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Fairview Northland Medical Center Community Health Needs Assessment (CHNA) Implementation Plan

Fairview Northland Medical Center serves more than 120,000 patients from the communities of Milaca,

Princeton, Zimmerman, Elk River, Rogers and St. Francis. Fairview Northland’s mission is to optimize

the health of all people in the communities we serve. Fairview Northland is a full-service, 54 bed medical

center. Since 1993, it has served the area with specialists in everything from heart and cancer care to

trauma care and surgery. In 2011, Northland’s leadership team participated in more than 450 hours of

community service, partnering with, educating and serving our communities.

This implementation plan summarizes the process to date and priorities established for Fairview

Northland to sustain and develop new community benefit programs that 1) address prioritized needs from

the 2012 Community Health Needs Assessment (CHNA) conducted by the Fairview Northland Medical

Center Community Health Needs Assessment Steering Committee with assistance from the Fairview

Health Services Community Health Department and 2) respond to additional identified community health

needs.

Target Areas and Populations

Fairview Health Services identified the community and assessment area as the population within the zip

codes that comprise the Primary Service Area for Fairview Northland. The entire population within this

area is included in the assessment, not just Fairview Northland patients. See appendix A for a map of the

assessment area.

How the Implementation Strategy Was Developed

The Fairview Northland Medical Center implementation strategy was developed based on the findings

and priorities established by Fairview Northland Medical Center’s Community Health Need Assessment

Steering Committee

Fairview Northland along with Fairview Community Health provided leadership for the 2012 Fairview

Northland Community Health Needs Assessment. Fairview Northland reached out to members of our

community in the fourth quarter of 2011, asking a diverse group of community leaders to represent the

community by becoming a member of the Community Health Needs Assessment Steering Committee.

The following are members of that Steering Committee:

Fr. Kevin Anderson, Pastor, Christ Our Light Catholic Parish

Ann Ellison, Director, Fairview Community Health

Carie Fuhrman, Community Development Director, City of Princeton

Marni Gustafson, Executive Director, Sterling Point Senior Community

Sue Herm, Fairview Northland Board Member and faculty, St. Cloud State University

John Herman, President, Fairview Northland Medical Center

Pete Jensen, M.D.

Marie Maslowski, Manager, Community Health Outreach

Allison Miller, Patient Educator, Rum River Health Services

Brian Payne, Chief of Police, City of Princeton

Pam Pringle, Director of Patient Care Practice and Community Member

Janelle Schroeder, Community Health Supervisor, Mille Lacs County

Dawn Sievert, District Nurse, Princeton Schools

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Major Needs and How Priorities Were Established

Both qualitative and quantitative data was gathered in the assessment process. The qualitative data

includes:

Focus groups of three populations (mothers, seniors, vulnerable)

Web surveys with Chamber of Commerce members

Key stakeholder interviews with elected officials, community leaders, physicians and members of

local public health departments.

Quantitative data includes:

Mortality data

Hospital utilization data

Emergency room data

Community Need Index (CNI) scores which are based on underlying socio-economic indicators

of health. Causation has been shown between high CNI scores and inappropriate emergency

room admission for ambulatory sensitive conditions. See appendix B for a map of CNI scores for

the assessment area.

The assessment resulted in five themes These themes identify specifically what Fairview Northland

community members need to maintain or improve their health. These five themes are:

Affordable place to exercise

Access to affordable health care

Health care information and education

Access to mental health services

Access to healthy foods

These five themes were discussed by the Steering Committee members and prioritized using a Need

Prioritization Worksheet and Criteria, see appendix C. The prioritization, by the Steering Committee,

resulted in the following ranking, from most important to least important:

1. Healthcare information and education

2. Access to affordable healthcare

3. Access to healthy foods

4. Access to mental health services

5. Affordable place to exercise

Fairview Northland’s review of current community benefit programs found that the hospital is meeting

existing community needs through provision of charity care, Medicaid services, health professional

education programs, ImPACT Concussion testing, Meals ala Car, the annual Be Healthy Be Safe: safety

fair and bike rodeo, membership on REACH, annual community based flu shot clinics and Medical

Explorers. These activities were determined to be valuable priorities for the medical center’s

implementation strategy.

