MidMichigan Medical Center - West Branch
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Building Healthy Communities 2018 Community Health Needs Assessment MidMichigan Medical Center - West Branch
Transcript of MidMichigan Medical Center - West Branch
Building Healthy Communities2018 Community Health Needs Assessment
MidMichigan Medical Center - West Branch
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Building Healthy Communities
MidMichigan Medical Center - West Bran
Table of Contents
Background ......................................................................................................................................................... 4
Process Overview .............................................................................................................................................. 9
Representing the Community and Vulnerable Populations ...................................................................... 11
CHNA Methodology ....................................................................................................................................... 14
Findings ............................................................................................................................................................. 18
Prioritization Process ...................................................................................................................................... 34
Assessment of Exisiting Resources that are Addressing Priorities ........................................................... 38
Written CHNA Report and Implementation Plan ..................................................................................... 39
Additional Documents Available Upon Request ........................................................................................ 45
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Executive Summary
This report is a primary data source that complements other primary and secondary data sources collected by West Branch Regional Medical Center for its 2016 Community Health Needs Assessment. The primary data contains information from the West Branch Regional Medical Center (WBRMC) and District Health Department Number 2 CHNA Community Health Survey developed and distributed by hospitals and public health departments in Ogemaw, Iosco, Oscoda, Clare, Roscommon, Gladwin and Arenac Counties. West Branch distributed surveys in 27 zip codes in its service area. West Branch also held two focus groups of two women and seven men. They represented community members, hospital board and auxiliary members, a mental health care provider, the school district, a retired employee and the ministry/faith community. Ages ranged from mid to late 30’s to retirement. The survey findings are based on the responses of 524 individuals, 62% of whom were female; well
educated (27% with some GED or college) and nearly one‐third (23%) with household income
between $25,000 ‐ $49,999. It covered five areas of concern: community health, quality of life, availability of health services, safety and environment, delivery of health services and vulnerable populations (seniors, females, low education and low income). It also asked about preventing access to care. Many concerns were about access to and availability of health care providers and the costs of healthcare. Survey respondents were also concerned about access to healthy food, lack of local doctors, low incomes and limited access to exercise and fitness activities. With respect to vulnerable populations, respondents were concerned about: (a) youth alcohol use and abuse, drug and substance abuse and bullying (b) cost of medications and the availability of resources for seniors to help them stay in their
homes. Low‐income respondents desired affordable health insurance. Focus group members perceived a lack of healthy food options and economy. They identified six groups as being medically underserved: the elderly, lower middle income, those with mental health issues, preschool aged/young children and young adults. Participants thought most people utilize West Branch services because of its location and providers/staff available, but used other health centers because West Branch lacked specialties and resources.
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Background and Overview
West Branch Regional Medical Center is designated as a 501(c) (3) nonprofit rural hospital on
December, 2015. Organizations and not‐for‐profit hospitals, in order to maintain their tax‐exempt or "charitable" status under section 501(c) (3) of Federal Internal Revenue Code, have long been required to provide benefit to the communities they serve. Recent changes in legislation require hospitals explicitly and publicly demonstrate community benefit by conducting a community health needs assessment (CHNA) and adopting an implementation strategy to meet the identified community health needs (IRS).
Our Mission Our mission is to provide quality healthcare services to improve the health status of the communities we serve. Our Vision Our Vision is to be recognized as the health care provider of choice and the employer of choices by creating a culture of quality and unsurpassed service excellence. Customer Service West Branch Regional Medical Center is committed to providing superior customer services, safe and quality health care. Respect West Branch Regional Medical Center employees, volunteers and physicians treat everyone with courtesy, dignity and respect. Teamwork West Branch Regional Medical Center employee, volunteers and physicians are committed to developing and maintaining productive working relationships based on mutual respect.
Attitude West Branch Regional Medical Center values its workforce, their experience, skills, knowledge and commitment.
Continuous Improvement
In an effort to remain state‐of‐the‐art, WBRMC encourages continuing education of its staff and supports equipment upgrades as necessary to remain competitive in the marketplace.
Fun WBRMC supports employee’s extracurricular activities, understanding balance in life is important.
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Services at West Branch Regional Medical Center
3‐D Radiation Therapy EKG
64‐128 Slice CT Scanning Emergency Services
Adult Ventilator Care Functional Capacity Evaluations
Amputations General Radiography
Angiography, Biopsies, Localizations, Drainages
General Respiratory Care
Arterial Blood Gas Analysis General Surgery
Bio‐engineered Skin Grafts/Substitutes Hand/Arm Injuries
Blood Banking and Transfusion Services Hematology and Coagulation
Bone Densitometry Holter Monitor Recording
Cancer Rehabilitation Hyperbaric Oxygen Therapy
Cardiac Catheterization Image‐Guided Radiation Therapy
Cardiac Event Monitoring Joint Replacement Rehabilitation
Cardiac Rehabilitation with Cardiac Monitoring
Lymphedema Therapy
Chemistry/Immunochemistry Massage Therapy
Chemotherapy Medical Nutrition Therapy
Clinical Pathology Microbiology
Compression Therapy Modified Barium Swallow Studies
Coronary CTA MRA
Debridement MRI
Diabetes Education Neurologic Rehabilitation
Digital Mammography Neuromuscular Electrical Stimulation
DNA Collection NM Cardiac Stress Test
Drug Screen Collection Non‐Invasive Studies
EEG Nuclear Medicine
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Off Campus Outpatient Lab Services Spinal Rehabilitation
Ophthalmology Surgery Sports Orthopedic Injuries
Orthopedic Surgery Stress Testing with Echo Imaging
Patient Respiratory Imaging Tele-Pathology
Pediatric Rehabilitation Transthoracic and Transesophageal Echocardiograms
Pediatric Therapy Treadmill Stress Testing
PET/CT Scanning Treadmill Stress Testing with Nuclear Imaging
Pharmacologic Stress Testing Treatment of Wound, Skin and Bone Infections Including Antibiotic Therapy
Post‐Surgical Shoulder Rehabilitation Ultrasound
Pulmonary Function Testing Body Plethysmography
Urinalysis and Body Fluid Analysis
Pulse Vac Wound Care Urinary Incontinence
Radiation Therapy Vestibular/Balance Rehabilitation
Reference Laboratory Weight Management
Serology Work Hardening
Specialty Wound Dressings Wound Consultation/Evaluation, Diagnostic and Ongoing Assessments and Treatment
Speech Generating Devices Wound Cultures and Biopsies
Speech and Swallow Disorders
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What is a Community Health Needs Assessment?
The first step in meeting community needs is identifying what the needs are. Using an objective approach ensures priorities are based on evidence and accurate information. The assessment process used by West Branch Regional Medical Center included a dual approach of reviewing two sources of primary data. In the dual approach, when there are two sources of data that illustrate a need, a greater likelihood will produce a powerful impact.
Two methods were utilized to collect primary data:
Surveys: Surveys were distributed to 27 zip codes in the hospital’s service area. It was also posted online using www.surveymonkey.com.
Focus Groups: The hospital held two focus groups September 14-15, 2016, comprised of seven men and two women. Participants represented community members, hospital board and auxiliary members, a mental health care provider, the school district, a retired employee and the ministry/faith community and a ges ranged from mid to late 30’s to retired. Attendees were invited to participate by hospital staff (Catherine Cleland). The facilitator followed a script (see Appendix E) and engaged the group in several procedures, including asking participants to review and comment on a list of potential health concerns that may affect the community as a whole, using sticky notes on an easel pad or wall and group discussion/brainstorming.
In addition to the primary data, secondary data was reviewed for comparison to state rates and counties in Northeast Michigan. This data was organized into a report card. Primary and Secondary data analysis was the first component of the CHNA process. The next step was prioritization and an implementation meeting. Once priorities were selected, there was an assessment of existing services and programs. This assessment was used to identify gaps in services and develop strategies to address priority needs. The strategies were organized into an implementation plan where progress will be monitored.
This is the first cycle of Community Health Assessment and Planning. The process is
intended to be completed on a three‐year cycle that aligns with Affordable Care Act requirements.
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Why is a Community Health Needs Assessment Valuable? Most experts agree there are many challenges facing healthcare today. Rapidly changing technology, increased training needs, recruiting medical professionals and responding to health needs of a growing senior citizen population are just a few. These challenges occur at a time when resources for families and healthcare providers are stretched. These conditions make the Community Health Needs Assessment (CHNA) process even more critical. A CHNA helps direct resources to issues that have the greatest potential for increasing life expectancy, improving quality of life and producing savings to the healthcare system.
Background and Acknowledgments In May 2016, the Michigan Center for Rural Health, District Health Department No. 2 and West Branch Regional Medical Center convened a discussion group around the CHNA process in Ogemaw, Roscommon, Gladwin and surrounding Counties. This region includes four area hospitals and a public health department.
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Needs Assessment Process
Process Overview
Steps in Process In May 2016, Michigan Center for Rural Health, West Branch Regional Medical Center and District Health Department No. 2 collaborated to develop and distribute the Community Health Needs Assessment. A process was developed for the area that provided consistent data collection, which would provide county and regional aggregation of data. In addition to the local hospital plans and activities, this process would afford greater impact of countywide and regional projects and initiatives. The process was developed based on the review of the University of North Dakota
Model1:
Step 1: Establish a local and regional timeline
Step 2: Convene county teams to manage logistics of assessment activities
Step 3: Develop and administer Survey Instrument*
Step 4: Design and implement community focus groups in local hospital communities*
Step 5: Produce localized hospital reports based on survey zip code data, local focus groups and county interview data
Step 6: Local hospitals hold Implementation Planning Meetings
Step 7: Local hospitals prepare a written CHNA Report and Implementation Plan
Step 8: Production of county and regional reports
Step 9: Convene county and regional meetings to review reports
Step 10: Monitor progress
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Timeline
* In order to utilize the dual model, these two data collection methods were consistent in scope and question topics.
Review of CHNA Process Documents (May‐June 2016)
Forced Answer Survey Distribution (June‐September 2016) Conduct Focus
Groups (September 2016)
Compile Results from Surveys (October‐November 2016)
Prioritization Meeting and Develop Reports (January 2017)
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Representing the Community and Vulnerable Populations
Define the Community Served Ogemaw County is a rural county located in the northeastern section of Michigan’s Lower Peninsula. A population of 25,000 resides in Gladwin County. The following charts highlight characteristics of the population.
Demographic Indicator Michigan Ogemaw Gladwin Roscommon Population 9,909,877 21,039 25,411 23,955
% below 18 years of age 22.40% 18.8% 19.3% 15.1%
% 65 and older 15.40% 24.3% 25.1% 30%
Non‐Hispanic African American 13.90% 0.3% 0.4% 0.5%
% American Indian and Alaskan Native 0.70% 0.9% 0.6% 0.7%
% Asian 2.90% 0.4% 0.3% 0.6%
% Native Hawaiian/Other Pacific Islander 0.00% 0.0% 0.0% 0.0%
% Hispanic 4.80% 2.0% 1.3% 1.5%
Non‐Hispanic White (below Hispanic 75.80% 95.2% 96.5% 95.5 %
% Not Proficient In English (2014) 1% 0.1% 0.7% 0.2%
% Females 50.90% 50.3% 49.7% 50.1%
% Rural 25.40% 100% 88.6% 66.1% Table 1
Education Levels
Indicator Michigan Ogemaw Gladwin Roscommon High School Graduation** 78% 85.1% 84.5% 86%
Some College 66% 11.6% 12.5% 13.3% Table 2
Household Income
Indicator Michigan Ogemaw Gladwin Roscommon Median Household Income $49,800 $35,968 $39,721 $35,002
Table 3
Poverty Rates
Indicator Michigan Ogemaw Gladwin Roscommon Children in Poverty: under age 18 living in poverty
23% 36% 31% 34%
ALICE level: household above poverty level, but less than the basic cost of living for county
NA
46%
45%
49%
Poverty Rate – US Census 16.9% 21.5% 21.4% 22.2%
Table 4
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Unemployment
Indicator Michigan Ogemaw Gladwin Roscommon Unemployment 7.30% 9.7% 9.2% 11.3%
Table 5
Common Occupations and Industries
Healthcare and social assistance
Manufacturing
Retail trade
Education services
Manufacturers’ shipments
Uninsured rates
Indicator Michigan Ogemaw Gladwin Roscommon Uninsured 13% 15% 16% 16%
Uninsured adults 16% 18% 19% 19%
Uninsured children 4% 6% 7% 5% Table 6
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Surveys and Focus Groups Distribution of surveys was intentionally planned to include individuals from vulnerable population groups:
senior citizens, under‐resourced families, veterans, youth and women. Data analysis included cross tabulation of results for vulnerable populations. Hospitals invited a variety of individuals that represented multiple sectors of industry, age and health conditions for the focus group.
Vulnerable Populations Represented in Survey Findings Indicator Respondent Demographics
Age Respondents were asked their year of birth, which was then recoded into quartiles. Of the valid cases, 10% were between the age of 18‐ 25 years, 30% were 26‐39 years, 20% were between the age 40‐54, 21% were 55‐64 years and 19% were 65 years or older.
Gender Seventy-four percent of the respondents were female and 26% were male.
Number of Individuals Living in Household
Forty-three percent of the households reported having two people living in them; 10% one person per household; just under 17% have three people per household; just over 19% have four people per household; 5% have 5 per household; 4% have 6 and 2% have 7 people living in one household.
Education Five percent of the respondents have attended some high school. Twenty-nine percent of respondents indicated they have received either a High School Diploma or GED. Twenty-eight percent have attended some college; 12% have a college degree from a technical/junior college; 13% have a Bachelor’s degree and 13% have a Graduate or Professional degree.
Race Ninety-seven percent self‐identified as White/Caucasian; 2% as two or more races and 1% as American Indian or Alaska Native.
Household Income Twenty-seven percent reported having an income between $25,000‐$49,999; 21% less than $15,000; 18% $15,000‐$24,999; 17% $50,000‐$74,999; 10% $75,000‐$99,999; 4% $100,000‐$149,999 and 3% over $150,000 a year.
