2021 Community Health Needs Assesment

2021 Community Health Needs Assesment Building Healthy Communities -Together MidMichigan Medical Center-Alpena
Approved by MidMichigan Health's Board of Directors June 22, 2021
Table of Contents
Communities Served .......................................................................................................... 3
Population Change ............................................................................................................. 5
Behavioral Health ............................................................................................................. 19
Section V – 2018-2021 Community Health Improvement Plan Results…32-41
Section V – Appendices………………………………………………………42-61 Appendix A – Indicator Table ........................................................................................... 43
Appendix B – 2021 Community Wellbeing Survey............................................................ 56
Appendix C – Hanlon Method Overview .......................................................................... 58
1 2021 Community Health Needs Assessment I MidMichigan Medical Center - Alpena
AN OVERVIEW OF
headquartered in Midland, Michigan, is a leader in
providing award-winning, high-quality care to the
23-county region it serves. With Medical Centers in
Alpena, Clare, Gladwin, Gratiot, Midland, Mt.
Pleasant and West Branch, MidMichigan Health
provides a full continuum of care across a wide
array of settings, including urgent care centers,
home health, virtual care, as well as medical offices
in more than 30 specialties and subspecialties
including cardiology, hematology/oncology,
more. MidMichigan Health demonstrates its
commitment to the future of medicine by
partnering with leading institutions to offer medical
education programs that train medical students,
physicians, nurse practitioner and physician
assistant students, nursing students and other
clinical experts for our region. Its more than 8,800
employees, volunteers, health care providers and
other personnel work together to create healthy
communities through solutions designed to meet
the ever-changing needs of the 938,000 residents in
the health system’s 23-county service area. In fiscal
year 2020, MidMichigan Health provided more than
$91 million in community benefits, as well as
supported its patients and families with new
equipment, services and programs with funds
raised by the MidMichigan Health Foundation.
Achieving Our Purpose
Assessment (CHNA) as it is a key component for
identifying and articulating top health priorities.
Aligning 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 called the
Quadruple aim improve the health of the
populations; enhance the patient experience of care
(including quality, access and reliability); reduce, or at
least control, the per capita cost of care; and improve
the work life of health care providers, clinicians and
staff.
requirement for tax-exempt hospitals under the
Patient Protection and Affordable Care Act, our
assessment is more importantly a reflection of the
purpose, values, and foundational elements. We truly
believe that health happens where we live, learn,
work and play, and that 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.
populations we serve unfold. Our next steps will be
to address these needs through development and
implementation of three years health improvement
plan. We will work with our health system leaders
and community partners within each county; we will
share goals, resources and actions to drive these
plans towards improved health in our service region.
Feedback is welcomed via
Demographic Composi on
What are the common characteris c of individuals that reside in our community?
ABOUT MIDMICHIGAN MEDICAL CENTER- ALPENA
A 139 licensed-bed hospital located in northeast
Michigan on the shores of Lake Huron, Alpena's first
community hospital opened in 1915 as the Donald
McRae Hospital. It served until 1939, when a petition
was passed to build a new public hospital. On April
16, 1940, a new 88-licensed bed hospital opened
called Alpena General Hospital. On April 1, 2016,
Alpena Regional Medical Center joined MidMichigan
Health, making it the fifth Medical Center in the
MidMichigan Health system. To reflect the hospital
joining MidMichigan, the Medical Center changed its
name to MidMichigan Medical Center - Alpena.
