalachia counties.
The poverty rate (30.3%) is significantly higher than the national rate of 11% and the median
household income ($29,725) is also lower than the national average ($50,221). The
unemployment rate was about 2% higher in Floyd County than in Kentucky. In total, there are
currently 16,255 jobs in the county.
10
Table 7 Floyd County Community Economic and Demographic Profile
Indicators
Social Factors
Population
Kentucky
National Benchmark
Data Source
Year
39,451
4,314,113
-
U.S. Census
2010
White
98.7%
89.9%
U.S. Census
2010
African American
0.8%
7.5%
U.S. Census
2010
Hispanic
0.6%
2.6%
U.S. Census
2010
High school graduation rates
68.9%
81.0%
92%
% of population with limited English proficiency (LEP)
0.2%
2.1%
-
Self rated health status (%of adults who report fair or poor
health)
38.0%
21.7%
10%
Children in single parent households
36.9%
32.4%
20%
ACS
Race
Economic Factors
Floyd
Kentucky Health Facts
'ACS 5-Year Estimates
BRFSS
2006-2010
2009
2004-2010
2006-2010
30.3%
18.4%
11%
SAIPE
2009
$29,725
$40,061
$50,221
SAIPE
2009
Unemployment rate
12.6%
10.7%
9.3%
Bureau of Labor Statistics
2010
% of workers who travel 30 minutes or more one way to work
28.7%
28.2%
35.1%
ACS
Total number of jobs
16,255
% of people living below poverty level
Median household income
2005-2009
EMSI
11
Community Health Care Resources
The availability of health care resources is critical to the health of a county’s residents and a measure of
the soundness of the area’s health care delivery system. An adequate number of health care facilities and
health care providers are vital to sustain a community’s health status. Fewer health care facilities and
health care providers can impact the timely delivery of services. A limited supply of health resources,
especially providers, results in the limited capacity of the health care delivery system to absorb charity
and indigent care as there are fewer providers upon which to distribute the burden of indigent care.
Floyd County is not considered a medically underserved area; however, adjoining Knott County is
considered medically underserved. Knott County is Saint Joseph Martin’s second largest market area.
The following addresses the availability of health care resources to the residents of Saint Joseph Martin’s
service area.
Hospitals
There are three hospitals in Floyd County; Highlands Regional Medical Center, Prestonsburg, KY – 184
beds, 50 active physicians and two clinics in Floyd County; McDowell Appalachian Regional Hospital,
McDowell, KY – 25 beds, 77 active physicians and three clinics; and, Saint Joseph Martin – 25 beds, 22
active physicians and four rural health clinics. Highlands Regional Medical Center and McDowell
Appalachian Regional Hospital operate home health services.
Health Department
There is one health department in Floyd County located in Prestonsburg, KY; however, there are satellite
clinics in Wheelwright and Betsy Layne areas.
Federally Qualified Health Center
Big Sandy Health Care (BSHC), a federally qualified health center, has been in operation since 1974 and
operates two medical clinics in Floyd County. Also BSHC operates clinics in Pike, Magoffin and Martin
counties of the Big Sandy Area District.
Health Status of the Community
Good health can be defined as a state of physical, mental, and social well-being, rather than the absence
of disease or infirmity. According to Healthy People 2010, the national health objectives released by the
U.S. Department of Health and Human Services, individual health is closely linked to community health.
Community health, which includes both the physical and social environment in which individuals live,
work, and play, is profoundly affected by the collective behaviors, attitudes, and beliefs of everyone who
lives in the community. Healthy people are among a community’s most essential resources.
Numerous factors have a significant impact on an individual’s health status: lifestyle and behavior, human
biology, environmental and socioeconomic conditions, as well as access to adequate and appropriate
health care and medical services. Studies by the American Society of Internal Medicine conclude that up
to 70 percent of an individual’s health status is directly attributable to personal lifestyle decisions and
attitudes. People who do not smoke, who drink in moderation (if at all), use automobile seat belts (car
seats for infants and small children), maintain a nutritious low-fat, high-fiber diet, reduce excess stress in
12
daily living, and exercise regularly have a significantly greater potential of avoiding debilitating diseases,
infirmities and premature death.