Health Insurance Thirty-eight percent of respondents reported getting health insurance through their employers; 20% had Medicare; 19% had Medicaid; 10% purchased it from the Marketplace; 5% purchase their own; 3% have VA insurance and 5% have other or none at all.
Table 7
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CHNA Methodology
Surveys Sample/Target Population: The West Branch Regional Medical Center and District Health Department No 2 CHNA Collaboration members decided to use non-probability sampling, combining convenience sampling with purposive (judgmental) sampling. In a convenience sample, respondents can be anyone who comes into contact with the researcher or has access to the survey. This could range from people on a street corner, in a mall or those who came across the survey online. Since each hospital used the same survey methodology, the results can be analyzed and compare. Although the findings cannot be generalized, they can point out common needs and solutions.
Demographic Highlights of Survey Respondents Age Respondents were asked their year of birth, which was then
recoded into quartiles. Of the valid cases, 10% were between the age of 18‐ 25 years, 30% were 26‐39 years, 20% were between the age 40‐54, 21% were 55‐64 years and 19% were 65 years or older.
Gender Seventy-four percent of the respondents were female and 26% were male.
Number of Individuals Living in Household Forty-three percent of the households reported having two people living in them; 10% one person per household; just under 17% have three people per household; just over 19% have four people per household; 5% have 5 per household; 4% have 6 and 2% have 7 people living in one household.
Education Five percent of the respondents have attended some high school. Twenty-nine percent of respondents indicated they have received either a High School Diploma or GED. Twenty-eight percent have attended some college; 12% have a college degree from a technical/junior college; 13% have a Bachelor’s degree and 13% have a Graduate or Professional degree.
Race Ninety-seven percent self‐identified as White/Caucasian; 2% as two or more races and 1% as American Indian or Alaska Native.7% self‐identified as White/Caucasian; 2% identified as two or more races; and 1% self‐identified as American Indian or Alaska Native.
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Household Income Twenty-seven percent reported having an income
between $25,000‐$49,999; 21% less than $15,000; 18% $15,000‐$24,999; 17% $50,000‐$74,999; 10% $75,000‐$99,999; 4% $100,000‐$149,999 and 3% over $150,000 a year.
Health Insurance Thirty-eight percent of respondents reported getting health insurance through their employers; 20% had Medicare; 19% had Medicaid; 10% purchased it from the Marketplace; 5% purchase their own; 3% have VA insurance and 5% have other or none at all.
Hospitals Used Past 2 years West Branch Regional Medical Center was the most frequently used hospital with 35% of respondents reporting they used it in the past two years. Tawas St. Joseph in Tawas City had 19%; Covenant Hospital in Saginaw 9%; Mid‐Michigan Hospital 9%; Grayling Munson 8%; McLaren Bay Region 6%; St. Mary’s of Michigan Standish 6% and Other 8%.
Zip Codes Of the 27 zip codes, approximately 40% of respondents lived in the 48661 of West Branch.
Table 8
Survey Instrument and Procedures: The survey instrument contained 24 questions covering Community Assets, Community Concerns, Delivery of Health Care and Demographic Information (Appendix A). It was printed and posted online - the online version was posted at www.surveymonkey.com. Each county developed a distribution list identifying public locations for envelopes and surveys. They were distributed at meetings, the end of focus groups and links were included in press releases and regional promotion efforts. Links were distributed by direct e-mail and sent to hospitals and service providers who could forward it to their staff and e-mail patient base. Surveys were entered and data sets prepared by District Health Department No. 2 and Michigan Center for Rural Health. Data was analyzed using an Excel database.
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Focus Groups:
Focus groups were conducted in a standard format across the two counties. The facilitator followed a script (see Appendix E) and engaged the group in several procedures, including asking participants to review and comment on a list of potential health concerns that may affect the community as a whole, using sticky notes on an easel pad or wall and group discussion/brainstorming. Focus group notes were recorded and coded by the Michigan Center for Rural Health (MCRH) with summaries provided for analysis.
There were two focus groups held on September 14‐15, 2016 at West Branch Regional Medical Center. Twelve community members participated. They were invited to participate by the hospital staff. Participants included seven men and two women, representing community members, EMS professionals, auxiliary members, a mental health care provider, a VA representative, restaurant
owners, the school district, a retired employee and county on aging. Ages ranged from mid‐thirties to retired.
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Secondary Data
Major Data Sources for CHNA Public Health Statistics
Source/ Participants URL or Citation Dates of Data
Additional Descriptors
United States Census Bureau
http://quickfacts.census.gov 2010 Includes data from the American Community Survey (5‐year averages), Census Demographic profiles from the 2010 Census and subtopic data sets.
Michigan Labor Market
http://www.milmi.org 2016 Unemployment Data
Michigan Department of Community Health
http://milmi.org/cgi/dataanaly sis/?PAGEID=94
2000- 2014
Date ranges varied by health statistic. Some statistics represent one year of data as others are looking at 3 or 5 year averages.
Michigan Behavioral http://www.michigan.gov/mdch/0 2003‐ Local data available for 2003 and 2008 only. County data that is
Risk Factor Survey ,1607,7‐132‐ 2015 more recent was pulled from County Health Rankings. 2945_5104_5279_39424‐‐‐ ,00.html and www.trhn.org
Health Resources & Services Administration (HRSA)
http://bhpr.hrsa.gov/shortage/ 2016 Shortage designations are determined by HRSA.
Michigan Profile for Healthy Youth (MIPHY)
http://michigan.gov/mde/0,1607,7 ‐140‐28753_38684_29233_44681‐ ‐‐,00.html
2014 Local data from surveys of 7th, 9th, and 11th grade students is compared to county data. State and national data using the MIPHY was not available. 9th‐12th grade Youth Behavior Risk Factor survey data was used for state and national statistics.
County Health Rankings
www.countyhealthrankings.org 2005- 2013
Includes a wide variety of statistics. Many statistics represent a combined score and reflect multiple years of data.
Kids Count http://www.mlpp.org/kids‐ count/michigan‐2/mi‐data‐book‐ 2016
2016 Includes a variety of data from Michigan Department of Community Health, Department of Human Services, and Department of Education.
Community Survey
Community Survey 524 community members participated in survey.
2016 Questions included rating draft priorities, open ended questions and input on the current healthcare services provided in the community.
Focus Group/Stakeholder Interviews
Focus Group Community stakeholders and representatives
2016 Meeting included discussion of questions.
Focus Groups Representatives Ogemaw, Iosco, Oscoda, Clare, Roscommon, Gladwin and Arenac Counties
2016 Results from interviews and meetings were included in survey report.
Table 9
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Findings
Findings Companion documents are available for the information included in this report. The following pages summarize the key information utilized by the committee. Information has been organized into two
categories (survey and focus groups); however, most of the data is inter‐related.
Survey
Purpose
The purpose of the Community Health Survey was to:
Learn about the good things in the community as well as concerns in the community.
Understand perceptions and attitudes about the health of the community.
Gather suggestions for improvement.
Learn more about how local health services are used by community residents. Survey results for community assets and concerns are in Appendix C. The main focus of this analysis is to identify problem areas that prevent access to health care and the concerns of vulnerable groups- seniors, low education and low income regarding health and health care.
