MASTERS CAPSTONE FM010 APA INTEXT CITATION

10. (Not included in prioritization process) Cross‐Cutting Driver: Access to Health Care Services is a health need in the county because socioeconomic conditions (poverty, low levels of education, lack of health insurance) as well as factors, such as the size of the healthcare workforce, linguistic, and transportation barriers all affect access to care, which negatively impacts health.

Next Steps

After making this CHNA report publically available in June 2013, Western Hospital will develop an implementation plan based on this data.

2. INTRODUCTION/BACKGROUND

Purpose of CHNA Report and Affordable Care Act Requirements

Enacted on March 23, 2010, federal requirements included in the Affordable Care Act (ACA) stipulate that hospital organizations under 501(c)(3) status must adhere to new regulations, one of which is conducting a community health needs assessment (CHNA) every 3 years. The CHNA Report must document how the assessment was done, including the community served, who was involved in the assessment, the process, and methods used to conduct the assessment, and the community’s health needs that were identified and prioritized as a result of the assessment.

As part of the tri‐annual CHNA assessment, hospitals must:

Collect and take into account input from public health experts as well as community leaders and representatives of high need populations including: minority groups, low‐income individuals, medically underserved populations, and those with chronic conditions.

Identify and prioritize community health needs.

Document a separate CHNA for each individual hospital.

Make the CHNA report widely available to the public.

Adopt an Implementation Strategy to address identified health needs.

Submit the Implementation Strategy with the annual Form 990.

Pay a $50,000 excise tax for failure to meet CHNA requirements for any taxable year.

3. ABOUT WESTERN HOSPITAL

Western Hospital is a 358‐bed acute care, community hospital located in the heart of the largest city in Jefferson County, the county with the largest population in the state. We provide care for the youth, adults, and elderly living in the county. Our key services include: cardiac, stroke, emergency, orthopedic and joint replacement, women and children, and wound care. In an effort to provide services to patients who are less fortunate, Western sponsors programs such as the Health Benefits Resource Center and the Family Medicine Residency Program.

Community Served

Demographic Profile of Community Served

Western Hospital serves Jefferson County, which has 1.84 million residents. The county’s six cities contain 95% of the population; more than one third (37%) of the county’s residents (53%) live in the city of Middletown.

Diversity

Western Hospital is within the top 5% of all U.S. counties in terms of racial and ethnic diversity. According to the 2010 U.S. Census, the racial and ethnic composition is 35% White, 32% Asian, 27% Latino, 2% African American, and 3% indicated they were two or more races. No one racial or ethnic classification is a majority within the county. Of those who selected Asian, the predominate subgroups are: 27% Chinese, 22% Vietnamese, 21% Asian Indian, and 18% Filipino. The vast majority of those who selected Hispanic are Mexican (84%).

Thirty seven percent of the county’s population is foreign born, compared to 27% of the state’s population. Of those foreign born, 61% were born in Asia and 27% were born in Latin America. In the county, 50% of the population speaks a language other than English at home

Gender and Age

According to the 2010 U.S. Census, women (49.8%) and men (50.2%) make up equal proportions of the county population. The median age of a county resident is 36 years old, which is slightly younger compared to the overall age composition of the U.S.

Young people (ages zero to 19) make up about 26% of the county’s population, and 38% of households have individuals under 18 living in them. The younger population is more diverse than the overall county population: 37% is Hispanic, 31% is Asian, 24% is White, and 5% is Multiracial.

Residents, aged 65 and over, make up 12% of the county’s population. The fastest growing age group in the county is 85 and over; the aging resident trend is expected to continue. In the county, 23% of households have individuals over 65 living in them.

Poverty

Although the median annual income in the county is high at approximately $89,064, 9.2% of the population lives below the federal poverty level. In 2013, the federal poverty level for a family of two adults and two children was $23,550.

