St.Vincent anderSon regional HoSpital community HealtH needS aSSeSSment report FiScal year 2013-2015 1 2013 St.Vincent anderSon regional HoSpital community HealtH needS aSSeSSment table of contents community Health needs assessment Summary Description of the Community Served page 3 Who was Involved in the Assessment page 3 How the Assessment was Conducted page 4 Health Needs Identified page 5 Community Assets Identified page 7 Assessments and Priorities page 7 Next Steps page 7 appendices Appendix A: Demographic Data with Map page 9 Appendix B: Planning Participants page 13 Appendix C: Asset Analysis page 14 Appendix D: Health Data page 17 Appendix E: Summary of Community Engagement page 19 Appendix F: Prioritized Health Needs page 22 Appendix G: Indiana Prevention Resource Center Report page 24 for Madison and Randolph For comments or questions about this report, please contact St.Vincent community development & Health improvement: [email protected] 2 2013 St.Vincent anderSon regional HoSpital community HealtH needS aSSeSSment During fiscal year 2013, St.Vincent Anderson Regional Hospital (formerly Saint John’s Health System) conducted a Community Health Needs Assessment (CHNA) to identify both the health assets and health needs within Madison County. As a nonprofit hospital, and part of St.Vincent Health, St.Vincent Anderson Regional is dedicated to improving the health of Madison County residents, with special attention to the poor and vulnerable. This can be accomplished only by partnering broadly with others within the community to address key community health issues. A critical step in this process is to identify priority needs through a CHNA. The following summary identifies how the CHNA was conducted and highlights key findings. Additional detail about the CHNA process and the data collected can be found in the appendices. description of the community Served by St.Vincent anderson regional Hospital St.Vincent Anderson Regional Hospital is located in Anderson, Indiana, and serves Madison County and contiguous counties in Central Indiana. This assessment focused on the hospital’s primary service area, which includes 130,000 Madison County residents in Anderson and surrounding communities of Alexandria, Chesterfield, Elwood, Frankton, Ingalls, Lapel, Markleville, Pendleton and Summitville. From 2000 to 2010 the population is estimated to have dropped by 1.1 percent and the number of households fell by 2.2 percent. The population is projected to grow by 0.9 percent by 2015. Currently, median age is 39.7 and expected to rise to age 40 by 2015. The population is 88.2 percent White, 8.8 percent African American, and 0.2 percent Asian. Hispanic population is estimated at 2 percent. Data published by the Indiana Business Review in 2012 show a mixed economic picture in the Madison County area. There are a few encouraging signs in the local economy: • The unemployment rate has decreased over the past year. • Manufacturing employment has increased as have overall wages. • Anderson, like other cities in the Midwest, is struggling to redefine itself after the exodus of large-scale manufacturing firms over the past several decades. • Added to this mix is the necessary restructuring of local government activities due to property tax caps. • Additionally, more than 15,000 people live in the county, but work outside the county, particularly in Marion and Hamilton counties. See Appendix A for additional details regarding the community served. Who was involved in the assessment The assessment process was initiated by St.Vincent Anderson Regional Hospital in collaboration with St.Vincent Mercy Hospital in Elwood and St.Vincent Randolph Hospital in Winchester as part of a regional overview. Each of these ministries also worked with representatives from local public health departments and community partner organizations to identify community-specific health care needs. To ensure input from persons with broad knowledge of the community, invitations to participate in focus groups were sent to organizations representing minorities, the underserved and vulnerable, physicians, business leaders and social workers. The Indiana Prevention Resource Center at Indiana University Center was engaged to collate and analyze public health and hospital-specific data. 3 2013 St.Vincent anderSon regional HoSpital community HealtH needS aSSeSSment How the assessment was conducted The St.Vincent Anderson Regional Hospital CHNA began with a review of public health data conducted by the Indiana Prevention Resource Center (IPRC) at Indiana University Center. IPRC review encompassed an in-depth review of the County Health Rankings data as well as hospital-specific utilization data and other data sources. Madison County residents were compared to those of other counties and ranked. This information was shared with the hospital leadership team, as well as the board of trustees and medical staff leadership as part of the community planning process. Additional data sources (local, state and national) were identified by the hospital to supplement the findings presented by IPRC. The aggregate information was collated and summarized to provide a comprehensive review of the health status of Madison County residents relative to the rest of the state. To garner input from persons who represent the broad interests of the community, five focus groups were conducted in September 2012. These groups included 1) physicians, 2) business leaders, 3) discharge planners / long term care representatives, 4) underserved / most vulnerable persons, and 5) minority populations. The focus groups were conducted by IPRC and the results were collated and summarized. Detailed information about the focus groups is included as Appendix E and the full report conducted by IPRC is included as Appendix G of this report. Staff from Community Solutions, Inc. (hereafter CSI), an Indianapolis-based consulting firm, reviewed the compiled quantitative and qualitative data. Quantitative data were analyzed to detect links between St.Vincent Anderson Regional Hospital utilization and the health behaviors or factors of Madison County residents. Qualitative data (focus group reports) were analyzed to articulate perspectives on the gaps in local service or care, critical health needs facing the community, and the strengths of St.Vincent Anderson Regional Hospital. CSI staff prepared summary reports that identified key findings from both data sets. On November 28, 2012, CSI staff presented these key findings, along with supporting background information, to members of the Community Health Needs Assessment Team. Team members are listed below; the group includes representatives from both St.Vincent Anderson Regional Hospital in Anderson and St.Vincent Mercy Hospital in Elwood, plus representatives from community partner organizations. Following the presentation, CSI staff facilitated a planning session during which members of the team selected priority health needs for the Anderson and Elwood communities. The prioritization process is outlined in detail in Appendix F. In the judgment of the team, the priority health issues are: • Obesity • Smoking • Substance Abuse In addition to these priority health concerns, the planning team identified two critically important paradigm shifts that must occur for Madison County residents to make sustainable improvements to their health. First, Madison County residents must have sufficient access 4 2013 St.Vincent anderSon regional HoSpital community HealtH needS aSSeSSment to health care. “Access,” in this instance, relates to patients’ ability to pay for health care (via private or public health insurance or through other means); their ability to get to healthcare facilities (given very limited public transportation); and adequate availability of non-emergency health care (including sufficient numbers of primary care providers and coverage during nights and weekends). Second, the team identified a general need for Madison County residents to become good stewards of their own health by actively engaging in healthier behaviors. In short, the team articulated a need for Madison County residents to have ready access to healthcare services and to make effective use of those healthcare resources by assuming greater personal responsibility for achieving and maintaining health. Health Needs Identified By service line, cardiology, pulmonary, obstetrics and gastroenterology are the top four in-patient discharge diagnoses in Madison County. At St.Vincent Anderson Regional Hospital, psychiatry, pulmonary, cardiology and gastroenterology are the top four in-patient discharge diagnoses, accounting for a combined 43 percent of all discharges. This discharge data align closely with Madison County’s rankings for Health Behaviors and Morbidity, drawn from the County Health Rankings & Roadmaps program. See Appendix G for more details. The County Health Rankings & Roadmaps program is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The Rankings help counties understand the factors that influence how healthy residents are and how long they will live. The Rankings look at a variety of measures that affect health, based on data available for every county in all 50 states. Indiana has 92 counties; a county’s “rank” for any health factor or behavior indicates the degree to which it exhibits the identified factor or behavior relative to every other county in the state. The lower the “rank” number, the better that county’s health is. Of Indiana’s 92 counties, Madison County ranks 92nd in overall health behaviors. A closer look at individual health behaviors reveals why: Madison County ranks 92nd for percent of obese adults, 87th in physical inactivity, 85th in smoking, 86th in rates of sexually transmitted diseases, and 55th (a more moderate rank) in excessive alcohol use. Smoking, poor diet, and lack of exercise lead to pulmonary, cardiovascular and gastroenterological diseases— three of the county’s (and the hospital’s) four top discharge diagnoses. In addition, Madison County’s rate of Morbidity (relative incidence of disease) is the 10th highest in Indiana, meaning its residents suffer very poor health compared to their neighbors in other counties. Psychiatric issues are the number one discharge diagnosis for St.Vincent Anderson Regional Hospital; it is the sixth-leading discharge diagnosis in Madison County overall. This finding correlates closely with the broad consensus of medical staff, business leaders, and patients that Madison County lacks sufficient mental health treatment resources—particularly for substance abuse treatment. A review of the key findings from all focus groups conducted as part of this assessment reveals community-wide concern about this gap in care. In fact, Madison County has fewer mental health providers per resident (1:5,469) than the state average (1:3,816). Other data support this concern: Madison County residents rank 84th (out 5 2013 St.Vincent anderSon regional HoSpital community HealtH needS aSSeSSment of 92 counties) in number of reported mentally unhealthy days per month, and is one of only a handful of counties in the state where reported mentally unhealthy days/month are higher than reported physically unhealthy days/month. Pulmonary issues rank second at St.Vincent Anderson Regional Hospital for in-patient discharge diagnosis. Pulmonary issues are directly related to health risk behaviors such as smoking. Among adults ages 18 and older, smoking in Madison County is higher than the state average, and an estimated 17.5 percent of residents smoke four or more packs of cigarettes per week. As listed above, Madison County’s smoking rank is very high (85th out of 92 counties). Cardiology and gastroenterology rank third and fourth, respectively, in discharge diagnoses from St.Vincent Anderson Regional Hospital. Diseases in these specialties are closely related to health behaviors such as smoking (detailed above), poor diet and exercise, and alcohol abuse. Madison County ranks 92nd (out of 92 counties) for percent of obese adults and 87th for physical inactivity; these factors, combined with the high rates of smoking in the county, very likely contribute to the rates of cardiology and gastroenterology discharges from St.Vincent Anderson Regional Hospital. And, although Madison County has a more moderate ranking (55th) for excessive alcohol use, the data reveal that more than 1 in 10 Madison County adults (15 percent) report regular heavy or binge drinking. Additionally, focus group participants repeatedly raised concerns about the need for substance abuse treatment options in the county. These concerns may point to additional alcohol- or drug-related factors contributing to poor cardiovascular and gastroenterological health. In addition, poor scores for diet and exercise, smoking, sexually transmitted infections, and other health behaviors (like those seen in Madison County) may represent a general lack of recognition of health problems—a concept that was echoed in the focus group discussions. Across the board, focus group participants noted a need for Madison County residents to become more engaged in getting and staying healthy. Many also mentioned barriers to this engagement, including access to insurance, transportation and limited financial resources. Socioeconomic factors can have significant impact on community health needs. Low educational attainment, high unemployment, low income and lack of family and social support affect overall health and can lead to negative health behaviors. Madison County ranks 85th in Indiana for overall social and economic factors. The county ranks 86th in educational attainment, 66th in employment, 82nd in percent of residents living in poverty, and 62nd in percent of adults lacking adequate family and social support. Twenty-eight percent of Madison County’s children live in poverty (85th in the state) and 38 percent live in single-parent households (88th in the state). In addition, the county’s high rankings for sexually transmitted infections (86th) and teen birth rate (73rd) point to a prevalence of unsafe sex practices . While this assessment is quite comprehensive, it cannot measure all possible aspects of health in the community, nor can it adequately represent all possible populations of interest. It must be recognized that these information gaps might in some ways limit the ability to assess all of the community’s health needs. For example, certain population groups – such as the homeless or members of the Amish community – are not represented in the survey data. Other 6 2013 St.Vincent anderSon regional HoSpital community HealtH needS aSSeSSment population groups might not be identifiable or might not be represented in numbers sufficient for independent analysis. In terms of content, this assessment was designed to provide a comprehensive and broad picture of the health of the overall community. However, there are certainly a great number of medical conditions that are not specifically addressed. Community Assets Identified The assessment identified a wide variety of community assets (Appendix C), including the three hospitals in the county, a Federally Qualified Health Center (FQHC) with two locations, and various public and private community agencies that provide a variety of services (health care, basic needs, transportation, counseling, etc.) to area residents. These organizations are identified in Appendix C. assessments and priorities Planning team members reviewed and reflected on the key findings. Following a brief question-and-answer period, team members were divided into two small groups to discuss the data and their responses in more detail. Based on their assessments of the qualitative and quantitative data, the team identified the most pressing health needs in their community. In summary, prioritized needs identified are listed below. Appendix F lists all needs identified and further describes the priority setting approach. Assessment data is summarized in Appendix D. 1. Obesity 2. Personal responsibility by users 3. Substance Abuse 4. Access to Healthcare 5. Tobacco Cessation 6. Access to Primary Care 7. Mental Health 8. Diabetes 9. Teen Pregnancy 10. Sexually Transmitted Infections 11. Dental Services 12. Access to fresh food 13. Physical Activity 14. Prenatal Care 15. Transportation 16. Access to specialists next Steps Once community priorities had been identified, members of the Community Health Needs Assessment Planning team tasked themselves with developing strategies to address the priorities. To leverage maximum community and hospital capacity, the leadership of St.Vincent Anderson Regional and St.Vincent Mercy Hospitals elected to collaborate with the Community Health Needs Assessment Planning Team from Randolph County, Indiana, home to St.Vincent Randolph Hospital. 7 2013 St.Vincent anderSon regional HoSpital community HealtH needS aSSeSSment On February 27, 2013, representatives from all three hospitals convened for a strategy discussion led by staff of Community Solutions, Inc. CSI provided additional county-level data on the priorities previously identified by planning teams. After some discussion about cross-county collaboration, the combined planning team decided to merge their respective priorities as follows: 1. Obesity 2. Tobacco Cessation/Substance Abuse 3. Mental Health 4. Access to Primary Care Team members began their planning efforts by listing what their hospitals and community partners were already doing to address each priority. They then self-selected the priority for which they were best suited to develop strategies to address. Using a template provided by Community Solutions Inc., group members developed between 1-3 strategies for identified target populations and detailed indicators of success, lead staff or department responsible, partners, and time frame for implementation. Small group members were encouraged to build on successful strategies already in place at their hospitals or in the broader community. Each small group then shared their ideas with the full team, making modifications based on other members’ input. The strategies will be included in the Implementation Strategy Report. Planning team members will have ongoing responsibility for developing and managing work plans related to each strategy, developing connections with appropriate community partners, and communicating with the community at large as it relates to strategy implementation. 8 2013 St.Vincent anderSon regional HoSpital community HealtH needS aSSeSSment appendix a Ap pe nd ix A: D e mograph ic D ata with Map s Overview for Madison County, IN Part of: Anderson IN, Metropolitan Area Part of: Indianapolis-Anderson-Columbus IN, Combined Statistical Area Madison County is one of 92 counties in Indiana. It has 452.1 sq. miles in land area and a population density of 290.3 per square mile. On the most recent census form, 98.2% of the population reported only one race, with 8.3% of these reporting African-American. The population of this county is 3.2% Hispanic (of any race). The average household size is 2.40 persons compared to an average family size of 2.90 persons. In 2011 health care and social assistance was the largest of 20 major sectors. It had an average wage per job of $37,736. Per capita income declined by 9.6% between 2000 and 2010 (adjusted for inflation). Rank Rank People & Income Overview Industry Overview (2011) Value in Value in (By Place of Residence) (By Place of Work) State State Population (2011) 131,235 13Covered Employment 38,333 18 Growth (%) since 2010 Census -0.3% 61 Avg wage per job $33,098 53 Households (2010) 51,927 13Manufacturing - % all jobs in County 9.8% 82 Labor Force (persons) (2011) 61,156 13 Avg wage per job $52,581 19 Transportation & Warehousing - % all Unemployment Rate (2011) 10.5 15 5.7% 18 jobs in County Per Capita Personal Income $28,809 76 Avg wage per job $39,472 48 (2010) Median Household Income Health Care, Social Assist. - % all jobs in $39,449 77 16.9% 9 (2010) County Poverty Rate (2010) 18.0 10 Avg wage per job $37,736 20 H.S. Diploma or More - % of Finance and Insurance - % all jobs in 86.4 31 2.7% 29 Adults 25+ (2010 ACS 5yr) County Bachelor's Deg. or More - % of 16.6 33 Avg wage per job $43,915 22 Adults 25+ (2010 ACS 5yr) Source: STATS Indiana – Indiana Business Research Center A | Appendix 9 9 2013 St.Vincent anderSon regional HoSpital community HealtH needS aSSeSSment appendix a Population for Madison County, IN Part of: Anderson IN, Metropolitan Area Part of: Indianapolis-Anderson-Columbus IN, Combined Statistical Area Population Over Time Number Rank in State Percent of State State 2011 131,235 13 2.01% 6,516,922 2010 131,636 13 2.03% 6,483,800 2000 133,358 10 2.19% 6,080,485 1990 130,669 7 2.36% 5,544,156 1980 139,336 6 2.54% 5,490,210 2000 to 2010 % change -1.3% 70 6.6% 1990 to 2010 % change 0.7% 75 16.9% 1980 to 2010 % change -5.5% 77 18.1% Source: US Census Bureau Pct Dist. Pct Dist. Population Estimates by Age in 2011 Number Rank in State in County in State Preschool (0 to 4) 7,978 12 6.1% 6.6% School Age (5 to 17) 21,856 12 16.7% 17.9% College Age (18 to 24) 11,811 13 9.0% 10.1% Young Adult (25 to 44) 33,272 13 25.4% 25.6% Older Adult(45 to 64) 35,741 11 27.2% 26.7% Older (65 plus) 20,577 9 15.7% 13.2% Median Age = Median Age 39.7 52 37.1 Sources: US Census Bureau; Median age calculated by the IBRC. Population Estimates by Race and Hispanic Pct Dist. Pct Dist. Number Rank in State Origin in 2011 in County in State American Ind. or Alaskan Native Alone 466 10 0.4% 0.4% Asian Alone 583 24 0.4% 1.7% Black Alone 11,000 8 8.4% 9.4% Native Hawaiian and Other Pac. Isl. Alone 55 17 0.0% 0.1% White Alone 116,993 13 89.1% 86.8% Two or More Race Groups 2,138 15 1.6% 1.7% Hispanic or Latino (can be of any race) Non-Hispanic or Latino 126,831 13 96.6% 93.8% Hispanic or Latino 4,404 18 3.4% 6.2% Source: US Census Bureau Hispanic or Latino Population in 2010 Pct Dist. Pct Dist. Number Rank in State (can be of any race) in County in State Hispanic 4,189 18 3.2% 6.0% Mexican 3,302 16 2.5% 4.6% Cuban 48 17 0.0% 0.1% Puerto Rican 202 16 0.2% 0.5% Other 637 17 0.5% 0.9% White, Not Hispanic (reporting white alone) 113,577 13 86.3% 81.5% Source: US Census Bureau, American Community Survey, 5 Year Estimates A | Appe ndi x 10