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Preventing Access to HealthCare Table 8 contains responses to Q21. Please rate how much the following issues prevent you or other community residents from receiving health care. Responses were on a four point scale from 1 being not a problem to 4 being major problem. Means and standard deviations were calculated for each.
The table reveals that 25% the people in the counties cannot afford visits to doctors/clinics/hospitals. There is also a 24% lack of health care providers in this area. People also reported there is a waiting list to be seen by doctors in the area. This reflects the rural nature of Ogemaw County, which had a population of 21,035 in 2014.2
2 Populations of Michigan Counties 2000 and 2010. Available at http://www.michigan.gov/cgi/0,1607,7‐158‐54534‐252541‐‐,00.html
Table 8
Q21 Issues Prevent Receiving Health Care
Issues prevent Receiving Healthcare Number of Responses
Percent
No problems getting healthcare 105 20.0
Transportation issues 56 10.7
Lack of healthcare providers 127 24.2
Lack of convenient times 91 17.4
Waiting list to be seen by doctor 102 19.5
Difficult to get away from work 91 17.4
No insurance 34 6.5
Lack of cultural diversity or inclusion 24 4.6
Lack of sensitivity of healthcare providers 42 8.0
Difficult to set appointment 69 13.2
Language barriers 24 4.6
Do not know where to go 38 7.3
Cannot afford medications 66 12.6
Cannot afford visits to doctor/clinic/hospital 130 24.8
Lack of childcare 35 6.7
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Table 11 contains responses to Q20: “How you feel about: healthcare in your community; ability to get appointments; quality of care; informed about options; cost and sensitivity to your culture/beliefs/values?” Respondents were encouraged to reply on a ranking system of poor, fair, good, very good and excellent.
Table 11 shows the number one cost consideration preventing receiving health services was cost with 33.8% of the responses. The second largest was access to healthcare in the community with 38.7%.
Q20 How you feel:
Poor (1) Fair (2) Good (3) Very Good (4) Excellent (5)
Health care in your Community?
14.3% 38.7% 33% 11.5% 2.5%
Ability to get appointments? 12.8% 27.7% 38.7% 16% 5%
Quality of Care? 6.7% 23.9% 41.2% 21.4% 6.1%
Informed about options? 13.2% 29.2% 35.5% 14% 6.3%
Cost? 33.8% 15.3% 23.1% 5% 2%
Sensitivity to our culture/beliefs/vlues?
6.5%
16.8%
50%
18.3%
10.9%
Table 11
That a solid majority of respondents picked cost, is not surprising. In theory, both deductibles and copays are cost sharing devices designed to prevent policy holders from making small nuisance claims or seeking health care unnecessarily. The charges have to be just large enough to influence people's decisions, and not so big as to keep people from getting the care they need. Consumers are asked to decide ahead of time between plans that have lower premiums but higher deductible, which they would prefer if they are less likely to need health care, and higher premiums but lower deductibles, which they would prefer if they are more likely. Theoretically, this balances risk with cost.3 Unfortunately; the costs of premiums, deductibles and copays have steadily increased, making cost a determining factor in obtaining health insurance. In terms of CHNA implementation, although hospitals and health departments may adjust their own copays, they have almost no ability to change insurance deductibles. Although only 6.5% of respondents answered they had no health insurance, 42.1% thought that not having insurance prevent themselves or community residents from receiving health services. This is more than double the Census Bureau’s 2014 estimate4 of 18 -19% uninsured in Gladwin, Ogemaw and Roscommon Counties. The question may reflect a concern with the costs of purchasing health insurance through healthcare.gov rather than indirectly measuring the population not having any health insurance.
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Community Concerns
Concerns about the community’s health included:
Access to healthy food
Awareness of local health resources and services
Assistance for low‐income families
Access to exercise and fitness activities
Understanding/Navigating Healthcare Reform Concerns about the quality of life in the community:
Jobs with livable wages
Attracting and retaining young families Concerns about availability of health services:
Availability of doctors and nurses
Ability to get appointments
Availability of mental health services
Availability of substance abuse/treatment services
Availability of specialists
Availability of wellness and disease prevention services Concerns about the community’s safety and environment:
Public transportation (options and cost) Concerns about the delivery of health services:
Cost of health insurance
Ability to retain doctors, nurses and other healthcare professionals
Cost of health care services
Cost of prescription drugs
3Kunreuther, H. and Pauly, M. (2005). Insurance Decision‐Making and Market Behavior. Foundations and Trends® in Microeconomics. 1:2 p 63‐127. 4 US Census Bureau 2014 Small Area Health Insurance Estimates (SAHIE) Insurance Coverage Estimates: Percent Uninsured: 2014 http://www.census.gov/did/www/sahie/data/files/F4_Map.jpg
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Concerns Related to Vulnerable Populations
One purpose of the Community Health Needs Assessment is to address perceptions and concerns of and about vulnerable populations. Vulnerable populations include youth, seniors, females, low education, low income and race/ethnicity. The survey instrument asked all respondents for their concerns about youth and seniors (see Appendix C).
Table 9 below shows the largest concern about youth is obesity with 29.4% of the responses. It was
selected by three‐eighths (37.6%) of the respondents. The second largest concern was wellness and
disease prevention, including vaccine‐preventable (21.7%), chosen by 27.7% of the respondents. The third largest concern was youth hunger and nutrition (19.0%). This was followed closely by teen pregnancy with 18.6% of the responses (41 of 221).
Q16 Top Concerns Physical Health in Your Community (Youth Frequencies)
Concern Frequency Percent
Youth Obesity 128 24.4%
Teen Pregnancy 104 19.8%
Youth Hunger and Poor Nutrition 67 12.8%
Youth Sexual Health (i.e. - STD/ STI) 43 8.2%
Table 9
Table 13 shows the largest concern in youth mental health and substance use youth drug use with 28.4% of the responses. It was chosen by half (49.6%) of the respondents. The second largest concern with 23.7% of the responses (112 of 472) was youth bullying, selected by 41.5% of the respondents. The third largest was youth alcohol use and abuse at 17.4%.
Q17 Top concerns mental health substance abuse in your community (youth frequencies)
Frequency Percent
Youth Alcohol Use and Abuse (including binge drinking) 121 23.1%
Youth Bullying 110 21.0%
Youth Drug Use and Abuse (including prescription drug abuse) 102 19.5%
Youth Tobacco Use (including exposure to secondhand smoke, and/or use of alternate tobacco products like e‐cigs, vaping, hookah)
99
18.9%
Table 13
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As shown in Table 14 below, the top concern for the senior population in their community is the cost of medications (67.4% of the responses). The second largest at 41.4% is the availability of resources to help elderly stay in their homes. The third largest concern was assisted living options chosen by a little more than 29.4% of the respondents.
Q18 Top 3 Concerns about Senior Population in Your Community
Frequency Percent
Cost of medications 353 67.4%
Availability of resources to help the elderly stay in their homes 217 41.4%
Assisted Living Options 154 29.4%
Dementia/Alzheimer’s disease 146 27.9%
Transportation 139 26.5%
Availability of resources for family and friends caring for elders, such as respite care
119
22.7%
Availability of activities for seniors 114 21.6%
Hunger and poor nutrition 93 17.7%
Elder Abuse 82 15.6%
Long‐term/nursing home care options 64 12.2%
Cost of activities for seniors 45 8.6%
Other 16 3.1% Table 14
An additional analysis examined the top concerns of respondents who self‐identified as members of vulnerable populations: low income, low education, seniors and females (see Appendix D).