Accredited by The Joint Commission, the Medical
Center has approximately 1,000 employees, 200
volunteers and about 100 physicians. In 2017, the
Medical Center in Alpena was recognized as a Top
Rural Community Hospital by the National Rural
Health Association, was named to the Becker's
Hospital Review 2017 list of 100 Great Community
Hospitals, and received Michigan’s Quality
Improvement Organization (MPRO) 2019 Governor’s
Awards of Excellence for outstanding achievement in
Effective Reporting and Measurement in
Outpatient Quality Reporting Acute Care Hospitals,
as well as Hospital Value-based Purchasing Acute
Care Hospitals. A new $59 million inpatient tower
featuring private patient rooms slated to open
spring 2022, broke ground in June 2020
Communities Served This Community Health Needs Assessment (CHNA)
was prepared to identify the health needs in
MidMichigan Medical Center-Alpena’s primary
service area. A county was identified to be within
our primary service area, if 70% or more inpatient
admissions were received during the preceding
fiscal year. As such, the primary service area for
MidMichigan Medical Center - Alpena for the 2021
-2024 CHNA are comprised of the following 19 zip
codes: Alcona County: 48705 (Barton City), 48721
(Black River), 48728 (Curran), 48738 (Greenbush),
48740 (Harrisville), 48742 (Lincoln), 48745
(Mikado), 48762 (Spruce); Alpena County: 49707
(Alpena), 49744 (Herron), 49747 (Hubbard Lake),
49753 (Lachine), 49766 (Ossineke); Montmorency
County: 49709 (Atlanta), 49746 (Hillman); Presque
Isle County: 49743 (Hawks), 49776 (Posen), 49777
(Presque Isle), 49779 (Rogers City).
POPULATION CHANGE
among the least populous of Michigan’s 81 counties.
The total population of the 23 towns and cities that
comprise MidMichigan Medical Center-Alpena’s
service area (MMCASA) in 2019 was estimated at
60,730. Most counties within MMCASA have
experienced population decline since 1990. MMCASA’s
population has decreased by 10% overall, a vast
decline compared to Michigan’s 0.4% increase. SEE FIG 2
Presque Isle County experienced the greatest
population decline, from 13,743 residents in 1990 to
12,592 residents in 2019—just over an 8% decrease. SEE
TABLE 1
Overall, the median age of people from each county
within MMCASA is much older than the Michigan SEE TABLE 1 average. Between 2000 and 2019,
Montmorency County had the steepest increase in
median age from 47 to 58.2 years, an increase 2.7
times higher than for Michigan. SEE TABLE 1 As a service
area, the proportion of seniors aged 80 years and older
increased by 27% from 2000 to 2019, but the
population for all other age groups declined. SEE FIG 2
Children and teens aged 0 to 17 saw a 32%
reduction in population, closely followed by the
18 to 34 (15% decline) and 35 to 64 (16% decline)
age groups. Interestingly, the 65 to 79 age group
increased by 50% in Michigan, but a 2% decline
was observed for MMCASA. SEE FIG 2
Static Diversification
within MMCASA, the majority of the population is
white non-Hispanic (97%). Compared to the racial
composition of Michigan, MMCASA’s population
is less diverse. Similar to the racial composition
levels, the ethnicity composition levels are less
than Michigan (5.3%), as only 1.4 to 1.6% are of
Hispanic/Latino origin in MMCASA. Despite this,
small gains in diversification appeared overall but
were most prevalent among individuals aged 24
and younger. The highest population increases
among racial groups from 2000 to 2019 in
MMCASA were the following: Black/African
Americans in Alcona County (4.2-fold), Native
Americans in Montmorency County (2.2-fold),
and Asian and Pacific Islander in Presque Isle
County (3.4-fold). During this same time period,
the proportion of individuals of Hispanic/Latino
origin grew the fastest in Presque Isle County
with a 2.5-fold increase. SEE FIG 1
TABLE 1
(YRS) LOCATION
MEDIAN
Alcona County 10,145 10,405 49 56.1
Alpena County 30,605 28,405 40.4 48.1
Montmorency County 8,936 9,328 47 58.2
Presque Isle County 13,743 12,592 45.1 55
FIG 1
LOCATION TOTAL
ASIAN & PACIFIC ISLANDER
FIG 2
SECTION II
work, play, and worship
HEALTH CARE ACCESS AND QUALITY
Two in five community members and stakeholders
surveyed for the community health needs
assessment expressed that inadequate access to
care impacts their community’s health. To
understand the potential barriers to health care our
community may face, the following will be
explored: (1) provider availability, (2) insurance
status and cost of care, (3) health literacy, (4)
transportation, and (5) technological limitations for
telemedicine use.
Provider Availability A key measure of health in any community is access
to health care services, specifically access to quality
care in a timely manner. The availability of health
care providers directly impacts the community’s
ability to obtain care primary and specialized health
services when a need is recognized without delay.
Overall, access to care issues appear when
examining provider-to-population ratios for dentist,
primary care, and mental health services. SEE FIG 3
Dentist
population ratio compared to Michigan. The
greatest health disparity appears in Alcona County,
with 10,410 residents for one dentist. This ratio is
7.9 times greater than the Michigan average and
second-worst among all Michigan counties in 2019,
closely followed by Presque Isle County that has the
fifth-highest ratio in the state but is trending steady
since 2010. SEE FIG 3
Mental Health Providers
(HRSA) has designated all counties within MMCASA
as having a mental health professional shortage, as
reflected in FIG 3. Again, Presque Isle County’s one
mental health provider for every 4,200 residents is
a ratio 11.7 times higher than Michigan. Making it the
highest in MMCASA and second-worst among all
Michigan counties in 2020.
area has a ratio of primary care physicians to
population that exceeds the Michigan benchmark.
Presque Isle County has one primary care physician
for every 4,250 residents, a ratio 3.3 times the
Michigan benchmark and the highest in MMCASA.
FIG 3
Provider-to-Population Ratios
OTHER PRIMARY CARE PRO IDERS
The importance of an individual having an
established relationship with a primary care provider
cannot be underestimated, as the American
Academy of Family Physicians denotes:
“A primary care practice serves as the
patient's first point of entry into the health
care system and as the continuing focal point
for all needed health care services. Primary
care practices provide health promotion,
disease prevention, health maintenance,
treatment of acute and chronic illnesses in a
variety of health care settings.”1
As such, all counties served by MidMichigan Medical
Center-Alpena were designated by the HRSA as a
primary-care medically undeserved area/population
three of this assessment.
Factors Impacting Utilization Although an individual may have a medical home,
the following health-related challenges may impact
health care-seeking behaviors: transportation, health
insurance coverage and type, cost of care, health
literacy, and technology.
Presque Isle County has the most uninsured children
(7.7%). The uninsured are less likely to receive
routine preventative care or treatment for chronic
diseases and are less likely to adhere to their
prescription medication regime. Furthermore,
uninsured people are less likely to seek care due to
an inability to repay medical debts.21 Of the
individuals surveyed, 19% delayed seeking care and
fill or rationed prescription medication within the SEE FIG 5 last 12 months due to cost.
Similar to the uninsured, those with high-deductible
health insurance plans may have trouble repaying
medical debt before meeting their deductible. FIG 4
illustrates that, from 2017 to 2020, bad medical
debt decreased and the amount of financial
assistance provided to patients by MMCASA
increased. The increased utilization of MidMichigan
Health’s financial assistance program likely resulted
from community education efforts and an expansion
of our eligibility criteria that allows more individuals
to qualify for assistance. Considering that 54% of
survey respondents were unaware of MidMichigan
Health’s financial assistance program, greater
efforts must be made to educate our community.
Health Insurance Type Government-sponsored health insurance programs
(e.g., Medicare and Medicaid) act as a safety net by
providing health insurance to low-income
individuals. One-fifth of residents in MMCASA are
Medicaid recipients, which is consistent with the
Michigan average. One in three residents within
MMCASA are 65 years and older, and the high
prevalence of Medicare recipients is directly
correlated.
Alcona and Montmorency County has the highest
prevalence of Medicare recipients (42%), which was
twice the Michigan benchmark in 2019.
Health Literacy According to the Department of Health and Human
Services, “health literacy is the degree to which
individuals have the capacity to obtain, process and
understand basic health information and services
needed to make appropriate health decisions.”
Health literacy impacts an individual’s ability to
manage health conditions, communicate with
providers, and seek appropriate care. 2 Health literacy
in MMCASA is complicated by the higher proportion
of adults 65 years and older, those without a high
school diploma/GED, and/or living in poverty.
Transportation Transportation impacts access to care because of the
burden that travel places on the patient’s time and
resources needed to seek care. Among the
community members and stakeholders surveyed
during CHNA process, one in ten indicated that
transportation issues prevented them from seeking
care within the last 12 months.
Technology Telemedicine can increase access to essential health
services, and opportunities to “maintain the
continuity of care to the extent possible can avoid
additional negative consequences resulting from
delayed preventive, chronic, or routine care. Remote
access to healthcare services may increase
participation for those who are medically or socially
vulnerable or who do not have ready access to
providers. Remote access can also help preserve the
patient-provider relationship at times when an
in-person visit is not practical or feasible.”3 Despite
its many benefits, barriers to using telemedicine
technologies within MMCASA may exist, as the
proportion of households with broadband access SEE APPENDIX A (81.5%) was below the Michigan average.
