Community Health Needs Assessment

Background Information

Pana Community Hospital’s mission is to be a leading partner in assuring community-based quality healthcare to the persons within the hospital’s defined service area.

The organization consists of Pana Community Hospital, an acute care, general critical access hospital; the Community Medical Clinic, a multi-physician primary care practice with its main office in Pana, and with outlying satellite office sites in the communities of Assumption, Nokomis, and Ramsey, Illinois; the Quad County Home Health Care and Hospice programs that serves persons in portions of Christian, Shelby, Fayette, and Montgomery counties. The newest service the hospital has added to the range of healthcare services it offers the community is the Rehab and Wellness Center that promotes wellness and healthy lifestyles. The Hospital is preparing to celebrate its 100th year of providing care to the residents of its service area in 2014.

The organization is a not-for-profit organization, exempt from federal taxation under Section 501(c)(3) of the Internal Revenue Code. In the past, Pana Community Hospital has employed many different methods to assess the health needs of the area it serves and has adapted its services to meet those needs. The newly effective Affordable Care Act requires organizations like Pana Community Hospital to conduct a local Community Health Needs Assessment (CHNA) every three years beginning with the first tax year after March 23, 2012 and will report the completion of these Assessments as part of their corporate tax filings with the Internal Revenue Service. This report is the first one to be prepared and submitted in compliance with that requirement.

Service Area / Community Served

The service area of Pana Community Hospital is defined as portions of Christian, Shelby, Fayette, and Montgomery Counties within the State of Illinois. In addition to the city of Pana, communities surrounding Pana to the north, south, east and west are served by the hospital organization and these areas are more specifically and accurately defined by a group of zip codes that define the hospital organization’s primary service area. This area has been determined over the years as a result of an analysis of the locations of the residences of those persons who come to the hospital to receive services and/or those who come to physicians who are on the medical staff of the hospital to receive medical care.

A diagram of this service area is illustrated below.

Demographic Profile

The demographic profile of the Pana Community Hospital service area was determined using data reported by the U.S. Census Bureau and Claritas 2012. The following chart and graph identify trends in the demographics of the service area of Pana Community Hospital.

Table 1. Population by service area sectors – Pana Community Hospital

The population of the overall service area is projected to stay basically the same with minimal growth in total service area population over the next five years.

Table 2. Population by Age – Pana Community Hospital Service Area

The Pana Community Hospital service area is projected to see increases in the population age groups of age 18 to 44 and 65+, while experiencing decreases in the age groups of age 18 and younger and age 45 to 64. These changes are expected over the next five years and are comparable to the changes in population age distribution for much of rural Illinois.

Table 3. Median Household Income – Pana Community Hospital Service Area

In the Pana Community Hospital service area median household income for 2013 is reported at an average of $41,961 by the U.S. Bureau of Labor and Statistics. This compares to $49,339 for the state of Illinois and $49,233 for the United States. Overall, the majority of the area served by Pana Community Hospital struggles with lower household incomes. CURRENT SERVICES PROVIDED As a healthcare provider in central Illinois, the hospital organization provides a significant number of healthcare services to persons residing within or while visiting the hospital’s service area. A list of the services the organization currently provides to persons within its service area is shown in the Scope of Services that is included in Part V of this report as Exhibit 1. RESOURCES UTILIZED AS INFORMATION TO SUPPORT THE COMMUNITY HEALTH NEEDS ASSESSMENT Multiple methods and approaches were utilized in performing this Community Health Needs Assessment and several informational resources were accessed to collect important and meaningful information. Some of those information resources that were utilized are as follows: • Demographic and clinical information accessed through the HEALTHY COMMUNITIES INSTITUTE, Burbank California; • Resource data provided through the ILLINOIS HOSPITAL ASSOCIATION, Naperville, Illinois; • Healthcare information provided through the ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK; • Review of the Community Health Plan 2008 – 2013 (I-PLAN), developed by the CHRISTIAN COUNTY HEALTH DEPARTMENT, Taylorville, Illinois. The following resource documents provided by the above mentioned organizations and other resources utilized to support this study are as follows: HEALTHY COMMUNITY INSTITUTE • Health Indicators for Christian County • Environment Indicators for Christian County • Social Environment Indicators for Christian County • Economy Indicators for Christian County • Transportation Indicators for Christian County • Education Indicators for Christian County • Public Safety indicators for Christian County CHRISTIAN COUNTY HEALTH DEPARTMENT • Working For A Healthy Future, COMMUNITY HEALTH PLAN, 2008 – 2013 TAYLORVILLE MEMORIAL HOSPITAL • Memorial Health System Community Needs Assessment of Christian County AMERICAN COLLEGE of HEALTHCARE EXECUTIVES • FUTURESCAN 2013 – Healthcare trends and implications 2013 – 2018 LOCAL ENTITIES WITH INTERESTS IN HEALTH ISSUES The Pana Community Hospital, as a not-for-profit community hospital, is structured with a voluntary Board of Directors whose role is to represent the community in overseeing the governance of the hospital and insuring that the hospital assumes its corporate role of providing quality healthcare services, and effectively carries out their role in delivering such services. The hospital’s Board of Directors is composed of persons representing, not only Pana, but also the surrounding communities that are within the hospital’s service area. On a regular basis, these persons are active in identifying unmet needs, and working to insure that the hospital successfully accomplishes its mission in delivering the healthcare services it provides. The Pana City Government, the Mayor and the City Alderman, are active supporters of the hospital and regular two-way communications occur between city officials and hospital management. Needs and opportunities to improve receive prompt attention and actions and solutions are promptly pursued. The Senior Citizens Center is an active community organization and since the hospital and its medical staff provide a significant volume of service to senior citizens in the community, this organization can be a key source of information regarding hospital and medical services. The area nursing homes, including Heritage Health and Prairie Rose serve many of the hospital’s patients following a hospital stay. Coordination of activities with these organizations are key to both parties’ success in caring for the people in the community. The county health departments in Christian County, Shelby County, Fayette County, and Montgomery County represent an opportunity to build stronger bridges in improving services to people in the hospital’s service area since its service area overlaps all four counties. Since the hospital is located in Christian County, the relationship with that health department is the closest but outreach is important to the other three as well.