Income Respondents with household incomes of less than $25,000 were more likely than those with higher incomes to be concerned about:
Affordable housing
Availability of dental care
Availability of vision care
Availability of affordable dental services
Youth tobacco use
Respondents with household incomes of less than $25,000 were less likely than those with higher incomes to be concerned about:
Understanding/navigating Healthcare Reform
The ability of the community to retain health providers and professionals
Attracting and retaining young families
Youth drug use and abuse
The costs of medications
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Education
Respondents with a high school education or less were less likely than those with more education to be concerned about:
Obesity/overweight
Seniors
Respondents 59 years of age or older were more likely than younger respondents to be concerned about:
Youth obesity
Wellness/disease prevention. Their concerns may be more about preventing flu and shingles.
Respondents 59 years of age or older were slightly more likely than younger respondents to be concerned about:
Public transportation options and costs
Respondents 59 years of age or older were less likely than younger respondents to be concerned about:
Obesity/overweight
Youth hunger and poor nutrition
Youth sexual health
Adult mental health
Gender Females were more likely than males to be concerned about:
Adequate youth activities
Public transportation options and costs
Youth sexual health and wellness and disease prevention
Adult drug use and abuse Males were more likely than females to be concerned about:
Teen pregnancy
Youth obesity
Stress
Youth alcohol use and abuse
Focus Group
Purpose The purpose of the focus group is to:
• Learn about the good things in the community as well as concerns in the community.
• Understand perceptions and attitudes about the health of the community.
Gather suggestions for improvement. • Learn more about how local health services are used by its residents.
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Focus Group Results
The focus group schedule contained 19 questions/ topics and the complete results are in Appendix F. Focus Group participants were provided a list of potential health concerns that may affect the community as a whole. They were asked to review and comment on whether they thought the concerns were important to their local community, and which of the concerns would be the most important to their community.
The participants initially went through and identified all health concerns they thought were relevant to their community (column 1). They were then asked to identify their top 5 concerns. The second column shows the number of people who noted it was of concern in the community. The third column shows the number of people who listed the concern in their top five.
Top Concerns of Focus Group by Topic Community/Environmental Concerns
Concern Times chosen Times in top 5
Not enough jobs with livable wages, not enough to live on 11 4
Attracting and retaining young families 10 7 Not enough public transportation options, cost of public transportation
9 1
Poverty 5 4
Changes in population size (increasing or decreasing) 5 2 Table 10
Physical, mental health, and substance abuse concerns (adults)
Concern Times chosen Times in top 5
Drug use and abuse (including prescription drug abuse) 3 1
Alcohol use and abuse 3 1
Depression 1 0
Obesity/overweight 3 3 Table 11
Concerns about health services
Concern Times chosen Times in top 5
Cost of health insurance
Cost of prescription drugs 6 1
Availability of substance abuse/treatment services 1 0
Availability of mental health services 1 0 Table 12
Concerns about youth and children
Concern Times chosen Times in top 5
Youth drug use and abuse (including prescription drug abuse) 1
Youth alcohol use and abuse 1 Youth obesity 3
Table 13
26
Concerns about the aging population
Concern Times chosen Times in top 5
Availability of resources for family and friends caring for elderly/ availability of care for seniors without a family
3
Availability of resources to help the elderly stay in their homes 2 1
Being able to meet needs of older population 2
Assisted living options 2 Table 19
Focus group members identified affordable dental care as a service that was not on the list of potential health concerns that may affect the community as a whole. They thought the hospital needs to add substance abuse counseling/education for both children and parents.
There were six groups identified as being medically underserved. In addition to the elderly, they also categorized lower-middle income, those with mental health issues, the Amish, preschool and kids and young adults.
Group members thought most people use West Branch Regional Medical Center because of its location and providers/staff, but used other providers because WBRMC lacked specialties and resources.
They thought the health of the community would be improved by having a health advocate help with insurance and access to resources.
27
Secondary Data
The following Northeast Report Card illustrates how each county compares to data from the state. Table 14
Source Indicator Year Michigan Gladwin Ogemaw Roscommon
CHR Diabetes Prevalence** (age 20+ diagnosed with diabetes, 2012)
2012 10% 13% 12% 14%
CHR HIV Prevalence 2012) per 100,000 2012 178 23 NA 60
CHR
Health Factors (county rank)
78 77 76
CHR Health Behaviors (county rank) 64 58 48
CHR Adult Obesity** (BMI >30) 2012 31% 36% 36% 32%
PHY 7th Grade Obesity (>95th and 85th percentile)
2014 H‐T 2010 SC
NA NA 16.4%/20.0% 16.4%/20.0%
PHY
9th Grade Obesity (>95th and 85th percentile)
2014 H‐T 2010 SC
NA NA 16.6%/17.1% 16.6%/17.1%
PHY 11th Grade Obesity (>95th and 85th percentile)
2014 H‐T 2010 SC
NA NA 13.5%/14.6% 13.5%/14.6%
0‐8 Obesity among low income children 2014 13%
CHR
Limited Access To Healthy Foods: % of low income who don't live close to grocery store
2010
6%
3%
0%
9%
CHR
Index of factors that contribute to a healthy food environment, 0 (worst) to 10 (best)
2013
7.1
7.1
7.6
6.4
CHR Food Insecurity (did not have access to reliable source of food in the past year)
2013 16% 17% 16% 17%
CHR Physical Inactivity: no leisure‐time physical activity
2012 23% 30% 29% 25%
PHY
7th Grade ‐ 60 minutes of physical activity for at least 5 of 7 past days
2014 H‐T 2010 SC
NA NA 62.6% 62.6%
PHY 9th Grade ‐ 60 minutes of physical activity for at least 5 of 7 past days