FIG 5
Barriers to Care COMMUNITY MEMBER AND STAKEHOLDER REASONS FOR DELAYING MEDICAL CARE WITHIN THE LAST12 MONTHS
SOCIOECONOMIC FACTORS
than their parents were at the same age. More
worrisome are the third of survey respondents that
reported being unable to afford a $400 emergency
expense. To gain an understanding of the diminished
economic opportunity expressed by survey
respondents, the following factors are explored in
this section: (1) educational attainment, (2)
employment status, (3) household income, and (4)
other measures used to assess the economic vitality
of a given community.
An individual’s level of education has been shown to
impact their health throughout their life, as the
quality and level of education received can
potentially predict their employment and income.4
Consistent with the aforementioned observation,
21% of individuals surveyed indicated more
education and training is needed for career
advancement; however, 50% of survey respondents
indicated their community lacked jobs with
opportunities for advancement.
graduation rate objective, AH-08, seeks to raise the
percentage of students that graduate in four
years to 90.7%. Alcona and Presque Isle County
were the only counties within MMCASA that met
or exceeded this objective, with a 2019-2020
school year on-time graduation rate of 94.1% and
96.4%, respectively. Despite this, with the
exception of Montmorency County, all other
counties in the service area were at or above the
Michigan benchmark of 82.1%. Further disparities
in educational attainment can be observed among
the portion of adults that have earned a
bachelor’s and/or graduate degree when
compared to the Michigan benchmark. SEE TABLE 2
Economic Vitality Level of income impacts health across the entire
lifespan because it affects an individuals’ ability to
obtain basic needs and their access to health care
services. Research shows the economic viability of
“an area is largely influenced by the concentration
of poverty in the area. Areas where poverty is
highly concentrated have diminished
poor residents.”4 The following factors will be
explored to better understand the economic
vitality of the areas served by MidMichigan
Medical Center-Alpena: unemployment status
proportion of our community that are among the
working poor and/or living in poverty.
TABLE 2
Poverty Between 2017 and 2019, the proportion of
individuals living in poverty decreased 3% in Alcona
and Montmorency County, while increasing 1.5% in
Alpena County and 2.3% in Presque Isle County.
Following the same trend, the proportion of children
living in poverty in Alpena County increased 6.9%
between 2016 and 2019. During this same time
period, substantial reductions in childhood poverty
rates were observed in Montmorency (14.9%) and
Alcona (10.3%) County. Conversely, the proportion
of Montmorency and Presque Isle County seniors
living in poverty increased more than 2.5% SEE FIG 6
Disparities in Median Household Income In 2019, all counties in MMCASA had household
incomes significantly below the Michigan average of
$59,522 a year. As depicted in FIG 7, households in
Montmorency County earned on average nearly
$20,000 less than the average Michigan household.
Reduced median household income maybe linked to
increases in MMCASA’s aging and disabled
populations, as all sources of income (i.e. earned
from work, retirement, disability, etc.) are used to
calculate this indicator. The proportion of residents
FIG 7
average (23.7%) in Alcona (40.5%), Alpena (27.8%),
Montmorency (38.1%), and Presque Isle (34.8%)
County. In addition to retirement income, seniors
with a disability are eligible to receive supplemental
security income. As shown in TABLE 3, the
proportion of seniors in Alcona (35%), Alpena
(38.4%) and Montmorency County (40.4%) that were
supplemental security income recipients from 2015-
2019 exceeded the Michigan average (34.3%).
FIG 6

12 2021 Community Health Needs Assessment I MidMichigan Medical Center Alpena
Employment Status In 2020, 10% of the Michigan popula on aged 16
years and older were unemployed and seeking work
At 7.7%, Alpena County had the lowest unemployment rate among all coun es within
MMCASA. Conversely, the unemployment rate in
Montmorency and Presque Isle County exceeded the
Michigan average, as more than one in ten people
were unemployed in 2020. Although the
unemployment rate provides a surfacelevel picture
of economic opportunity within a given community, it fails to account for part me workers who would
prefer full me work and those who are interested
in working but are not ac vely searching for a job.