MEETINGS AND THE CONDUCT OF A COMMUNITY SURVEY

The Community Meetings In order to gain input from the residents of the communities served by Pana Community Hospital and to assess the organization’s strengths, and also identify areas where there were opportunities to improve services and areas of need that were not being met, the hospital organized and conducted a series of four community meetings. These four meetings were held in Pana, Assumption, Ramsey, and Nokomis in order to reach out to residents and to benefit from their ideas and input in the spirit of community health needs assessment as required under the Patient Protection and Afford able Care Act.

The announcement of the meetings was placed in the October 17, 2013 issue of the area newspaper, the Pana News-Palladium, and also in the October 31, 2013 issue. Informational flyers were also provided to all churches in the meeting locations listed above announcing these meetings. The meetings were held on November 4th, November 5th, November 7th, and November 11th, 2013 in the communities of Ramsey, Pana, Assumption, and Nokomis, Illinois respectively. A special part of the Pana Rotary Club meeting held on Wednesday, November 13th also addressed Pana Community Hospital’s CHNA Survey. The Agenda of the meetings was designed to address the Community Health Needs Assessment and information related to The Affordable Care Act.

The Community Health Needs Assessment Survey A three page survey (included in Part V, Exhibit 2) was developed to obtain input from residents of the communities attending the community meetings. This survey form served as the mechanism to capture structured and consistent input from residents of the hospital’s service area on a variety of issues. The survey addressed social and demographic information as well as important information related to the participants’ views on the health care that was available to them, their impressions of the quality of that healthcare, and any needs they could identify that would improve their healthcare.

Participants were asked to evaluate the physician and hospital services that were available to them. In evaluating the physician services, they were asked to address the quality of service provided to them by their personal or family physician as well as the quality of service provided by specialty and sub-specialty physicians to whom they were referred.

Lastly, and critical to the subject of needs assessment, the participants were asked to share their impressions on how the services provided to them could and should be improved. Of those they identified, they were asked to prioritize which they felt were of the highest importance.

The Community Survey Results The following is a summary of the profiles of those who participated by completing the survey and the key observations that resulted from the tabulation of the responses.

About the survey participants: 57 persons completed and returned the survey form

65% of the participants were female 35% were male

67% of the respondents were 65 years of age or older 28% were age 41 t0 64 5% were 40 or younger (only 2 of the respondents)

77% were married 23% were single or widowed

53% of the respondents were Pana residents 18% were residents of Assumption 9% were residents of Oconee 7% were residents of Nokomis 7% were residents of Ramsey 6% were residents of other surrounding communities

Physician relationship: 96% of the respondents claimed a personal/family physician Only one person stated they had no personal/family physician

91% of the above had seen their Dr. within the past year

11% stated they had seen a Dr. other than their family doctor within the past year

49% stated they or a family member had visited a hospital ED within the past year

46% of those visiting a hospital ED had been to the ED at PCH

Health insurance: 100% of the respondents stated they had some form of health insurance

