1 Peace Island Medical CenterCHNA 2016 Peace Island Medical Center Refresh & Align
2 AGENDA
3 Framing the conversation
4 What is a CHNA? A systematic process involving the community, to identify and analyze community health needs in order to prioritize, plan and act on unmet community need. -Catholic Health Association Community involvement Focus on vulnerable populations Emphasis on action
5 Jan - March April May JuneTimeline for PeaceHealth CHNA, 2016 Jan - March April May June Board Approval Prior CHNA review 2016 Design Data Collection Key Informant Interviews 6 – 8 in each community Community Stakeholder Convening 1 in each community OUTCOMES Affirm needs Identify gaps Affirm needs Identify possible evidence based strategies Three year plan/ annual updates Share CHNA Dashboards
6 Current Situation & PlanPeaceHealth hospitals conducted CHNA in 2013 and are now completing CHNAs for the second cycle PIMC completed its CHNA in 2015 (Later CHNA allowed for hospitals built or acquired in the period) Plan is to affirm/update current CHNA priorities Align structure CHNA structure with PeaceHealth approach Strengthen implementation plan Work with Health Department for robust assessment in 2018/19
7 CHNA Identified Needs, 2012/13COMMON ACROSS PEACEHEALTH COMMUNITIES OTHER RE-OCCURRING ISSUES Insurance coverage Access to community mental health and substance abuse services Care coordination for patients who are high utilizers of services Tobacco and obesity rates among subpopulations Access to primary care Adverse Childhood Events (ACEs) PeaceHealth cultural competency Support for aging population
8 Shift from “Self Pay” to Insured
9 Acute Payer Mix Updated 5-12
10 Provider Payer Mix Updated 5-12
11 High-level Review of Data Identified in 2014 Assessment, and Updates Where Available
12 Data Sources: Robert Wood Johnson Foundation County Health RankingsWashington State Department of Health: Chronic Disease Profiles; Vital Statistics; Immunization Program; Healthy Youth Survey Washington State Office of the Superintendent of Instruction Enroll America Community Commons Feeding America University of Washington Alcohol and Drug Abuse Institute US Census
13 Consistent with the Hospital District definition, the service area is defined as San Juan Island (98250), PHD#1 (includes all of San Juan Island, as well as Stuart, Henry, John’s, Spieden and Pearl Islands). The remainder of the County is considered a secondary service area. The data used for CHNAs is typically collected at the County level, but some data is available at the individual zip code level. Where available, we have used SJI data, where not, we report the County data.
14 SJI’s median income, its high school graduation rate and its poverty rate significantly better than the State at large. SJI rate of foreign born residents and rate of a language other than English spoken at home is about one-half the State rate. Area Population Foreign Born Language other than English spoken at home Per Capita Income Median Household Income Percent High School Graduate or Higher Poverty Rate* Friday Harbor (98250) 7,664 7.4% 8.5% $ ,775 $ ,227 93.9% 6.1% San Juan County 15,769 6.9% 7.1% $ ,636 $ ,712 94.5% 7.6% Washington 6,724,540 13.0% 18.2% $ ,661 $ ,374 89.8% 8.4% Source: 2010 U.S. Census Bureau, American Community Survey *Poverty Rate: % of families whose income in the past 12 month is below the poverty level
15 San Juan Island has a lower rate of adults that smoke and that are obese. However, the County sees a higher rate of excessive drinking. Health Behaviors San Juan County Washington Top US Performers* Adult smoking 13% 16% 14% Adult obesity 19% 28% 25% Physical inactivity 21% Excessive drinking 17% 10% Teen birth rate (per 1,000 female population age 15-19) 14 30 20 Source: County Health Rankings, San Juan County 2014, *90th percentile, i,.e., only 10% are better San Juan County adults are less likely to engage in some risk behaviors like smoking and physical inactivity, and are less likely to be obese than other groups. But San Juan County adults have high rates of ‘excessive drinking,’ defined as binge drinking or heavy drinking (1 drink per day for women, 2 for men). The teen birth rate is lower than most other areas in Washington and the US, and tends to correlate with higher-income and higher-education areas like San Juan County. 11
16 From 2014 CHNA: Low Immunization RatesNeeds/ Quantitative From 2014 CHNA: Low Immunization Rates
17 Other Findings from 2014: San Juan County has the 2nd oldest median age of any Washington County. Census data shows a growing Hispanic population on San Juan Island, and the numbers could be understated 8% of San Juan Island’s population is Hispanic. The Hispanic population grew rapidly between 2000 and 2010 (162%) and is expected to grow another 25% in the next 5 years. While performing better on many of the social determinants of health, at the time of the CHNA, 19% of the under 65 is uninsured (this has since improved ).