Description of What Fairview Northland Medical Center Will Do to Address Community Needs

Fairview Northland Medical Center CHNA Steering Team has identified several initiatives to address

these top community health needs.

Healthcare Information and Education Action Plan

ImPACT Concussion Testing – Fairview Northland will continue to work with Princeton and

Zimmerman high schools on offering education and testing related to concussion prevention. The

program was started in 2009. Athletes, parents and coaches at these schools receive education on

concussion dangers, signs and symptoms and actions to take. A free baseline with the

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computerized ImPACT test is offered to athletes. This initiative is lead by the medical center’s

Physical Therapy department and two physicians.

REACH (Resources, Education, Access, Caring, Health) – Fairview Northland will continue to

work with REACH, a literacy program lead by the Early Childhood Education department at the

Princeton, Minn. schools. This initiative works with public health staff from Milaca and

Sherburne counties along with staff from the Princeton and Elk River school districts to increase

literacy among children. Fairview Northland’s Birth Place staff includes information on the

importance of literacy and early childhood education in the packets which go home with all new

parents. Fairview Northland clinics also participate in the Reach Out and Read program which

emphasizes the importance of literacy in the home and provides children’s books to families

during well child visits.

Healthcare Professional Student Education – Fairview Northland works with local colleges,

universities and professional schools to offer training opportunities for healthcare students.

Examples of the institutions we currently work with are St. Cloud State University and the

University of Minnesota. We will continue to provide educational opportunities for future

healthcare professionals to serve the needs of our community.

Medical Explorers – Fairview Northland has hosted a Medical Explorers post for the last two

academic years. Medical Explorers provides an opportunity for high school students interested in

a career in health care to have contact with healthcare professionals and be exposed to

opportunities in the field. We are currently exploring moving the program from the academic year

to the summer to make it more accessible to students at outlying high schools.

Be Healthy Be Safe: Safety Fair and Bike Rodeo – Fairview Northland hosts a safety fair and bike

rodeo in conjunction with Rum River Days in June. The event is a partnership with the medical

center and local organizations such as the Princeton Police and Fire Departments, the Sherburne

County Sheriff’s Department, the Sherburne County Sheriff’s Water Patrol, Sherburne County

Safe Roads Coalition and a local bike shop. The goal is to provide safety information, education

and resources to the community, especially those with young children.

Access to Affordable Healthcare Action Plan

Free/Reduced Cost Clinic - Fairview Northland is working with Rum River Health Services to

develop a free/reduced cost clinic for community members who are uninsured and under-insured.

Initially the clinic will be held at Rum River Health Services every Thursday from 5-8 p.m.

Fairview Northland will continue to explore opportunities to partner with Rum River Health

Services to ensure access to care. Potential opportunities include shared patient education

materials, radiology and lab support, supply purchasing and consultation on operational issues.

Fairview Northland will assist in promoting Rum River Health Services as a new resource in the

community and will support efforts to enlist volunteers to work in the clinic. Fairview Northland

also will work with the Fairview Foundation to identify additional funding opportunities to

support the development of Rum River Health Services’ free clinic.

Access to Healthy Foods Action Plan

Meals ala Car – Fairview Northland Medical Center’s nutrition services prepares healthy meals in

the kitchen at Northland, and volunteers deliver those meals to recipients in the community. The

targeted population is senior citizens. This program began in 1973 and is a partnership with

seven local churches in the Princeton community.

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Affordable Place to Exercise Action Plan

Community Walking Maps – Fairview Northland has worked with the community to develop

community walking maps in Milaca. The city of Princeton has developed a historic walking map

of the city. These will continue to be promoted in the medical center.

Walking Trail – The medical center is currently working to install a walking trail on and adjacent

to the Fairview Northland campus for employee and community use. This work will be

completed in collaboration with the Princeton Park Board and its Park and Sidewalk Trail Plan.