35% had coverage through Medicare 20% had Medicare supplemental insurance coverage 19% had an employer provided health benefit 14% coverage through a previous employer’s health benefit 5 persons (5%) had personally purchased health insurance 3 persons (3%) were covered by Medicaid

1 person was exploring coverage through the Affordable Care Act

Evaluation of the quality of the service received: 63% rated the service by their family physician as excellent 30% rated the service as good 4% rated the service as average 1 person rated the service as marginal

61% rated PCH’s service as excellent 33% rated the hospital’s service as good 1 person rated the service as average

60% rated specialty physician care as excellent 30% rated specialty physician care as good None rated specialty physician care below good

35% rated referral hospital care as excellent 58% rated referral hospital care as good 2 persons rated referral hospital as average

Cost of Health Care: 84% stated the cost of healthcare was too high 11% stated the cost was about right No one stated the cost was too low

Access to care / services: 98% stated they had access to the care and services they need 2 persons did not answer this question

Observations/Conclusions/ Recommendations from the Survey Information from multiple choice survey input:

  1. Those identified as the most important and most frequent health care problems facing the people who live in our area:

    These were ranked as follows:

    1. Cancer
    2. Heart Disease
    3. Diabetes
    4. Obesity
    5. Drug Abuse (tie)
    6. Alzheimer’s (tie)
    7. Stroke
    8. Geriatrics
    9. Accidents
  2. Of those above, which are the ones to be identified as the most important problems to be addressed:

    These were ranked as follows:

    1. Cancer
    2. Heart Disease
    3. Obesity
    4. Stroke
    5. Diabetes
    6. Drug Abuse
  3. The persons currently most interested in their health status are seniors (age 65 and over) and females. We need to focus on educating and involving the younger persons and men in health issues, wellness activities, and prevention and early detection of health problems.
  4. Persons participating in the survey seem to be very pleased with the current availability and access to service. However there is unanimity (almost 100%) that the cost of healthcare is too high. This needs to be addressed from a nationwide perspective but applied locally.
  5. Heart Disease, Cancer, and Stroke have long been recognized as three areas of focus in providing healthcare services. These continue to be a high priority of the survey respondents. The results of the survey indicate that Obesity, Diabetes, and Drug Abuse are areas of concern in the local community where needs exist that need to be addressed.
  6. Persons participating in the survey appear to have good access to insurance coverage for healthcare services. The current activities related to implementation of the Patient Protection and Affordable Care Act have huge potential ramifications for healthcare providers – physicians, hospitals, nursing homes, and other providers of healthcare services. It is critical to remain alert and involved as these forces are unleashed and start impacting the local healthcare marketplace and the local providers of healthcare services.

Recommendations from the Narrative Responses to Questions in the Survey:

The key information items and resulting recommendations from the narrative responses to questions in the Community Health Needs Assessment Survey are documented below after each of the questions that were asked.

How could/should physician services be improved? Recommendations:

  • That a Dermatologist and a Urologist be recruited to offer physician specialty services on a local basis at the PCH Medical Mall.
  • That primary physicians continue to be recruited (particularly American born / American trained physicians) to insure an adequate supply are available to continue to serve patients in the hospital’s service area.
  • That Saturday primary care physician office hours be made available for the convenience of patients seeking service and to avoid utilizing the emergency department for non-emergency care.
  • Maintain the provision of primary medical services in the outlying communities utilizing clinical nurse practitioners as needed to maintain and/or expand services.

How could/should hospital services be improved? Recommendations:

  • Promote that all persons in the service area have an established relationship with a personal/family physician who is a member of the active medical staff of Pana Community Hospital.
  • Triage patients seeking non-emergent type primary care in the emergency department to avoid misuse and reduce the cost of care to such patients. Offer mental health services/programs to persons needing them and seeking them.
  • Emphasize wellness, fitness, good eating habits, healthy lifestyles, and prevention through education and programming to all ages (children, youth, adults, seniors) throughout the service area – especially outlying communities.
  • Strengthen relationships between the hospital and the outlying communities in the realm of emergency services. Consider Assumption’s request for better pharmacy services.

What are the most important things (3) that could be done to improve the health of the people in the service area? Recommendations:

  • Emphasize wellness, fitness, good eating habits, healthy lifestyles, and prevention through education and programming to all ages (children, youth, adults, seniors) throughout the service area – especially outlying communities.
  • Emphasize the practice of preventative medicine including knowledge of risks, regular screenings, early detection of problems.
  • Partner with area schools to promote “wellness” programs and emphasize good eating habits, exercise, weight control.
  • Promote incentives to exercise, control weight, and diet through recognition and possible financial incentives.
  • Address the effective implementation of the Affordable Care Act as it will impact the local community, their insurance coverage, and the expansion of those covered by Medicaid.