The interrelationship among lifestyle/behavior, personal health attitude, and poor health status is gaining
recognition and acceptance by both the general public and health care providers. Some examples of
lifestyle/behavior and related health care problems include the following:
Lifestyle/Behavior Primary Disease Factor
Life Lifestyle/Behavior
Smoking
Alcohol/Drug Abuse
Poor Nutrition
Driving at Excessive Speeds
Lack of Exercise
Overstressed
Primary Disease Factor
Lung cancer
Cardiovascular disease
Cirrhosis of liver
Motor vehicle crashes
Unintentional injuries
Obesity
Depression
Trauma
Motor vehicle crashes
Cardiovascular Disease
Depression
Mental Illness
Cardiovascular Disease
Emphysema
Chronic Bronchitis
Malnutrition
Mental Illness
Suicide
Digestive Disease
Alcohol/Drug Abuse
Health problems should be examined in terms of morbidity as well as mortality. Morbidity is defined as
the incidence of illness or injury and mortality is defined as the incidence of death. However, the law does
not require reporting the incidence of a particular disease, except when the public health is potentially
endangered.
Due to limited morbidity data, this health assessment relies heavily on death and death rate statistics for
leading causes in death. Such information provides useful indicators of health status trends and permits an
assessment of the impact of changes in health services on a resident population during an established
period of time. Community attention and health care resources may then be directed to those areas of
greatest impact and concern.
Table 8 provides an overview of the health of the community. There are certain needs that arise from the
data. These needs appear to be largely related to smoking and obesity/lack of physical activity. The
county has higher rates for “births to mothers who smoked,” “adult smoking,” “early childhood obesity,”
“adult prevalence of overweight and obesity,” “lack of physical activity,” and “lung cancer rates.” Again
these data are very similar across Appalachia but these are very costly issues both to the community and
the hospitals. Because a great deal of the individuals who have health issues is often un/underinsured the
cost of treatment falls on the hospital. If the hospital, along with other community partners, can
encourage healthier behavior, it can potentially also improve its own financial conditions.
13
Table 8 Community Health Profile
Floyd
Kentucky
National Benchmark
Maternal &
Teen birth rate per 1000
Indicators
68
52
22
Child Health
Adequate prenatal care
87%
85%
-
Number of reported child abuse cases (2010)
206
15,338
-
Behavioral Factors
Low birthweight
10.5%
9.0%
6.00%
Births to mothers who smoked during pregnancy
35.0%
24.0%
-
KIDS COUNT DATA CENTER
2002-2008
2009
17.7%
15.6%
26.9%
15%
Prevalence of youth smoking
27.1%
25.0%
-
Kentucky Health Facts
2007
-
National Center for Chronic Disease Prevention
and Health Promotion, calculated from BRFSS
2009
CDC, National Center for Hepatitis, HIV, STD, and
TB Prevention
2009
36.9%
32.9%
KIDS COUNT DATA CENTER
171
311.4
83
BRFSS
2010
2004-2010
7.9%
11.0%
8%
40.7%
31.5%
-
BRFSS
National Center for Chronic Disease Prevention
and Health Promotion, calculated from BRFSS
2004-2010
Lack of physical activity (% of adults reporting no PA in past
month)
Consume 5 or more fruits & vegetables/day
14.6%
-
-
Kentucky Health Facts
2005-2009
Percent of adults who received flu vaccine in past year
38.2%
-
-
Kentucky Health Facts
2008-2010
Tooth loss (percent of adults missing 6 or more teeth)
37.7%
-
-
Kentucky Health Facts
Avg 2006-2010
76.8%
82.4%
89%
16.3%
-
-
0
337
17
Census County Business Patterns
2009
2007
Diabetes Indicators Diabetes screenings (Medicare enrollees that receive screening)
% of population with diabetes
# of recreational facilities (per 100,000)
Medicare claims/Dartmouth Atlas
Kentucky Health Facts
2009
2009
2008-2010
Air pollution - particulate matter days
0
2
0