Exercise Facilities – Fairview Northland will explore the possibility of providing accessible

fitness facilities and services for the community on its campus.

Next Steps for Priorities

For each of the priority areas listed above, Fairview Northland will work with the Community Health

Assessment Steering Committee and community partners to:

Identify any related activities being conducted by others in the community that could be built

upon.

Develop measurable goals and objectives to evaluate the effectiveness of the interventions.

Build support within the community for the identified initiatives.

Develop detailed work plans.

Priority Needs Not Being Addressed and the Reasons

Fairview Northland Medical Center is not directly involved with the mental health priority because there

are scarce resources and lack of clarity about a community-based focus area for mental health. This will

be explored more fully with community members and partners to more clearly understand the need.

Meanwhile, Fairview Northland is in the process of initiating a Diagnostic Evaluation Center (DEC) on

site. DECs are located in emergency departments around the metro area and provide diagnostic

assessments by licensed clinicians to determine the appropriate level of care for patients experiencing a

behavioral crisis. The DEC is an innovative care model that has created immediate access to appropriate

care and promotes coordination of information with all providers involved in the patient's care.

Information gathered through DEC will inform future planning for community-based mental health

programming.

Resources

Fairview Northland Medical Center has identified an administrative leader to coordinate the activities of

this implementation plan. Responsibility for each focus area will be assigned to the appropriate hospital

lead with reporting responsibility to the Community Health Advisory Committee (formerly the CHNA

Steering Team).

Approval

Each year at the November meeting, the Fairview Northland Board of Directors will review the prior

fiscal year’s Community Benefit Report and approve the Community Benefit Implementation Strategy for

addressing priorities identified in the most recent Community Assessment and other plans for community

benefit.

This report was prepared for the Nov. 19, 2012 meeting of the Fairview Northland Board of Directors and

was approved by the Board at that meeting.

Appendices

A. Primary Service Area Map

B. Community Need Index (CNI) Score Map

C. Need Prioritization Worksheet and Criteria

D. Definition of Community – Zip Codes by Hospital PSA

E. Qualitative Data Tools and Questions

F. Top Ten Health Conditions by Population and Hospital

Appendix A: Primary Service Area Map

Fairview Northland Medical Center

Primary Service Area

Appendix B: Community Need Index (CNI) Score Map

Fairview Northland Medical Center

CNI Scores

Need Prioritization Worksheet

Criterion and Considerations Guide

Criteria #1: Is the need health related?

Considerations:

To what degree is the need health related?

Criteria #2: Is the need tied to Community Need Index (CNI) scores or similar measure of vulnerability?

Considerations:

To what degree is the need tied to CNI scores or other measure such as the percentage of school Free and

Reduced Lunch (FRL) participants (e.g. A community may have a low CNI score, but a school within that

community may have a high percentage of students who qualify for FRL).

The Community Need Index (CNI) Scores were developed by Catholic Healthcare West and Thompson Reuters.

Their underlying data is used to create an objective measure of socio-economic barriers to health care access

among populations and their effect on hospital admissions. CNI Scores range from a 5 (highest health

disparity/highest community need) to a 1 (lowest health disparity/lowest community need). CNI Scores provide a

high-level measure of community need and allow for comprehensive comparative analysis to be made on many

levels ranging from individual zip code comparison to regional or multi-state comparisons.

Criteria #3: Is the need tied to assessment or otherwise documented?

Considerations:

To what degree is the need tied to assessment (i.e. where did the need fall on your list of priorities)?

Are there contributing factors that may indicate the need for more immediate intervention (i.e. the need may fall

lower on the assessment, but there are additional considerations that make it a higher priority)?

Criteria #4: What is the magnitude of the need?

Considerations:

How many persons does the need affect, either actually or potentially?

Criteria #5: What is the seriousness of the consequences?

Considerations:

What degree of disability or premature death occurs?

What are the potential burdens to your community such as economic or social burdens?

What happens if we don’t respond?

Criteria #6: What is the feasibility of addressing?

Considerations:

Is it amenable to intervention? Is the problem preventable?