FROM PHYSICIANS AND CLINICAL NURSE PRACTITIONERS

Survey of Physicians and Clinical Nurse Practitioners As partners with the hospital in caring for the persons who reside in our area, physicians provide medical care and direct the provision of healthcare services to those in need. Clinical Nurse Practitioners assist and support the local doctors, and the specialty and sub-specialty physicians from the surrounding larger communities in delivering and directing that care.

It is clear that these important professionals have a major role to play in performing a Community Health Needs Assessment. In view of this, a Survey of Providers was performed to gain the input of physicians and clinical nurse practitioners regarding the needs of the residents of the community who become their patients.

A copy of the three page Survey of Doctors and Nurse Practitioners that was utilized is included in Part V, Exhibit 3.

Results of Surveys of M.D.’s and CNP’s The following is a summary of the survey results: 10 Surveys were completed

8 of the participants were physicians, 2 were CNP’s 6 participants were males, 4 were females

Questions asked: What does the future hold in store for the practice of rural medicine:

It will be better 0 It will be worse 4 It will be the same 5 No answer 1

Do you feel patients are responsible and responsive in dealing with matters related to their health?

Yes, all of the time 0 Yes, most of the time 3 Yes, some of the time 7 When they are ill 0 When in a crisis 0

Do patients use the hospital Emergency Department to deal with non-emergency health problems?

Regularly 5 Sometimes 5 Seldom/Never 0

Evaluation of Services: Are the current number of MD’s and CNP’s sufficient?

Yes 50% No 30% Don’t know One No answer One

Rating of the physician specialists practicing in the Medical Mall Excellent 60% Good 40%

Patient’s Knowledge of healthcare: How knowledgeable are patients in medical/healthcare matters?

Very knowledgeable 0% Somewhat knowledgeable 80% Have very little knowledge 10% No answer One

Has Internet had an impact on patient’s healthcare knowledge? Yes 50% No 40% No answer One

Has patient’s use of Internet impacted interaction with patients? Improved the interaction 40% Has had no impact 30% Complicated the interaction 30%

Are your patients investigating coverage by the Affordable Care Act? Yes 30% Don’t know 70%

What are your feelings about the cost of healthcare? Too high 70% About right 20% Too low 10%

Physician’s and Clinical Nurse Practitioner’s Impressions of the most IMPORTANT health Problems/ Illnesses/ Diseases/and Needs to be addressed in an effort to improve existing service: The results of the survey of the medical services providers showed that they felt the three most important clinical areas to be addressed in the service area of their medical practices that is also the service area of Pana Community Hospital to improve existing service are as follows: Most Important: Obesity Mental Health Diabetes

Following the three most important were the next two in priority: Preventative Medicine Geriatrics

Physician’s and Clinical Nurse Practitioner’s Impressions of the areas of health Problems/ Illnesses/ Diseases/and Needs that are being the most NEGLECTED and should be given more attention and more resources to improve the public’s health.

The results of the survey of the medical services providers showed that they felt the three most important clinical areas to be addressed in the service area of their medical practices that is also the service area of Pana Community Hospital to improve existing service are as follows:

Most Neglected: Diabetes Obesity Dental Care

Following the three most neglected were the next two in priority: Mental Health Preventative Medicine

Recommendations of M.D.’s and CNP’s: According to the input from the local clinicians, professional physicians and clinical nurse practitioners, the Health Problems / Illnesses / Diseases / and Needs that are the most important to be addressed and those that are the most neglected requiring more attention, and more resources to improve existing services and to improve the public’s health are as follows: Obesity – Most important and most neglected Diabetes – Most neglected and most important Mental Health – Most important Dental Care – Most neglected These require the highest level of attention.

The second tier in the rankings by the clinicians of the Health Problems / Illnesses / Diseases / and Needs that are the most important to be addressed and those that are the most neglected are as follows: Preventative Medicine - Most important and most neglected Geriatrics – Most important These require the next level of attention.

The three most important Specialty/Sub-specialty physicians to recruit to offer medical services to patients in the hospital’s Medical Mall are as follows: Urology Dermatology Tie between Gastroenterology, Endocrinology and Psychiatry

How to improve physician services? More specialists in specialty clinic. (See #3 above) Have in-house anesthesia coverage. Provide improved psychiatry service. Provide after-hours phone consultation by a registered nurse.