CDC-Environmental Protection Agency (EPA)
Collaboration
Primary care physicians (per 100,000)
1.3
1.0
-
Kentucky Health Facts
2009
Immunization coverage (ages 19-35mo)
81.8%
80.0%
-
Kentucky Health Facts
2007
% of uninsured adults
24.5%
-
13%
Kentucky Health Facts
2009
% of uninsured children
8.0%
-
-
Kentucky Health Facts
2009
5.9
4.3
2.3
Cancer deaths (per 100,000)
264.61
211.55
-
Lung cancer deaths (rate per 100,000)
108.33
75.06
21.43
19.93
-
35
23.41
Prostate cancer deaths (rate per 100,000)
22.53
Percent of adults with asthma
Poor mental health days (average/month)
Colorectal cancer deaths (rate per 100,000)
Breast cancer deaths (rate per 100,000)
Repiratory Illness
Vital Statistics, NCHS (County Health Rankings
2010
29.2%
Excessive drinking (among adults)
Cancers
KIDS COUNT DATA CENTER
2007
Early childhood obesity (age 2-4 yrs)
Chlamydia rate (per 100,000)
Access to Care
Kentucky Health Facts
Year
2002-2008
Adult smoking
Adult prevalence of overweight & obesity
Physical Factors
Data Source
Vital Statistics, NCHS (County Health Rankings
Number of asthma hospitalizations (3 yr average)
BRFSS
2004-2010
Kentucky Health Facts
2004-2008
Kentucky Health Facts
2004-2009
Kentucky Health Facts
2004-2010
-
Kentucky Health Facts
2004-2011
25.21
-
Kentucky Health Facts
2004-2012
21.0%
-
-
Kentucky Health Facts
2008-2010
134
6837
-
KIDS COUNT DATA CENTER
2009-2011
14
Leading Causes of Death
Eastern Kentucky’s health has been declining for many years. The Floyd County Times reported in
November 2011, that the head of the University of Kentucky Markey Cancer Center said that Eastern
Kentucky has the highest rate of lung cancer than any region in the state. In March 2012, the Floyd
County Times reported that Kentucky ranked sixth in nation for obesity, fourth in high blood pressure and
second for diabetes (Gallup-Healthways Well Being Index).
The table below shows that the leading causes of death in Floyd County are cancer – lung and breast;
chronic lower respiratory disease; unintentional injury; diabetes; diseases of the heart; and,
cerebrovascular diseases.
15
Primary Health Conditions Responsible for Inpatient Hospitalization
Table 9 provides an overview of the diagnosis-related group for the inpatient visits. Forty-five percent
and nearly $4 million of total charges for inpatient stays were pulmonary (lung) related. Ten percent of
the visits were related to cardiovascular disease. Thirty-one of the discharges were for general surgery
(average charge: $16,687).
Table 9 Saint Joseph Martin Inpatient Diagnosis-related Group 1/1/11 - 12/31/11
DRG Description
Discharges
Average LOS
Medicine - Pulmonary
374
4.2
$
Total Charges
3,980,304
Average Charges
$
10,643
Medicine - General
222
3.2
$
1,837,554
$
8,277
Medicine - Cardiovascular Disease
78
4.4
$
897,677
$
11,509
Medicine - Nephrology/urology
70
3.7
$
535,691
$
7,653
Surgery - General
31
3.1
$
517,308
$
16,687
Medicine - Neurosciences
14
2.6
$
119,858
$
8,561
Medicine - Otolaryngology
10
3.2
$
66,002
$
6,600
Medical - Oncology
7
5.7
$
65,919
$
9,417
Medicine - Orthopedics
4
5.3
$
55,482
$
13,871
Psychiatry
3
2
$
18,910
$
6,303
Chemical Dependency
2
1.5
$
3,317
$
1,659
Surgery - Cardiovascular and Thoracic
1
5
$
23,802
$
23,802
Surgery - Gynecology
1
2
$
15,793
$
15,793
Health Outcomes and Factors
Health Statistics and Rankings
An analysis of various health outcomes and factors for a particular community can, if improved, help
make that community a healthier place to live, learn, work, and play. And a better understanding of the
factors that affect the health of the community will assist with how to improve the community’s habits,
culture, and environment. This portion of the community health needs assessment utilizes information
from County Health Rankings, a key component of the Mobilizing Action Toward Community Health
(MATCH) project, collaboration between the Robert Wood Johnson Foundation and the University of
Wisconsin Population Health Institute.