18 Updates to 2014 CHNA Health Status data show dramatic improvement in uninsured.2013/2014 2015/2016 Uninsured adults 21% 7.8% PCPs 1,132:1 1,130:1 Preventable hospital stays 22 15 Diabetic screening 84% 88% Mammography screening 72% 62% Leading Causes of Death 2012 Cancer 125.3 115.4 Heart disease 123.3 130.9 Alzheimer’s 41.0 Chronic lung disease 35.7 24.9 Unintentional injury 6* 42.9 Adult Health Behaviors 2014 2016 Adult smoking 13% 12%** Adult obesity 19% 18% Physical inactivity 14% Excessive drinking 18%** This table is a comparison of some measures we collected at the 2014 CHNA with more recent data. Most of the data has remained the same, except for the change in the rate of uninsured adults. This dramatic improvement is due to the Affordable Care Act, and you can see that the rate of preventable hospital stays has fallen as well, possibly due to better primary care access among adults. So in clinical care, we’ve really improved dramatically since 2012/2013, when most of these 2014 data were collected. * Rate of unintentional injury not available for San Juan because low numbers- 6 represents total unintentional injury deaths in 2012 **methods changed/cannot compare to earlier years. Sources: 2016 County Health Rankings, 2014 WA Healthy Youth Survey, Personal Communication with WA DOH ( death rates)
19 Healthy Youth Survey shows increase in use of cigarettes, alcohol and drugs. Also shows large increase in depression. Teen birth rate (per 1,000 female pop. ages 15-19) 14 15 Youth Health Behavior 2012 2014 10th grade cigarette use in last 30 days** 11% 19.3% (CI: +/- 8.4) 10th grade alcohol use in last 30 days** 22% 35.6% (+/- 10.3) 8th grade marijuana use in last 30 days 23% 8th grade no data 2014 12th grade illegal drug use in last 30 days 8% 9.8% (CI: +/- 6.6) 10th grade depressed period of 2 weeks or more 27% (CI: +/- 9.1) 45.5% (CI: +/- 10.6) 8th grade obese or overweight 19% 8th grade considering attempting suicide in past year 14% 10th grade had sexual intercourse 33% 26.5% (CI: +/- 15.6) These data come from the yearly Washington Healthy Youth Survey. None of the youth health behavior measures have significantly changed from 2012 to Because the sample size in San Juan County is very small, there’s a wide range of possible true measurements in the survey. For example, even though cigarette use looks to have jumped from 11% to 19%, the confidence interval of 8.4 crosses back down to equal the 2012 rate of 11%, and up to 27.4%. So from this, we can conclude that the cigarette use in 2014 is not significantly different from cigarette use in And if we look at depression as measured in 2012, the confidence interval was 9.1, which crosses the range of possible true measures for So even though the numbers look very different, statistically we cannot say they are different. In summary, none of the the health factors among San Juan youth have changed since 2012. What is notable from these numbers is that San Juan County 10th graders are more likely than 10th graders in Washington state as a whole are more likely to report having smoked at least one cigarette or used alcohol in the past 30 days. These are the only two measures in the whole table where San Juan County teens differ significantly from the state rate. Alcohol and cigarette use in teens sets our young people up for substance use, abuse, and addictions later in life. And the higher alcohol use in teens is mirrored in our higher alcohol use among adults in San Juan County, as we saw in earlier slides. **2014 rate in San Juan County significantly higher than WA state Sources: WA Healthy Youth Survey,
20 RWJ County Health Rankings for San Juan CountyRanking out of 39 2014 2016 #3 Health Factors, include health behaviors, clinical care, social and economic factors and physical environment
21 Ranking out of 39 2014 2016 #1 The ranks are based on two types of measures: how long people live and how healthy people feel while alive.
22 Needs & Opportunities / Qualitative2014 CHNA: Needs, Potential Disparities and Opportunities Identified through Community Leader Key Informant Interviews
23 Areas for Improvement / 2014 CHNAHealth promotion and disease prevention – improving communication with residents about available resources and increasing immunization rates. Care coordination – helping residents navigate the health care system and identify those in need of additional support (elderly and patients with complex medical needs), as well as end-of-life care. Behavioral health – improving access to mental health and substance abuse treatment and prevention services.
24 2014 CHNA Priorities & Implementation ApproachIncrease immunization rates. Increase access to behavioral health services. Meet the psycho-social and medical needs of higher risk patient populations, e.g. frequent users of EMS and ED services, and people with chronic or end-of-life illness. Create a resource guide The last time we reported to the Board of health we outlined the priorities noted in the 2015 CHNA and described the development of the community health consortium. Develop community health consortium in partnership with Health Department to advance implementation strategies.
25 Community Health Improvement ConsortiumConsortium was co-convened by PeaceHealth and County Health Department in May 2015 for the purpose of implementing the CHNA objectives. Participants include: PeaceHealth and County Health Department Family Resource Centers Compass Health Community Foundation EMS Hospital District #1 Planned Parenthood Hospice Other
26 Plan to build the ConsortiumSecure resources Build more specific action plans Delineate clear measures of success / metrics Communicate progress to the PIMC Board and community partners on an ongoing basis.
27 Progress Reports on Consortium Focus AreasImmunization rates Resource guide Behavioral health access Care coordination / seniors and people with chronic or end-of-life illness
28 Child & Family Wellbeing Health Delivery SystemsMostly carried over from 2013 CHNA Lots of overlap CHNA 2016 Architecture Pillars & Focus Areas Healthy, Active Living Child & Family Wellbeing Health Delivery Systems Equity Focus Areas Physical activity, places to play Tobacco, alcohol and other drugs Healthy eating Social networks Maternal-child health Adverse childhood events (ACEs) and family resiliency Access to quality, affordable medical, behavioral health and dental services Respectful, culturally-appropriate care People who are homeless Ethnic/racial populations Specific urban neighborhoods and rural communities We want to start with a refined CHNA framework (carried over 2013) and then share what we have learned from updated data and a set of key informant interviews. Address issue of overlap
29 Significant Gaps and Opportunities DiscussionBreakup into small groups Discuss the question: Are there significant gaps or opportunities the Consortium should consider? Report on top three or so at the table We want to start with a refined CHNA framework (carried over 2013) and then share what we have learned from updated data and a set of key informant interviews. Address issue of overlap
30 Summary & Next Steps
31 Thank you