2014 H‐T 2010 SC
NA NA 66.5% 66.5%
PHY 11th Grade ‐ 60 minutes of physical activity for at least 5 of 7 past days
2014 H‐T 2010 SC
NA NA 51.6% 51.6%
Source Indicator Year Michigan Gladwin Ogemaw Roscommon
CHR
% of individuals in a county who live reasonably close to a location for physical activity such as parks
2010 & 2014
84%
62%
62%
95%
CHR Adult smoking (every day or most days) 2014 21% 19% 18% 19%
PHY
7th Grade youth who smoked cigarettes during the past 30 days
2014 H‐T 2010 SC
NA NA 3.0% 3.0%
PHY 9th Grade youth who smoked cigarettes during the past 30 days
2014 H‐T 2010 SC
NA NA 7.8% 7.8%
PHY 11th Grade youth who smoked cigarettes during the past 30 days
2014 H‐T 2010 SC
NA NA 14.1% 14.1%
28
0‐8 Live births to women who smoked d uring pregnancy
2011‐2013 21.6%
CHR Excessive drinking (binge ‐ 5+ drinks or daily drinking)
2014 20% 18% 18% 17%
CHR Alcohol impaired driving deaths (% of all driving deaths)
2010‐2014 30% 41% 32% 33%
PHY
7th grade students who had at least one drink of alcohol during the past 30 days
2014 H‐T 2010 SC
NA
NA
8.5%
8.5%
PHY
9th grade students who had at least one drink of alcohol during the past 30 days
2014 H‐T 2010 SC
NA
NA
16.4%
16.4%
PHY
11th grade students who had at least one drink of alcohol during the past 30 days
2014 H‐T 2010 SC
NA
NA
29.7%
29.7%
PHY 7th grade students who used marijuana during the past 30 days
2014 H‐T 2010 SC
NA NA 4.4% 4.4%
PHY 9th grade students who used marijuana during the past 30 days
2014 H‐T 2010 SC
NA NA 13.4% 13.4%
PHY 11th grade students who used marijuana during the past 30 days
2014 H‐T 2010 SC
NA NA 18.5% 18.5%
CHR Drug overdose deaths: drug poisoning deaths per 100,000
2012‐2014 16 18 30 18
CHR
Drug overdose deaths modeled: estimate of the number of deaths due to drug poisoning per 100,000
2014
18
≥20
18.1‐20.0
≥20
CHR
Motor vehicle crash deaths: traffic accidents involving a vehicle per 100,000
2007‐2013
10
17
14
10
CHR Sexually transmitted infections: diagnosed chlamydia cases per 100,000
2013 453.6 125.6 130.6 195.0
PHY 7th grade students who ever had sexual intercourse
2014 H‐T 2010 SC
NA NA 8.4% 8.4%
PHY 9th grade students who ever had sexual intercourse
2014 H‐T 2010 SC
NA NA 25.1% 25.1%
PHY 11th grade students who ever had sexual intercourse
2014 H‐T 2010 SC
NA NA 54.6% 54.6%
CHR Teen Births (# of births per 1,000 female population, ages 15‐19)
2007‐2013 29 33 32 40
Source Indicator Year Michigan Gladwin Ogemaw Roscommon
MDCH
Percent of total births to mothers age < 20
2011‐2013 7.8
CHR
Insufficient Sleep: adults who report fewer than 7 hours of sleep on average
2014 38% 32% 32% 32%
CHR Clinical care (county rank) 82 67 47
CHR
Uninsured: <65 that has no health insurance coverage
2013 13% 16% 15% 16%
CHR
Uninsured adults: 18 to 65 that has no health insurance coverage in a given county
2013
16%
19%
18%
19%
29
CHR
Uninsured children: <19 that has no health insurance coverage
2013 4% 7% 6% 5%
CHR
Health care costs: price‐adjusted Medicare reimbursements (Parts A and B) per enrollee
2013
$10,153
$10,131
$10,789
$10,168
CHR
Primary Care: ratio of the population to total primary care physicians; Higher = less access
2013
1,240:1
2,830:1
1,770:1
3,000:1
CHR
Ratio of other Primary Care Providers: nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists
2015
1,342:1
2,541:1
842:1
1,141:1
CHR
Dentists: ratio of the population to total dentists; Higher = less access
2014 1,450:1 5,080:1 2,630:1 2,180:1
Source Indicator Year Michigan Gladwin
Ogemaw Roscommon
CHR
Mental Health: ratio of the population to total mental health providers; Higher = less access
2015
450:1
1,160:1
1,910:1
1,140:1
HPSA
Provider Shortage Designations
Varies
NA
Primary Care
Dental Mental Health
Primary Care
Dental Mental Health
Primary Care Dental
0‐8
Live births to women with less than adequate prenatal care
2011‐ 2013
29.9%
0‐8
Toddlers ages 19‐35 months who are immunized; 4:4:1:3:3:1:4
2014 73.8%
CHR
Preventable hospital stays: discharge rate for ambulatory care‐sensitive conditions per 1,000 Medicare enrollees
2013
59
80
62
64
CHR
Diabetic monitoring: Medicare enrollees ages 65‐75 that receive HbA1c monitoring
2013
86%
87%
87%
91%
30
CHR
Mammography screening: female Medicare enrollees ages 67‐69 that receive mammography screening
2013
65%
68%
63%
73%
CHR
Social and Economic Factors (county rank)
65 75 81
CHR
High School Graduation: % of students who graduate high school in four years
2012‐ 2013
78%
80%
78%
73%
CHR
Some College: adults ages 25‐44 with some post‐secondary education; no degree
2010‐ 2014
66%
54%
52%
55%
0‐8
Births to mothers without a High School Diploma/GED
2011‐ 2013
13.8%
KC Children age 3‐4 enrolled in preschool.
2009‐ 2013
47.5% 38.9%
34.7% 58.5%
0‐8
Change in licensed childcare providers
2011‐ 2015
NA
CHR Unemployment: ages 16+ but seeking work
2014 7.30% 9.2%
9.7% 11.3%
CHR
Median household income: half the households earn more and half the households earn less than this income
2014
$49,800
$39,700
$36,000
$35,000
CHR
Income inequality: higher inequality
ratio indicates greater division between the top and bottom ends of the income spectrum
2010‐ 2014
4.7
4.0
4.3
4.0
CHR Children in single parent households
2010‐ 2014
34% 29%
41% 45%
Source Indicator
Year Michigan Gladwin Ogemaw Roscommon
CHR Children eligible for free lunch: % enrolled in public schools eligible for free lunch
2012‐
2013 42% 54% 54% 62%
CHR Children in poverty: under age 18 living in poverty
2014 23% 31% 36% 34%
Alice ALICE level: households above poverty level, but less than the basic cost of living for county.
2014 NA 27% 26% 30%
census Poverty rate ‐ US Census
2014 16.9% 19.9% 21.5% 22.1%
0‐8 Rate per 1,000 children ages 0‐8 who are substantiated victims of abuse or neglect
2014 20.6
0‐8 Change in rate per 1,000 children ages 0‐8 substantiated victims of abuse or neglect
From 2010
to 2014 2.6
0‐8 Rate per 1,000 of children ages 0‐ 8 in foster care
2014 5.9
31
PHY
7th grade students who have seen students get pushed, hit, or punched one or more times during the past 12 months
2014 H‐T
2010 SC
NA
NA
70.4%
70.4%
PHY 9th grade students who have seen students get pushed, hit, or punched one or more times during the past 12 months
2014 H‐T
2010 SC
NA
NA
86.8%
86.8%
PHY
11th grade students who have seen students get pushed, hit, or punched one or more times during the past 12 months
2014 H‐T
2010 SC
NA
NA
91.3%
91.3%
CHR Violent crime: offenses that involve face‐to‐face confrontation per 100,000.
2010‐
2012 464 206 211 199
CHR Homicides: deaths per 100,000 2007‐
2013 7 NA NA NA
CHR Injury deaths: intentional and unintentional injuries per 100,000
2009‐
2013 61 76 76 71
CHR Inadequate social support ‐ adults 2005‐
2010 20% NA NA NA
CHR Social associations: number of associations per 10,000 population
2013 10.2 9.4 15.1 15.8
CHR
Residential segregation black white: degree to which live separately in a geographic area (0 integration to 100 segregation)
2010‐
2014
74
NA
NA
NA
CHR
Residential segregation non-white/white: degree to which live separately (0 integration to 100 segregation)
2010‐
2014
61
19
22
38
Source Indicator Year Michigan Gladwin Ogemaw Roscommon
CHR
Physical environment (county rank)
64 48 55
CHR
Air pollution particulate matter: average daily density
2011 11.5 11.6 11.4 11.4
CHR Drinking water violations: Yes=presence
FY2013‐14
Yes No Yes
CHR
Severe housing problems: at least 1 of 4 problems ‐ overcrowding, high housing costs, or lack of kitchen or plumbing
2008‐ 2012
17%
17%
19%
17%
CHR
Driving alone to work: percentage of the workforce that usually drives alone to work.
2010‐ 2014
83%
82%
84%
78%
CHR
Long commute driving alone: greater than 30 minutes
2010‐ 2014
32% 44% 24% 28%
32
NOTE: This Report may be beneficial in Regional conversations about need and also can shed some light as a region to trends. This report did not include county or Michigan comparisons and therefore did not lend well to inclusion in the report card table.
Source Key
CHR ‐ County Health Ranking; 0‐8 ‐ Birth to 8 Indicators; PHY ‐ Michigan Profile for Healthy Youth; HPSA ‐ Health Provider Shortage Area; MDCH ‐ Michigan Department of Community Health; AR ‐ Alice Report; ALICE
‐ Asset Limited Income Constrained Employed; KC ‐ Kids Count
33
Discussion and Limitations
Discussion The survey and focus groups all identified the need for mental health services including substance abuse counseling for adults, parents and youth. They also agreed about a shortage of dental health services. Both noted people were not aware of the local health resources and services and had problems understanding their insurance and what was covered. The focus group proposed having a health advocate help with insurance and access to resources.
Survey respondents and focus group members were concerned about the costs of health insurance, prescriptions and medical services. Survey respondents noted the need for better public transportation, especially for health and medical needs. Survey respondents who self-identified as low income were concerned about access to dental and vision care.
Overall, the findings appear consistent with a rural county in terms of provider shortages, lack of transportation and little support for navigating the health care system and health insurance. Limitations
The survey employed a non‐probability sampling, combining convenience sampling with purposive (judgmental) sampling. Surveys were available online and paper surveys were distributed at a variety of locations. This resulted in some skewed demographics. Respondents were disproportionately female (74%), had some college degree (12%), and
one‐third (27%) had household incomes of $25,000‐$49,000. Census information on gender, education and income are grouped by census tracts, which are not always congruent with zip codes. It is not practicable to adjust the survey responses for gender, education and income for the nine zip codes. However, this could be done at the county level.
34
Prioritization Process A CHNA helps direct resources to the issues that have the greatest potential for improving the health of the community. Successfully addressing priority issues increases life expectancy, improves quality of life and results in a savings to the healthcare system.
Implementation Meeting
West Branch Regional Medical Center began the prioritization process by reviewing the data described in the findings section of this report. The Implementation meeting included approximately 30 participants, with members from the first focus group and hospital employees (department managers and hospital leadership). The meeting participants also reviewed the following list of concerns revealed in focus groups.
Top concerns of focus group by topic: Community/Environmental Concerns
Concern Times chosen Times in top 5
Not enough jobs with livable wages, not enough to live on 11 4
Attracting and retaining young families 10 7 Not enough public transportation options, cost of public transportation
9 1
Poverty 5 4 Changes in population size (increasing or decreasing) 5 2
Table 15
Physical, mental health, and substance abuse concerns (adults)
Concern Times chosen Times in top 5
Drug use and abuse (including prescription drug abuse) 3 1
Alcohol use and abuse 3 1
Depression 1 0
Obesity/overweight 3 3 Table 16
Concerns about health services
Concern Times chosen Times in top 5
Cost of health insurance
Cost of prescription drugs 6 1
Availability of substance abuse/treatment services 1 0
Availability of mental health services 1 0 Table 17
35
Concerns about youth and children
Concern Times chosen Times in top 5
Youth drug use and abuse (including prescription drug abuse) 1
Youth alcohol use and abuse 1
Youth obesity 3 Table 18
Concerns the aging population
Concern Times chosen Times in top 5
Availability of resources for family and friends caring for elderly/availability of care for seniors without a family
3
Availability of resources to help the elderly stay in their homes
2 1
Being able to meet needs of older population 2
Assisted living options 2
36
The meeting participants used a prioritization process that included analysis of issues located in multiple data sources. The ballot that was used during the meeting is available upon request. The final ballot results are below. We asked the group to work in smaller groups to fill out ballets. We had a total of eight ballots returned.
POTENTIAL NEEDS In Alphabetical order
(Combined indicators from surveys, focus groups, and secondary data)
= Not meeting
state average
=County Need based on data
Focus group
= Survey
VOTE for your top 5 (1 top
choice, 5 lowest)
1. Abuse and Violence, Including
Bullying
o
2. Access to Dental Healthcare and
Providers
1
3. Access to Emergency Care
4. Access to in Home Healthcare and
Supports
5. Access to Long Term Healthcare
S ervices
o
6. Access to Prenatal Care
7. Access to Primary Healthcare and
Providers
o
3
8. Access to Public Health Services and
Providers
1
9. Access to Specialized Healthcare
Services
o 3
10. Access to Vision Healthcare and
Providers
11. Alcohol Use/Abuse o 3
12. Cancer
13. Diabetes
14. Education
15. Environmental Health o
16. Families Services and Supports
17. Health Education and Awareness o
18. Health Insurance and Healthcare Costs
o 4
19. Healthcare Workforce o
20. Heart Disease
21. Local Economic Conditions o 4
22. Lung Disease and Asthma
23. Mental Health o
37
Table 19
24. Nutrition o
25. Obesity o 6
26. Personal Attitudes to Health and
Healthcare
o
27. Physical Activity o 2
28. Quality of Healthcare o
29. Reproductive Health
30. Safety and Violence o
31. Senior Support Services o
32. Social Conditions o
33. Social Emotional Support
34. Substance Abuse o 6
35. Teen Births o
36. Tobacco Use (prenatal) (prenatal) 1
37. Traffic Safety
38. Transportation o 1
38
Assess existing resources that are addressing priorities
Identified Needs and Available Resources The next step in the resource assessment was to group needs into categories. The categories are listed on Table 4 along with the resources provided by the hospital and the community.
Community Health Needs and Resources
Category Need5 and Related
Data Current WBRMC
Efforts Current Community Efforts
Substance
Abuse
Need Narcotic and Sedative
Policy - Emergency Department
Work with Drug Free
Coalition
Work with School
Outreach Program
Have a good
relationship with
Community Mental
Health Agencies
• Develop stronger partnership with Drug Free Coalition Group
• Narcotic and Sedative Policy
• Provide meeting space for AA/Al-anon
• Provide meeting space for Drug Free Coalition Group • Continue relationship with AuSable Valley Mental Health
Substance Abuse
Related Data
Secondary data
sources
Hospital focus
group
Survey
Activity/
Healthy
Lifestyles
Need Wellness Trail
Host Soles for Cardio
5K Walk/Run
Boy Scouts Peace
Trail
Well Being Meals
offered in Cafe
Garden Plate Wellness
Program
• Walk this Way
• Relay for Life
• Continue programs to support wellness trail
• Develop walking trail at MAC building
• Advertise Wellness Park
Activity/Healthy
L Related Data
Secondary data
sources
Hospital focus
group
Survey
Access to
Care
Need Family Practice open
in August, 2016
Working with a
specialists to provide
services a few days a
week/month
Recently added ENT
as a tenant at MAC
building
Added EMG services
to Family Practice
• Increase Rehabilitation Services • Develop Recruitment Committee • Build Relationships with Office Managers from practices
around the area for referral service to WBRMC.