The County Health Rankings model is grounded in the belief that programs and policies implemented at
the local, state, and federal levels have an impact on the variety of factors that, in turn, determine the
health outcomes for communities across the nation. The model ranks all 50 states and the counties within
each state based on two types of health outcomes—how long people live (mortality) and how healthy
people feel (morbidity)—and four health factors. These are defined below:
•
Health Outcomes - rankings are based on an equal weighting of one length of life (mortality)
measure and four quality of life (morbidity) measures.
•
Health Factors - rankings are based on weighted scores of four factors
16
•
•
•
•
Health behaviors (6 measures)
Clinical care (5 measures)
Social and economic (7 measures)
Physical environment (4 measures)
Those having high ranks, e.g. 1 or 2, are considered to be the “healthiest.” A more detailed discussion
about the ranking system, data sources and measures, data quality and calculating scores and ranks can be
found at the website for County Health Rankings (www.countyhealthrankings.org).
As part of this community health needs assessment, the relative health status of Floyd County is
compared to the state of Kentucky and a national benchmark. A better understanding of the factors that
affect the health of the community will assist with how to improve the community’s habits, culture, and
environment.
The following tables from County Health Rankings summarize the 2012 health outcomes for all counties.
Unfortunately, Floyd County ranks 112 out of 120 in Health Outcomes; and, 104 out of 120 in Health
Factors.
17
18
19
Source: University of Wisconsin Population Health Institute. County Health Rankings 2012.
20
Primary Data
Community Engagement and Input
Focus Groups: The communities that serve Saint Joseph Martin (SJM) and Highlands Regional Medical
Center (HRMC) conducted four focus groups in the late summer and early fall of 2012 ( August 28th,
September 12th, September 14th and October 9th. The focus groups conducted included a senior support
group, HANDS (Health Access Nurturing Development Services) participants, and general community
members. A total of 67 participants were involved in the SJM/HRMC focus groups and three of the
groups provided food during their hour long meeting. All participants were asked to complete the
Community Health Needs Assessment (CHNA) Survey before discussion began and all participants were
introduced to the CHNA process before discussion. CEDIK provided three questions that were the
foundation for each focus group meeting. These questions included:
a. What is your vision for a healthy community?
b. What is your perception of the hospital?
c. What can the hospital do to meet the needs of the community?
Documentation from Focus Groups (information from all groups have been compiled below):
*indicates mentioned more than once
1. Vision for a Healthy Community
•
Better Drinking Water *
•
Assisted living facilities *
•
Recreation Centers and more activities for youth *
•
More shopping options
•
Stronger economy – more jobs *
•
No drug problem – prescription and non-prescription *
•
Urgent treatment facilities that provide afterhours care and also have after hours pharmacy and
dental emergency care *
•
Affordable housing
2. Perception of Hospital
•
SJM is an older facility (not as nice)
21
•
SJM lacks equipment or it is outdated *
•
SJM and HRMC – everyone is flown out for “everything” – they can’t treat them locally *
•
SJM staff is very nice
•
SJM feels like a prison environment
3. Community Needs the hospital might address
•
More specialists (variety of specialists listed) *
•
Sleep disorder clinic
•
More preventative services *
•
Prescription cost assistance or help with finding programs
•
Ambulance service for other counties *
•
Assistance to other communities with obtaining Urgent Treatment Facilities or have hospital staff
assist at these facilities *
•
Diabetes education *
•
Walking programs
•
Help support financially and with staff - school programs – DARE, PSI, Tattoo *
Surveys: The hospital steering committee from both hospitals, along with input from several members of
the Community Steering Committee, adapted CEDIK’s CHNA survey template. A copy of the survey is
provided in the appendix. Surveys were distributed to the members of the Community Steering
Committee to give out to their clientele. In addition, surveys were also provided to patients as they were
discharged from both Saint Joseph Martin and Highlands Regional Medical Center.