According to the federal poverty level, only 6% of seniors are considered poor with an individual annual income below $10,201. But, according to the State Elder Economic Security Standard Index, nearly half of the county’s older adults (48.4%) are economically insecure. The Index measures how much income is needed for a retired adult age 65 and older to adequately meet his or her basic need including housing, food, out‐of‐pocket medical expenses, and transportation.

(Sections eliminated)

Summarized Descriptions of Prioritized County Community Health Needs

Access to healthcare is a health need in Jefferson County as marked by the proportion of the community who are linguistically isolated. In addition, there are areas with low educational attainment, which also impacts health outcomes. The community input indicates that underinsurance and lack of insurance coverage is an issue. Lack of transportation is also an access barrier that affects those in poverty. Stigma and lack of knowledge both impact the seeking of preventative care or treatment. Also, too few general and specialty practitioners, especially in community clinics, results in long wait times for appointments. These issues around lack of access contribute to community members using urgent care and emergency rooms for treatment of conditions that have worsened due to lack of treatment or preventative care.

Diabetes is a health need in the county as marked by relatively high rates of diabetes. The overall adult rate meets the HP 2020 benchmark but Latino and African American residents are disproportionately diabetic and worse off in comparison with the county and state averages and benchmark. Of all ethnic groups, African Americans experience the highest percentage of hospitalizations due to diabetes. Community input about diabetes was strong and expressed the connection between the disease and related health behaviors, such as poor nutrition and lack of physical activity. The health need is likely being impacted by health behaviors, such as low fruit and vegetable consumption, soda consumption, the proximity of fast food establishments, and a lack of grocery stores and WIC‐authorized food sources.

Prioritization of Health Needs

Before beginning the prioritization process, the Coalition chose a set of criteria to use in prioritizing the list of health needs. The criteria were:

1. 2. 3. 4.

Clear disparities/inequities exist among subpopulations in the community. An opportunity to intervene at the prevention or early intervention level. A successful solution has the potential to solve multiple problems. The community prioritizes the issue over other issues.

Scoring Criteria 1–3: The score levels for the prioritization criteria were:

3: Strongly meets criteria, or is of great concern

2: Meets criteria, or is of some concern

1: Does not meet criteria, or is not of concern

A survey was then created, listing each of the health needs in alphabetical order and offering the first three prioritization criteria for rating. Coalition members rated each of the health needs on each of the first three prioritization criteria during an in‐person meeting in November 2012.

Prioritization scores are based on the results of the primary data gathering process. The score levels for the fourth prioritization criterion were:

3: Health need was prioritized by more than half of the key informants and focus groups.

2: Health need was prioritized but by half or fewer of the key informants and focus groups.

1: Health need was mentioned by at least one key informant or focus group but not prioritized by any.

Combining the Scores: For the first three criteria, coalition members’ ratings were combined and averaged to obtain a combined coalition score. Then, the mean was calculated based on the four criterion scores for an overall prioritization score for each health need.

List of Prioritized Needs

The need scores ranged between 1.4 and 3.0, with 3 being the highest score possible and 1 being the lowest score possible. The needs are ordered by prioritization score in the table below. The specific scores for each of the four criteria used to generate the overall community health needs prioritization scores may be viewed in Attachment 8. Note that while the coalition prioritized access‐related drivers, the cross‐cutting driver, access to healthcare services, was not scored during the prioritization process.

Health Needs by Prioritization Score

Health Need

Overall Average Priority Score

Diabetes 3.0

Obesity 2.9

Violence 2.6

Poor Mental Health 2.6

Poor Oral/Dental Health 2.5

Cardiovascular Disease, Heart Disease, Stroke 2.4

Substance Abuse (Alcohol, Tobacco, and Other Drugs) 2.4

Cancers 2.2

Respiratory Conditions 2.0

STDs/HIV‐AIDS 2.0

Birth Outcomes 1.6

Alzheimer's 1.4

Adapted from: