COMMUNITY HEALTH NEEDS ASSESSMENT 2017 Hardin County General Hospital Rosiclare, Illinois TABLE OF CONTENTS Introduction Executive Summary Purpose of a Community Health Needs Assessment Background – Hardin County General Hospital & Clinic Community Health Needs Assessment Population Hardin County General Hospital Service Area Demographics Process / Methodology Primary Data Survey Focus Group Interviews Secondary Data Health Priority Issues Identified Needs and Priority Issues Appendix A – Community Survey Appendix B – Focus Group Interviews Appendix C – Sources of Data P a ge 1 | 21 INTRODUCTION - Executive Summary Hardin County General Hospital conducted a Community Health Needs Assessment (CHNA) spanning a period of several weeks in the fall of 2016. The CHNA is a systematic process involving the community to identify and analyze community health needs as well as community assets and resources in order to plan and act upon priority health needs. Through a focus group with key community members, public forums where community members provided information and surveys and research we have been able to find insight into the needs of the area. The most prevalent needs identified were substance abuse, access to specialty physicians including mental health. Wellness education and exercise programs were also identified as needs for the community. • Twenty-six percent of Hardin and Pope County residents expressed health issues related to high blood pressure and 24% indicated joint and back pain. Diabetes was 12% of respondents. The obesity rates are 33% and 31% respectively for Hardin and Pope Counties. The many health problems and chronic diseases associated with them have a major impact on our community. • Twenty-seven percent of survey respondents indicated a need for better access to specialty physicians including mental health services. • Eleven percent indicated services needed for substance abuse and prescription drug abuse was also identified by our focus group. Hardin County General Hospital will use its resources and partner with other community organizations to best meet the needs related to these issues and will create an implementation plan to help guide these efforts. PURPOSE OF A COMMUNITY HEALTH NEEDS ASSESSMENT Under the Patient Protection and Affordable Care Act (ACA) of 2010, nonprofit 501(c)(3) hospitals are required to perform a Community Health Needs Assessment (CHNA) every three years to be in compliance with IRS Notice 26 CFR Parts 1, 53 (published 12/31/2014). An implementation strategy must also be developed to address identified needs. In addition to compliance with ACA, establishing the community’s health needs help to prioritize resources allocation and to determine what services are currently available in our area and how we can coordinate activities with other organizations. The process of a community health needs assessment also ensures that needs are identified, efforts are not duplicated, and that the correct organizations that handle specific issues are involved in the process. P a ge 2 | 21 HARDIN COUNTY GENERAL HOSPITAL Hardin County General Hospital is a 25 bed, non-profit Critical Access Hospital licensed by Illinois Department of Public Health and is a member of the Illinois Hospital and Health Systems Association. The full scope of patient care is provided only by those professionals who are also competent to assess patients and plan of care based on findings from that assessment. Scope of Services Provided by Hardin County General Hospital include: 24 hour emergency room coverage by 3 physicians and 3 Family Nurse Practitioner – board certified. The hospital also employees 41 nurses on staff, of which 9 are ACLS certified; 5 are trauma certified and 9 are nurses that are Pediatric Advanced Life Support certified. Services provided include:  Respiratory  Radiology  Ultrasound  Rehabilitation Therapy  CAT Scan  Mammography  MRI  Social Services  Swing Bed  Behavioral Health  Provider-based Rural Health Clinic Hardin County General Hospital & Clinic accepts patients regardless of ability to pay. Charity care losses for the Fiscal Year 2015 were $814,047 for approximately 1,830 charity recipients. Patient Census for the Fiscal Year 2015:  445 Inpatient  64 Swing Bed  290 Observation  16,694 Outpatient Visits, including 4,906 Emergency Room Visits P a ge 3 | 21 COMMUNITY SERVED BY THE HOSPITAL HARDIN COUNTY GENERAL HOSPITAL (HCGH) PRIMARY SERVICE AREA Hardin County General Hospital & Clinic’s primary service area includes Hardin and Pope Counties. Key facts about our communities from the U.S. Census data are:  8,361 reside in the two counties  The median age for Hardin County is 46.3 and for Pope is 46.6  An average of 22.65% of our target population is 65 years of age and over as compared to 13.9%  Age distribution under 18 years of age is 19.1% for Hardin County and 14.2% for Pope with the State of Illinois being 23% under 18 years of age  Median income for Hardin is $38,170 and $39,395 for Pope with the State of Illinois Median income being $57,166 and US having median income of $53,482  An average of 20.15 of our population is below the poverty level.  Unemployment rate for our population is 7.9 for Hardin and 7.1 for Pope as compared to the state of Illinois at 5.4 and the U.S. at 4.8. P a ge 4 | 21 COMMUNITY PROFILE Vital Statistics of Hardin and Pope Counties in Illinois: Hardin County Pope County Population, 2015 4,135 4,226 Population, percent change April 1, 2010 to July 1, 2015 -4.3% -5.5% Persons under 5 years, percent, 2015 4.7% 2.9% Persons under 18 years, percent, 2015 19.1% 14.2% Persons 65 years and over, percent 2015 23.2% 22.1% Female persons, percent, 2015 48.0% 47.2% White alone, percent, 2015 95.4% 90.9% Black or African American alone, percent, 2015 2.0% 7.1% Hispanic or Latino, percent, 2015 2.0% 2.0% High School graduate or higher, percent of persons age 25+, 2010-2014 81.8% 86.4% Bachelor's Degree or higher, percent of persons age 25+, 2010-2014 10.8% 29.3% Mean travel time to work (minutes), workers age 16+, 2010-2014 23.8 min. 30.8 min. Housing Units, 2015 2,454 2,464 Homeownership rate, 2010-2014 82.7% 83.3% Households, 2010-2014 1,731 1,672 Persons per household, 2010-2014 2.4 2.41 Median household income, 2010-2014 $38,170 $39,395 Persons below poverty line, percent 2010-2014 20.6% 19.7% Health Statistics of Hardin and Pope Counties in Illinois: Birth Characteristics, 2010-2014 Hardin County Pope County Births (per 1,000 women of child-bearing age) 2010-2014 174 153 Teenage Births (per 1,000 women age 15-19) 11 17 Pre-term Births, 2014 3 5 Low Birth weight, 2014 2 6 Disease and Death Hardin County Pope County Heart Disease Deaths 15 8 Cancer Deaths 17 12 Stroke Deaths 2 4 Prevalence of Diabetes 12% 11% Drug Overdose 2013-2015 2 5  In Hardin County 6% of the births are by teenage mothers, as are 11% in Pope County.  Cancer is still the leading deaths in both Hardin and Pope Counties followed by heart disease. P a ge 5 | 21 PROCESS / METHODOLOGY ASSESSMENT TOOLS & PROCESS The community health needs assessment is both a document and a process. Elements of the Hardin County General Hospital’s process include: 1. A collection and analysis of data from existing data sources regarding community demographics, socioeconomic and health statistics, and health care resources. 2. Community surveys and area service provider interviews. 3. Public forums held within both service counties to receive input from community residents about the services provided by Hardin County General Hospital. 4. An analysis of existing community IPLAN from Southern Seven Health Department This document is a synopsis of available information collected during the initial cycle of community health needs assessments required by the IRS. It will serve as a resource until the next assessment cycle. Both the process and document serves to assist in identifying and prioritizing community health needs and will aid in planning to meet those needs. PRIMARY DATA Primary data was collected from surveys and from the public forums attended by community residents as well as key stakeholders interviews with other community organizations. SURVEY Primary data was collected through a survey of Hardin and Pope County residents. Participants were asked their gender, race, education and income levels. All of the surveys were anonymous. We surveyed Hardin and Pope County residents from September 2016 to November 2016. We used a personal interview survey to collect the data. In five to ten minutes, respondents answered 25 questions related to individual health and access to care, health services, challenges and risk factors; and sources of health information (Appendix A) Through the survey we learned the following: • Nearly 66% of the respondents considered their overall health as excellent or very good. • 93% of the respondents have utilized services at Hardin County General Hospital or clinic and they can see a doctor when needed. • 85% of respondents describe the overall quality of Hardin County General Hospital and Clinic as Very Good or Fair. P a ge 6 | 21 • With almost 25% of the total population of Hardin and Pope County over the age of 65, the need for more services geared toward senior citizens is likely. Regarding health services, challenges, and risk factors, the results were: • 