In total 480 surveys were returned for both hospitals to use for their CHNA. Of those 480 surveys, 31 of
the respondents visited Saint Joseph Martin (and not Highlands Regional Medical Center) in the last two
years. Eleven respondents also visited a Lexington Hospital (2), Pikeville (7), Ashland (2), and
Huntington WV (2). There were a total of 17 of the respondents who said they visited the Saint Joseph
Martin emergency department. Approximately 35.3% of those visits for were self-reported as life
threatening issues; 41.9% of the respondents utilized outpatient services and 19.4% utilized inpatient
services.
22
Of those who used a hospital other than Saint Joseph Martin, 37.5% did so because the services they
needed were not available. The remainder of the reasons included the reputation of the hospital, doctor
referral and the other hospital was closer.
Respondents also provided their perception of quality of care at Saint Joseph Martin. In total only one
respondent was dissatisfied, four were neutral about their experience, and 23 were satisfied (several did
not answer the question).
Because both hospitals were interested in the type of specialty services that were in demand, the survey
specifically asked about the specialty services patients used “anywhere,” “at Saint Joseph Martin,” and “at
Highlands Regional Medical Center.” The results are provided in Table 10. It appears that the majority of
the patients who used Saint Joseph Martin also utilize the specialty services when available. Only in the
case of OB-GYN does there appear to be patients who go primarily elsewhere.
Table 10 Respondents’ Specialty Service Utilization
Services
Cardiology
OB-GYN
Radiology
Neurology
Psychiatry
Oncology
Urology
Orthopedics
Pulmonary
Pediatrics
Dialysis
Family Practice
Outpatient
Services
Number of
respondents using
the service anywhere
7
4
16
2
0
0
2
2
3
2
1
13
14
Number of respondents
using Saint Joseph
Martin
6
1
16
2
0
0
2
2
3
1
1
13
14
Table 11 provides some detail about the respondents’ health risks. To make certain that there was broad
community input, Saint Joseph Martin wanted to ensure that they were engaging the medically needy
population. The results in Table 11 suggest that 29% of the respondents or a member of the respondent’s
family has diabetes, 64.5% have high blood pressure, and nearly 10% of the respondents or a member of
their family have cancer.
Table 11 Prevalence of Disease Among Survey
Respondents
Do you or anyone in your family
have…?
Diabetes
High Blood Pressure
Percentage of respondents who
indicated yes
29%
64.5%
23
Cancer
Heart Disease
Mental Illness
9.7%
19.4%
6.5%
In addition, Table 12 provides evidence that the survey reached a lower-income population. Of the
respondents, 35.5% stated that they had delayed health care due to a lack of money or insurance.
Approximately 28% of the households that responded did not have health insurance while 12.9% and
35.4% were enrolled in Medicaid and Medicare, respectively. Twenty-nine percent of the households
received SNAP (Supplemental Nutrition Assistance program) assistance. As a result of the characteristics
of the survey sample, the needs that have been suggested throughout the surveys reflect the needs of those
who have high health risks and don’t necessarily have affordable access to health care.
Table 12 Respondents' Financial Situation
Have you or someone in your household delayed health care due to lack
of money and/or insurance?
Are you or members of your household currently eligible for
Medicare
Medicaid
Public Housing Assistance
SNAP (Food Stamp Program)
Are you or anyone in your household without health insurance currently?
35.5% yes
35.4%
12.9%
12.9%
29.0%
28.2%
Both hospital steering committees had a genuine interest in understanding how residents perceived the
path to a healthier community. The survey specifically asked, “What do you think are the THREE most
important factors for a healthy community and improving the quality of life in your community?” There
were fifteen choices provided to the respondent to choose from. The ranking of these choices is provided
below. The most often selected choice was “access to health care,” “good jobs and healthy economy,”
“religious or spiritual values,” and “supportive services for seniors”.