How to improve hospital services? Faster reporting of test results. Link results via computer from hospital to office. More hours of coverage in CT, MRI, and Laboratory. Provide Inpatient Hospice Service.

In our area, what are the most important things to be done to improve the health of the people? The most frequent observation that was made was the need for more education of the public focused on health in order to build a sense of personal responsibility for one’s own health.

The need for the public to pursue healthy lifestyles, exercise regularly, have a healthy diet, control their weight, and avoid risky behaviors (smoking, drugs, alcohol) was the second most frequent observation. Prevention of illness and early detection of health problems by having regular check-ups and screenings with a personal/family physician was frequently recommended. A need was identified for better mental health services. Emphasis on better treatment processes for persons with dependencies on drugs, alcohol, tobacco, or any other substance was mentioned as a need.

A CHNA Committee was formed that included key administrative staff of the hospital and the Public Health Administrator and her assistant from the Christian County Health Department. The health needs and recommendations identified as a part of this assessment process were reviewed and categorized by this committee as high, medium, low, or as not a priority for the purpose of identifying those that deserved the greatest level of attention prior to taking the implementation plan related to this report to the hospital’s Board of Directors for review and action.

Prioritization of Needs and Recommendations The prioritization of needs identified and summarized in Part II and Part III was performed by each member of the CHNA Committee. After reviewing the CHNA prioritization done by the CHNA Committee the following six items were identified as critically important:

  1. The most important problems to be addressed are
    1. Cancer
    2. Heart disease
    3. Obesity
    4. Stroke
    5. Diabetes
    6. Drug abuse
  2. Emphasize wellness, fitness, good eating habits, healthy lifestyles and illness prevention
  3. Providers listing of most important/neglected health needs are
    1. Obesity
    2. Diabetes
    3. Mental health issues
    4. Dental care
  4. Second tier of above listing
    1. Preventative medicine
    2. Geriatrics
  5. Providers believe that more education of the public focused on health to build personal responsibility should be a priority
  6. The need for the public to pursue healthy lifestyles, exercise regularly, have a healthy diet, control their weight, and avoid risky behaviors (smoking, drugs and alcohol)

Summary of Identified Health Need Priorities

The items set forth below are those which found consistent identification through the survey and discussion process and ultimately identified as critical priorities by the CHNA Committee.

  1. Continue Focus on Chronic Disease Management

    Concerns were expressed by all groups surveyed that focus should remain on the following major health concerns in our service area.

    • Cancer
    • Heart Disease
    • Diabetes
    • Stroke
  2. Emphasize wellness, fitness, healthy lifestyles and illness prevention

    All survey respondents and CHNA Committee members felt it critically important to emphasize fitness, wellness, healthy lifestyles and illness prevention in our service area. All agreed that this emphasis would help to improve obesity levels in our service area. Obesity was identified as another key concern and can lead to the chronic health conditions identified above.

  3. Mental Health Services

    Gaps in access to mental health services at virtually all levels were identified by all the survey groups and the CHNA Committee. Many of the issues noted involve service delivery and community partners outside of the control of Pana Community Hospital. Issues concerning substance abuse as a related need were also identified by each survey group. Opportunities for community and external partnerships with cooperative planning will be pursued as potential resolution.

Implementation Plan

Approved by the Board of Directors on March 25, 2014

Health Needs Priorities
Priorities Plans Developed or Actions Taken

Continue focus on chronic disease management with focus on the following major health concerns in our service area:

  • Cancer
  • Heart Disease
  • Diabetes
  • Stroke
  • Host monthly meetings, “Lunch, Learn & Live Well”, that provide education to the service area related to the management of these identified diseases
  • Continue participation in Stat Heart program
  • Prepare to participate in Stat Stroke initiatives, work to become a Stroke Ready hospital
  • Implement expanded breast care services to focus on improving early detection and treatment of breast cancer
  • Sponsor annual Community Health Fair
  • Provide Dietician services that include focus on diabetes management

Emphasize wellness, fitness, healthy lifestyles and illness prevention; this emphasis can lead to improvements in the chronic conditions listed above

  • Sponsor community wellness initiatives through the Rehab Wellness Center, including Couch to 5k program and weekly community wellness workshops
  • Provide Fitness Wellness programs to the community including individualized exercise program development and group exercise class offerings
  • Sponsor a minimum of two employee wellness challenges each year with rewards for participation and goal achievement
Mental Health Services
  • Work with Christian County Mental Health service to strengthen current programs
  • Research additional opportunities to offer mental health services

This Implementation Plan will be updated annually to include additional plans developed or actions taken by Pana Community Hospital to meet the identified health need priorities in the communities we serve.