Are there scientifically feasible (evidence-based) interventions available?

Is intervention acceptable to the community (i.e. are there economic, social, cultural or political issues that may

influence the communities ability to address the health need)?

Does intervention have the potential to produce measurable outcomes?

Are there adequate technology, knowledge, human and financlal resources to effect change?

Criteria #7: Does the need tie to Fairview Strategy?

Considerations:

Fairview Strategy is defined as prevention, awareness and treatment of conditions related to cardiovascular,

orthopedics, oncology, mothers/children and behavioral health.

Appendix D: Definition of Community – Zip Codes by Hospital Primary Service Area, 2012 Fairview Lakes Medical Center Fairview Ridges Hospital University of Minnesota

Medical Center, Fairview/ Amplatz Children’s Hospital

Zip Code Community Zip Code Community Zip Code Community

55012 Center City 55020 Elko 55102 St. Paul Downtown

55013 Chisago City 55024 Farmington 55104 Midway

55014 Lino Lakes 55044 Lakeville 55105 MacGroveland

55025 Forest Lake 55054 New Market 55108 Falcon Heights

55032 Harris 55068 Rosemount 55112 New Brighton

55038 Hugo 55121 Eagan 55113 Roseville

55045 Lindstrom 55122 Eagan 55114 Como/Hwy 280

55056 North Branch 55123 Eagan 55116 Highland Park

55063 Pine City 55124 Apple Valley 55401 Mpls – North Loop

55067 Rock Creek 55306 Burnsville 55402 Mpls – Downtown

55069 Rush City 55337 Burnsville 55403 Mpls – Loring

55073 Scandia 55372 Prior Lake 55404 Mpls – Franklin

55074 Shafer 55378 Savage 55405 Mpls – Cedar

55079 Stacy Fairview Southdale Hospital 55406 Mpls – East Lake

55084 Taylors Falls Zip Code Community 55407 Mpls – Phillips

55092 Wyoming 55035 Hopkins 55408 Mpls – LynLake

Fairview Northland Med Ctr. 55317 Chanhassen 55409 Mpls – Harriet

Zip Code Community 55318 Chaska 55410 Mpls – Linden Hills

55017 Dalbo 55331 Excelsior 55411 Mpls – Near North

55309 Big Lake 55343 Hopkins 55412 Mpls – Camden

55330 Elk River 55344 Eden Prairie 55413 Mpls – Central NE

55371 Princeton 55345 Minnetonka 55414 Mpls – SE

55398 Zimmerman 55346 Eden Prairie 55415 Mpls – Downtown

56313 Bock 55347 Eden Prairie 55416 St. Louis Park

56329 Foley 55386 Victoria 55417 Mpls – Nokomis

56330 Foreston 55391 Wayzata 55418 Mpls – Northeast

56353 Milaca 55409 Mlps – Harriet 55419 Mpls – SW

56357 Oak Park 55410 Mlps – Linden Hills 55421 Columbia Heights

56358 Ogilvie 55416 St. Louis Park 55423 Richfield

56363 Pease 55417 Mpls – Nokomis 55432 Fridley

Fairview Range Regional Health Services

55419 Mpls – SW 55454 Cedar Riverside

Zip Code Community 55420 East Bloomington 55455 University

55703 Angora 55423 Richfield

55709 Bovey 55424 Edina

55710 Britt 55425 Bloomington

55719 Chisolm 55426 St. Louis Park

55723 Cook 55431 Bloomington

55738 Forbes 55435 Edina

55742 Goodland 55436 Edina

55746 Hibbing 55437 Bloomington

55751 Iron 55438 Bloomington

55765 Elmer 55439 Edina

55768 Mountain Iron

55769 Nashwauk

55775 Pengilly

55781 Side Lake

Appendix E: Qualitative Data Tools & Questions

Focus Group Notes—Fairview Health Services 2012 CHNA Fairview Health Services Community Health Needs Assessment Focus Group Summary Hospital: Name of Group: Date Held: Summary by: Questions:

1. What current health issues trouble you and your family?

2. What is the number one health issue for you or (your clients) your family?

3. What roadblocks do you experience when you are working to maintain your health?

4. Now tell us what roadblocks you experience when seeking healthcare from a professional?

5. To whom do you turn or where do you go when you need help with a health issue?

6. What is needed in our community to help you maintain or improve your health?

7. What is the role of the hospital to help you or others maintain or improve your health?

8. What do you see as your role in maintaining or improving your health?

Appendix E: Qualitative Data Tools & Questions

Stakeholder Interview Summary—Fairview Health Services 2012 CHNA

Fairview Community Health Needs Assessment 2012 Fairview Health Services Community Health Needs Assessment Stakeholder Interview Summary Hospital: Name of Individual: Date Held: Summary by: Background: 1. What do you believe to be the number one health issue in our community? 2. What are the difficulties, challenges and roadblocks faced by community members when they

seek healthcare from a professional? 3. When community members seek help about a health issue, where do you think they go for help? 4. What do you think is needed in your community to help individuals like yourself maintain or

improve your health? 5. What do you see as the health systems/hospitals role? 6. What do you see as your role in these improvements?

Appendix F: Top 10 Health Conditions by Population and Hospital

Fairview Northland Medical Center Primary Service Area—All Population

Top 10 Reasons for Hospitalization, All Population

With Birth Data Without Birth Data

1. Birth, vaginal ^ 1. Pneumonia (nos)

2. Birth, cesarean ^ 2. Hardening of the heart arteries ^

3. Pneumonia (nos) 3. Osteoarthritis, lower leg (nos)

4. Hardening of the heart arteries 4. Lumbar disc displacement ^

5. Osteoarthritis, lower leg (nos) 5. Irregular heart beat

6. Birth, previous cesarean (nos) 6. Dehydration

7. Birth, second degree laceration 7. Osteoarthritis, pelvic region

8. Birth, first degree laceration 8. Chest pain (nec)

9. Lumbar disc displacement 9. Obstructive chronic bronchitis

10. Irregular heart beat 10. First heart attack Source: Minnesota Hospital Association, 2008-2010 ^ designates a 0.5% or higher percentage of difference between hospital and state of MN nos = not otherwise specified (unspecified diagnosis) nec = not elsewhere classified (diagnosis does not fit into a different category)

Top 10 Reasons for ER Visits Not Resulting in Hospitalization, All Population

1. Middle ear infection (nos)

2. Upper respiratory infection (nos)

3. Headache

4. Chest pain (nec)

5. Urinary tract infection (nos)

6. Abdominal pain (nec)

7. Open wound, fingers

8. Chest pain (nos)

9. Migraine (nos)

10. Fever (nos) Source: Minnesota Hospital Association, 2008-2010 ^ designates a 0.5% or higher percentage of difference between hospital and state of MN nos = not otherwise specified (unspecified diagnosis) nec = not elsewhere classified (diagnosis does not fit into a different category)

Top 10 Causes of Death, All Population

1. Cancer ^

2. Heart diseases

3. Mental disorders

4. Stroke

5. Symptoms, ill-defined conditions ^

6. Chronic obstructive pulmonary disease

7. Diseases of nervous system/sense organs

8. Diabetes

9. Motor vehicle accidents ^

10. Lung, other respiratory diseases Source: Minnesota Department of Health, 2008-2010 ^ designates a 0.5% or higher percentage of difference between hospital and state of MN

Appendix F: Top 10 Health Conditions by Population and Hospital

Fairview Northland Medical Center Primary Service Area—Children Top 10 Reasons for Hospitalization, Children Ages 18 and under

With Birth Data Without Birth Data

1. Birth, vaginal 1. Dehydration ^

2. Birth, cesarean ^ 2. Pneumonia (nos)

3. Dehydration 3. Depression (nec)

4. Pneumonia (nos) 4. Appendicitis (nos)

5. Birth, cesarean (twins) 5. Bronchiolitis (nec)

6. Depression (nec) 6. Bronchiolitis

7. Appendicitis (nos) 7. Chemotherapy

8. Bronchiolitis (nec) 8. Depression, single episode (nos) ^

9. Bronchiolitis 9. Asthma (nos)

10. Fetal/neonatal jaundice 10. Diabetes, uncontrolled Source: Minnesota Hospital Association, 2008-2010 ^ designates a 0.5% or higher percentage of difference between hospital and state of MN nos = not otherwise specified (unspecified diagnosis) nec = not elsewhere classified (diagnosis does not fit into a different category)