1st – Access to Health Care
2nd – Good jobs and healthy economy
2nd – Religious or spiritual values
3rd – Supportive services for seniors
4th – Clean Environment
4th – Low crime and safe neighborhoods
5th – Healthy behaviors and lifestyles
6th – Good schools
7th – Strong family life
8th – Good place to raise children
9th – Affordable housing
10th – Low level of child abuse
11th – Low adult death and disease rates
11th – Parks and recreation
12th –Excellent race and ethnic relations
12th – Emergency preparedness
13th –Arts and cultural events
13th – Low infant deaths
24
The survey ended with an open ended question: “What could the Hospital do to better meet you and your
household’s health needs (educational programs, after-hours access, outpatient services)?” The responses
are loosely categorized as “access to after hour care,” “quality of care,” and “services” below.
After Hours Care:
The number of respondents who indicated they would like to have access to after hours care: 3
Quality of Care Responses:
• “Saint Joseph Martin is doing as good a service as any”
• One individual suggested an equipment update would be useful
Services:
• Many requested additional outpatient services (8 of the respondents)
• Specific services often requested: Bloodwork/Xray/labs
• Offer more specialty services
• Assistance programs for seniors
Supplemental Data
There were also additional respondents who used both Saint Joseph Martin & Highlands Regional
Medical Center in the last two years. These responses were included separately because it is harder to
determine how specifically Saint Joseph Martin could better meet the community health needs. However,
the responses are useful for planning purposes and should be included in the analysis.
Twenty-two of the respondents used both Highlands and Saint Joseph Martin in the last two years.
Eleven respondents also visited a Lexington Hospital (3), Pikeville (5), and Ashland (2). There were 25
total visits to the emergency department among the respondents (some used the ED for both life
threatening and non-life threatening purposes). Approximately 27.3% of those visits for were for life
threatening issues, 72.7% of the respondents utilized outpatient services and 22.7% utilized inpatient
services.
Of those who used a hospital other than Saint Joseph Martin or Highlands, 13% did so because the
services they needed were not available. The remainder of the reasons included choice of surgeons and
where the EMT took them.
Respondents also provided their perception of quality of care at either Saint Joseph Martin or Highlands.
In total no one was dissatisfied, five were neutral about their experience, and 14 were satisfied (four did
not answer the question).
Table 13 Respondents’ Specialty Service Utilization
(Supplemental Surveys)
Services
Number of respondents
using the service
anywhere
Number of
respondents using
Highlands
Number of
respondents using
Saint Joseph Martin
25
Cardiology
OBGYN
Radiology
Neurology
Psychiatry
Oncology
Urology
Orthopedics
Pulmonary
Pediatrics
Dialysis
Family Practice
Outpatient
Services
4
6
12
4
0
1
2
1
2
3
0
7
12
2
3
12
2
0
1
2
0
1
3
0
4
6
3
2
9
1
0
0
0
0
0
0
2
4
5
Again, both hospitals were interested in the type of specialty services that were in demand, the survey
specifically asked about the specialty services patients used “anywhere,” “at Saint Joseph Martin,” and “at
Highlands Regional Medical Center.” The results are provided in Table 13. Again, Saint Joseph Martin
appears to be outsourcing OBGYN as well as urology and pediatrics.
Table 14 provides some detail about the respondents’ health risks. The results in Table 14 suggest that
27.3% of the respondents or a member of the respondent’s family has diabetes, 63.6% have high blood
pressure, and nearly 4.5% of the respondents or a member of their family have cancer.
Table 14 Respondents’ Health Risks (Supplemental
Surveys)
Do you or anyone in your family have…?
Diabetes
High Blood Pressure
Cancer
Heart Disease
Mental Illness
Percentage of respondents who indicated yes
27.3%
63.6%
4.5%
13.6%
4.5%
Of the respondents, 45% stated that they had delayed health care due to a lack of money or insurance
(Table 15). Approximately 32% of the households that responded did not have health insurance while
22.7% and 27.3% were enrolled in Medicaid and Medicare, respectively. Thirteen percent of the
households received SNAP (Supplemental Nutrition Assistance program) assistance.
Table 15 Respondents’ Financial Condition
(Supplemental Surveys)
Have you or someone in your household delayed health care due to lack of money and/or
insurance?
Are you or members of your household currently eligible for
45% yes
26
Medicare
Medicaid
Public Housing Assistance
SNAP
Are you or anyone in your household without health insurance currently?