26% of the respondents indicated that high blood pressure was a challenge along with 24% indicating joint pain or back pain. • Diabetes and Overweight had 12% and 8% respectively from the respondents as a challenge that they face • The top three items that respondents felt greatly impacted the health of the community were 1) Access to primary care physicians 2) Access to dental health services and 3) Chronic disease management with ease of Emergency Room use and Substance Abuse rounding the top 5. • Addiction, Poverty and Underemployment/Unemployment were the top 3 things that negatively impact the community with lack of education and family/social services support rounding the top 5. P a ge 7 | 21 FOCUS GROUP INTERVIEWS: We facilitated focus group interviews on November 3, 2016 with key community members representing the broad interests of the community. We selected the focus group members based on their ability to understand the most prominent health issues affecting Hardin and Pope County residents, as well as their ability to identify existing community strengths and resources. The results of the focus group interviews are in listed below. The focus group members included:  Sherri Crabb, Family Counseling Center  Nancy Holt, Southern Seven Health Department  Perry Foster, Hardin County Emergency Management & Anna Bixby Center  Deann Williams, Shawnee Development Council Our community forum group determined that the following was the top list of significant health factors in Hardin and Pope Counties: 1. Substance Abuse (Prescription Drug Abuse and Illicit Drug Abuse) – The need to address substance abuse among the youth and adults emerged from the focus group especially prescription drug abuse and use of synthetic drugs. It is supported by the secondary resources, including the local IPLAN. 2. Mental and Behavioral Health Issues – the need for additional mental health and behavior services was also an issue for the focus group. Issues raised included availability of local crisis care, intervention counseling and access to transfer. Additional providers for these services could be available with community partners and other providers. 3. County Wide Poverty – poverty is an ongoing issue and was of concern for the focus group as well as the survey participants 4. Chronic Disease among county resident. Education and support groups for patients and families facing cancer, heart disease, diabetes and asthma were identified as a need. 5. Wellness and its many components was discussed by the focus group. Giving the community a variety of wellness education programs and healthy living options was discussed by the group. Our forum group also indicated that the hospital is doing a good job with inpatient care however concluded that a better job of marketing other services provided by community organizations is always needed. P a ge 8 | 21 SECONDARY DATA In the second phase, we analyzed readily available data from secondary sources to identify priority areas of concern when compared to survey data. We gathered health and demographic data from various sources (Appendix B) Health Indicators Hardin Pope Adult Obesity 33% 31% Physical Inactivity 29% 27% Sexually Transmitted Infections 305 749 Uninsured Adults 13% 14% Primary Care Physicians 2090:1 2090:1 Preventable Hospital Stays 198 114 Diabetic Screenings 87% 92% Mammography Screenings 49% 66% Children in Poverty 33% 31% Access to Healthy Foods 27% 28% Violent Crime Rate 337 291 Drinking Water Safety 18% 0% Health Status and Outcomes: County Health Rankings County Health Rankings are a way to measure and understand how healthy communities, served by the Hardin County General Hospital facilities are. The ranks are based on four types of measures: health behaviors, clinical care, social and economic, and physical environment factors. Actual health outcomes such as causes of death and quality and length of life are measured along with the other counties in the state to draw comparisons. High ranks (e.g., 1 or 2) area estimated to be the ‘healthiest’ areas. In general, a poor ranking on health factors translates to poor health outcomes. The Hardin County General Hospital service area posts some of the lowest ranks out of 102 counties in Illinois. County Health Rankings 2016: Illinois (102 counties) Health Outcome County Health Factor Rank Rank Hardin 102 99 Pope 97 84 Consistently Hardin and Pope Counties struggle with obesity and inactivity in comparison to the state averages. Once again, both Hardin and Pope Counties have more children living in poverty than the state average and have a higher of percentage of people without access to health foods. P a ge 9 | 21