Top 10 Reasons for ER Visits Not Resulting in Hospitalization, Children 18 and Under

With Birth Data

1. Middle ear infection (nos)

2. Upper respiratory infection (nos)

3. Fever (nos)

4. Croup ^

5. Strep, sore throat

6. Open wound, forehead

7. Head injury (nos)

8. Pneumonia (nos)

9. Sore throat

10. Contusion to head, excluding eyes Source: Minnesota Hospital Association, 2008-2010 ^ designates a 0.5% or higher percentage of difference between hospital and state of MN nos = not otherwise specified (unspecified diagnosis) nec = not elsewhere classified (diagnosis does not fit into a different category)

Top 10 Causes of Death, Children Ages 18 and Under

With Birth Data Without Birth Data

1. Perinatal conditions 1. Birth defects ^

2. Birth defects ^ 2. Motor vehicle accidents ^

3. Motor vehicle accidents ^ 3. Suicide ^

4. Suicide ^ 4. Lung, other respiratory diseases ^

5. Lung, other respiratory diseases ^ 5. Residual (other) ^

6. Residual (other) ^ 6. Chronic obstructive pulmonary disease ^

7. Chronic obstructive pulmonary disease

^ 7. Arthritis, including vertebrae ^

8. Arthritis, including vertebrae ^ 8. Other infectious diseases ^

9. Other infectious diseases ^ 9. Cancer

10. Cancer 10. Other accidents (e.g. falls, poison) Source: Minnesota Department of Health, 2008-2010 ^ designates a 0.5% or higher percentage of difference between hospital and state of MN Note: While Northland experiences higher than average mortality rates for children this increase in mortality is not significant due to the smaller population size

Appendix F: Top 10 Health Conditions by Population and Hospital

Fairview Northland Medical Center Primary Service Area—Seniors

Top 10 Reasons for Hospitalization, Ages 65 and Over

1. Pneumonia (nos)

2. Osteoarthritis, lower leg (nos)

3. Hardening of the heart arteries ^

4. Irregular heart beat

5. Obstructive chronic bronchitis

6. Osteoarthritis, pelvic region

7. Blood poisoning (nos)

8. First heart attack

9. Stroke (nos)

10. Urinary tract infection (nos) Source: Minnesota Hospital Association, 2008-2010

^ designates a 0.5% or higher percentage of difference between hospital and state of MN nos = not otherwise specified (unspecified diagnosis) nec = not elsewhere classified (diagnosis does not fit into a different category)

Top 10 Reasons for ER Visits Not Resulting in Hospitalization, Ages 65 and Over

1. Urinary tract infection (nos)

2. Chest pain (nec)

3. Dizziness and giddiness

4. Chest pain (nos)

5. Nose bleed

6. General discomfort, fatigue (nec)

7. Pneumonia (nos)

8. Fainting

9. Hypertension (nos)

10. Obstructive chronic bronchitis Source: Minnesota Hospital Association, 2008-2010 ^ designates a 0.5% or higher percentage of difference between hospital and state of MN nos = not otherwise specified (unspecified diagnosis) nec = not elsewhere classified (diagnosis does not fit into a different category)

Top 10 Causes of Death, Ages 65 and Over

1. Cancer ^

2. Heart diseases

3. Mental disorders

4. Stroke

5. Symptoms, ill-defined conditions ^

6. Chronic obstructive pulmonary disease

7. Diseases of nervous system/sense organs

8. Diabetes

9. Motor vehicle accidents ^

10. Lung, other respiratory diseases Source: Minnesota Department of Health, 2008-2010

^ designates a 0.5% or higher percentage of difference between hospital and state of MN