27.3%
22.7%
9%
13.6%
31.8%
The survey specifically asked, “What do you think are the THREE most important factors for a healthy
community and improving the quality of life in your community?” There were fifteen choices provided to
the respondent to choose from. The ranking of these choices is provided below. The most often selected
choice was “access to health care,” “good jobs and healthy economy,” “low crime and safe
neighborhoods,” and “strong family life”.
What do you think are the THREE most important factors for a healthy community and improving the
quality of life in your community?
1st – Access to Health Care
2nd – Good jobs and healthy economy
3rd – Low crime and safe neighborhoods
4th – Strong family life
5th – Affordable housing
6th – Good place to raise children
6th – Religious or spiritual values
7th – Supportive services for seniors
7th – Good schools
7th – Low adult death and disease rates
8th – Healthy behaviors and lifestyles
9th – Clean Environment
9th – Low level of child abuse
10th – Emergency preparedness
10th – Parks and recreation
10th –Arts and cultural events
10th – Low infant deaths
10th –Excellent race and ethnic relations
The survey ended with an open ended question: “What could the Hospital do to better meet you and your
household’s health needs (educational programs, after-hours access, outpatient services)?” The responses
are loosely categorized as “access to after hour care,” “quality of care,” and “services” below.
Access to After-Hours Care:
Number of respondents who indicated they would like to have access to after hours care: 6
Quality of Care Responses:
• 1 said need specialists
• 2 people said they would like to see shorter wait times in the ER/ faster service
Services:
• Many requested additional outpatient services (2 of the respondents)
• Specific services often requested: Bloodwork/Xray/labs
27
Priority Community Health Needs Identified
The management of Saint Joseph Martin has accomplished much over the past several years and
continues to work on the development and implementation of programs and initiatives that work toward
the improvement of community health and wellness.
Primary and secondary data from this assessment process are a valuable resource for future planning. The
community input findings obtained through the collaborative survey process are especially useful in
understanding residents’ needs about community health. The findings provide Saint Joseph Martin much
information on which to act.
Based on the analysis of information, the following needs were identified.
List of Identified Needs
•
Access to Services
o
o
o
o
o
•
Educational Programs
o
o
o
•
After-hours health care
Assistance to other communities with obtaining Urgent Treatment Facilities or have
hospital staff assist at these facilities
More specialists (variety of specialists listed)
More preventative services
Ambulance service for other counties
Diabetes education
Smoking cessation
Walking programs
Financial Assistance Programs
o
o
Prescription cost assistance or help with finding programs
Help support financially and with staff - school programs – DARE, PSI, Tattoo
To facilitate prioritization of identified health needs, a ranking and prioritization process was used and is
described below.
Health needs were ranked based on six factors:
1) The ability of Saint Joseph Martin to evaluate and measure outcomes.
2) How many people are affected by the issue or size of the issue?
3) What are the consequences of not addressing this problem?
4) Prevalence of common themes.
5) How closely does the need align with KentuckyOne Health strategies?
28
6) Does the hospital have existing programs which respond to the identified need?
Health needs were then prioritized taking into account their overall ranking, the
degree to which Saint Joseph Martin can influence long-term change, and the impact of the identified
health needs on overall health.
29
30
Violence in the Community
In 2008, Catholic Health Initiatives launched United Against Violence, a national violence-prevention
initiative that represents an integral part of the organization’s commitment to building healthy
communities. This multidimensional strategic initiative promotes community-based programs designed
to address violence in all of its forms — domestic violence, gun violence, child and elder abuse, school
violence and other behavior that affects the well-being of every community in the nation.
Saint Joseph Martin is committed to eradicating violence in their community, particularly violence against
the vulnerable; however, Saint Joseph Martin does not have an established violence prevention initiative
with dedicated personnel at this time. Saint Joseph Martin is an active participant of the Floyd County
Domestic Violence Council.
By 2015, all KentuckyOne facilities will have worked with their communities to identify a priority area of
violence, established a baseline measure of that violence and develop or expand a violence prevention
initiative that will foster the culture of non-violence in the community they serve and result in a
measureable reduction in the priority area of violence by 2020.