• Advertise WBRMC services to corporations
• Affiliate with larger healthcare system
Related Data Secondary data
sources
Hospital focus
group
Survey
Table 20
39
Written CHNA Report and Implementation Plan The CHNA report was completed in draft form in September 2017. The final CHNA assessment
report was reviewed and posted to the hospital website at https://www.wbrmc.com/ in January
2018. The Final Community Health Needs Assessment Plant that follows was approved by the
MidMichigan Medical Center-West Branch Board on Monday, October 22.
5 *indicates issue related to top community health priorities ** indicates issue related to top health system priorities
40
Part Two: The Implementation Plan
The following plan was developed in partnership with the Community Health Team of MidMichigan Health, which supports the Community Health Needs Assessment (CHNA) as a key component for identifying and articulating top health priorities. The team aligns with the Institute for Healthcare Improvement’s (IHI) belief that new designs can and must be developed to simultaneously accomplish four critical objectives, or what is known as the “Quadruple Aim”: improve the health of the population (known as Population Health); enhance the patient experience of care (including quality, access and reliability); reduce or control the per capita cost of care and improve the work life of those who provide care: health care providers; clinicians and staff.
West Branch Regional Medical Center (WBRMC) joined MidMichigan Health, an affiliate of Michigan Medicine, the health care division of the University of Michigan in February 2018. The partnership makes West Branch the seventh Medical Center in the MidMichigan Health system. To reflect the hospital joining MidMichigan, WBRMC changed its name to MidMichigan Medical Center - West Branch. Providing a CHNA every three years is a requirement for tax exempt hospitals under the Patient Protection and Affordable Care Acts. However, the previous assessment and following plan are a reflection of the Mission, Vision, and Core Values of MidMichigan Health. We truly believe health happens where we live, learn, work and play, and all people should have the opportunity to make choices that allow them to live a long, healthy life, regardless of their income, education or ethnic background. Priority issues for the populations served by MidMichigan Medical Center - West Branch unfolded in the CHNA report. A plan based upon the prioritized needs identified in the CHNA and reviewed by the MidMichigan Medical Center - West Branch Board follows. We will work with our health system leaders and community partners to share goals, resources and actions to drive these plans towards improved health in our service region.
41
Focus Area: Substance Use
Goal: Increase awareness of substance use and available supports
Medical Center Role
Lead Collaborate
Strategy 1: Promote education of substance use.
1.1 Increase collaboration with and provide meeting space for the Drug Free Coalition. X
1.2 Partner with the School Outreach Program to disseminate substance use messages. X
1.3 Provide meeting space for AA/Al-Anon. X
1.4 Provide education through the Speakers Bureau. X
1.5 Partner with community mental health agencies to disseminate substance use messages. X
Strategy 2: Implement actions to identify and treat substance use.
2.1 Explore the launch of the ASSERT project in the emergency department. X
2.2 Partner with the local police department to host an annual prescription drug take back event.
X
2.3 Screen tobacco use for adults 18 years of age and older. X
2.4 Promote use of the Michigan Quit Line to patients and the public. X
2.5 Administer an Opioid Risk Tool in primary care practices. X
2.6 Research current protocols from law enforcement and emergency rooms related to referring overdose patients to treatment.
X
42
Focus Area: Activity/Healthy Lifestyles
Goal: Encourage Healthy Lifestyles with physical activity and proper nutrition to prevent the development of diseases associated with obesity.
Medical Center Role
Lead Collaborate
Strategy 1: Increase access to fresh fruits and vegetables.
1.1 Continue the Garden Plate Wellness program to educate children and their families about food production.
X
1.2 Explore the option to host the Farmer’s Market at the Tolfree Wellness Park. X X
1.3 Maintain the Teaching Gardens to host events and provide fresh fruits and vegetables for park attendees.
X
1.4 Partner with the Community Gardens and CSA’s to promote local and fresh food consumption.
X X
1.5 Support CHOICES initiative through the Health Department. X X
Strategy 2: Increase physical activity within the community members.
2.1 Promote Tolfree Wellness Park as venue for physical activity and events. X
2.2 Promote Walk This Way program and explore scholarship options for participation. X
2.3 Promote Soles for Cardio event. X
2.4 Provide education for use of the outdoor equipment at the Tolfree Wellness Park and promote the use of the equipment.
X
2.5 Host physical activity events throughout the year to increase physical activity and promote the use of the Wellness Park.
X
2.6 Provide Matter of Balance and Think First balance classes. X X
43
2.7 Provide walking maps to the community to promote the use of the Tolfree Wellness Park. X
2.8 Partner with local Silver Sneakers venue. X X
2.9 Explore the development of the Boy Scouts Peace Trail at the Wellness Park. X X
Strategy 3: Increase awareness of healthy weight behaviors and the impact of obesity.
3.1 Continue Healthy Weighs program to provide education and resources for healthy lifestyles and provide data collection for continuation.
X
3.2 Provide information on chronic disease and risk factor reduction through several community channels.
X X
3.3 Increase partnership with the local Health Department for programs and policies that focus on healthy lifestyles and obesity prevention.
X X
3.4 Promote community education and support groups. X X
3.5 Provide education through Speakers Bureau. X X
3.6 Disseminate healthy weight messages on multiple media sites and venues. X X
3.7 Improve participation in breastfeeding education and breastfeeding support. X
44
Focus Area: Access to Care
Goal: Ensure MidMichigan Health provides health care services that are timely and accessible.
Medical Center Role
Lead Collaborate
Strategy 1: Provide information to support care access.
1.1 Promote public transportation, Dial-a-Ride, Council on Aging and 211 assistance. X X
1.2 Enable use of Find a Doctor online, and MidMichigan Health Line. X
1.3 Distribute information on obtaining health care services at community events, including physicians accepting new patients and hours of service.
X X
1.4 Provide community members with insurance and payment options. X
1.5 Promote educational classes and support services available using multiple means. X X
Strategy 2: Improve provider to patient communication.
2.1 Utilize approved materials to provide education and information. X
2.2 Support informed decision making for procedures and tests through provisions of resources such as Choosing Wisely.
X X
Strategy 3: Increase availability of providers and support workers.
3.1 Explore telemedicine opportunities for patients living in our rural community. X
3.2 Support health care provider recruitment efforts. X X
3.3 Promote community education and support groups. X X
45
Additional Documents (Available Upon Request) Survey Instrument
Focus Group Design
Interview Outline
Survey, Stakeholder, Focus Group Report
Thumb Area Health Status Data Reports
Prioritization Meeting Ballot