Appendix
31
Your Health Needs
We want to better understand your health needs and how the hospital and its partners
can better meet those needs. Please take just 3-5 minutes to fill out this survey. Please
do not include your name anywhere, all responses will remain anonymous.
1. Please tell us your zip code __________
2. Do you have a family doctor?
_____ Yes
_____No
3. Have you or someone in your household used the services of a hospital in the past
24 months?
_____ Yes
_____No
If yes, which hospital?
_____ Highlands Regional Medical Center
(formerly known as Our Lady of the Way)
_____Saint Joseph Martin
_____Other
4. If yes, what services did you use?
_____ Emergency Room for life-threatening issue
_____ Emergency Room for non-life threatening issue
_____ Outpatient Service
_____ Inpatient
5. If you did not go to Highlands Regional Medical Center or Saint Joseph Martin,
where did you go? (Check all)?
___Lexington hospital ___Pikeville hospital
___Ashland hospital
___ Huntington hospital
___ Other __________________________________
32
6. Why did you or someone in your household go to a hospital other than Highlands
Regional Medical Center or Saint Joseph Martin?
___ Service I needed was not available
___ I prefer larger hospitals
___ My insurance requires me to go somewhere else
___ Other __________________________________________
7. How satisfied were you or someone in your household with the care you received?
____ Satisfied
____ Neutral
____ Dissatisfied
8. Have you or someone in your household used any of the services below?
Check yes if care received anywhere
Highlands/Saint Joseph Martin
Check if care received at
Cardiology
____ Yes
____ at Highlands
____at Saint Joseph Martin
Obstetrics/Gynecology
____ Yes
____ at Highlands
____at Saint Joseph Martin
Radiology
____ Yes
____ at Highlands
____at Saint Joseph Martin
Neurology
____ Yes
____ at Highlands
____at Saint Joseph Martin
Psychiatry
____ Yes
____ at Highlands
____at Saint Joseph Martin
Oncology (Cancer Care)
____ Yes
____ at Highlands
____at Saint Joseph Martin
Urology
____ Yes
____ at Highlands
____at Saint Joseph Martin
Orthopedics
____ Yes
____ at Highlands
____at Saint Joseph Martin
Pulmonology (Lung care)
____ Yes
____ at Highlands
____at Saint Joseph Martin
Pediatrics
____ Yes
____ at Highlands
____at Saint Joseph Martin
Dialysis
____ Yes
____ at Highlands
____at Saint Joseph Martin
Family Practice
____ Yes
____ at Highlands
____at Saint Joseph Martin
Outpatient services
____ Yes
____ at Highlands
____at Saint Joseph Martin
(Please list the outpatient service)_______________________________________________________________
9. Have you or someone in your household delayed health care due to lack of money
and/or insurance?
_____ Yes
_____ No
10. Do you or someone in your household receive treatment for any of the following
conditions?
33
_____ Diabetes
_____High blood pressure
Disease
_____Mental Illness
_____Cancer
_____Heart
11. Are you or members of your household currently eligible for
____ Medicare?
____ Medicaid?
SNAP (food stamp program)?
____ Public Housing Assistance? ____
12. Are you or anyone in your household without health insurance currently?
_____ Yes
_____ No
13. From the following list, what do you think are the THREE most important factors
for a healthy community and improving the quality of life in your community?
Please select only THREE responses.
_____access to
health care
_____clean
environment
_____low crime
and safe
neighborhoods
_____excellent
race and ethnic
relations
_____affordable
housing
_____good
place to raise
children
_____low level of
child abuse
_____good jobs
and healthy
economy
_____arts and
cultural events
_____good
schools
_____emergency
preparedness
_____healthy
behaviors and
lifestyles
_____low
adult death
and disease
rates
_____low
infant deaths
_____religious or
spiritual values
_____parks
and recreation
_____supportive
services for
seniors
_____strong
family life
_____other:_________________________________________________________________________
14. What could the Hospital do to better meet you and your household’s health needs
(educational programs, after-hours access, outpatient services)?
Kentucky County Health Care Profiles
Page 2
34