Disability Status “Working people with disabili es experience
dispropor onate job loss during economic downturns compared to workers without disabili es, and supplemental security income (SSI) applica ons generally increase when the unemployment rate
increases.”5 SSI is provided to most individuals with
a disability that qualify; however, the monthly
maximum income falls below the federal poverty
level. The increased propor on of individuals age 18
to 64 in MMCASA that received SSI between 2015 2019 compared to Michigan has contributed to
income inequi es within the region. The effects of these inequi es can directly be observed in the
TABLE 3
0 17 YEARS 18 64 YEARS 65 YEARS & OLDER
MICHIGAN 4.8% 12.2% 34.3%
PRESQUE ISLE COUNTY 5% 16.2% 33.8%
diminished median household income which is below
the Michigan average. SEE FIG 7 Montmorency County
has largest number of disabled individuals receiving
SSI with 19.2%, followed by Alcona County that is 1.5
mes greater than the Michigan average from
2015 2019. SEE TABLE 3
SSI provided to lowincome families to support children with disabili es provides an economic safety net; “Without SSI, many more children with
disabili es would be in poverty.”6 Similar to
individuals age 1864, the propor on of children
within MMCASA receiving SSI exceeds the Michigan
average. Again, Montmorency County has the highest number of recipients, followed by Alcona County. SEE
TABLE 3
Basic Needs Out of Reach According to the United Way Associa on of Michigan, despite being gainfully employed, many
individuals and families are unable to meet their basic needs. In 2019, 25% of Michigan households were considered ALICE (Asset Limited, Income
Constrained, Employed). The ALICE threshold is based
on household survival budgets calculated for each
county that encompass the actual cost of basic necessi es such as housing, childcare, food, transporta on, and healthcare.
One in three households in MMCASA are es mated
to be ALICE. SEE FIG 6 Upon closer inspec on, varia ons in the propor on of ALICE households were iden fied
among the different zip codes that comprise each
county. SEE TABLE 4 When asked, “Which three do you
believe if addressed would improve the health of your community?” the following were iden fied by
community members and stakeholders: (1) jobs with
livable wages/pay (75%); (2) affordable and quality
housing (50%); and (3) more affordable healthy foods (47%). These results are consistent with those of the
CHNA conducted by the Northeast Michigan
Community Service Agency and the Northern
Michigan Public Health Alliance in 2019.
TABLE 4
ALICE Households by Zip Code, 2019
HEALTH BEHAVIORS
fulfill other basic needs.4 Beyond the availability of
resources, an individual’s behaviors that prevent
development and/or promote management of
chronic health conditions are further compounded
by the physical environment in which they live. In
this section, the following factors are explored for
their impact on health behaviors and outcomes:
food environment, opportunities for physical
activity, and nicotine product use.
Food Environment According to the Robert Wood Johnson Foundation,
the U.S. Department of Agriculture ’s food
environment index seeks to “measure the availability
of economical, close and nutritious food options in a
community” on a scale of 0 (worst) to 10 (best). 7
The food environmental index scores for all counties
in the service area exceed the Michigan benchmark
of 7, indicating relative ease in accessing healthy
foods. Despite this, ease of access to healthy food
varies in Presque Isle County, where 8.05% of
low-income residents live more than one mile in
urban areas or 10 miles in rural areas from a
supermarket.
As the data indicates, MMCASA has high access to but reduced affordability of healthy foods. The inability
the purchase healthy food is a predictor for the future development of and inability to manage chronic conditions. A 2017 study released by the U.S.
Department of Agriculture found:
“Food insecurity or the difficulty consistently obtaining access to adequate amounts of healthy, affordable food — is associated, among working-age adults, with an increased risk of 10 of the most common, costly and preventable chronic conditions: high blood pressure (hypertension), coronary heart disease, hepatitis, stroke, cancer, arthritis,
chronic obstructive pulmonary disease and kidney disease.”8
Consistent with the above findings, 57.8% of
community members and stakeholders surveyed
indicated the health of their communities would
improve if more affordable and healthy foods were
available. This perception is supported by the: (1)
high the overall food and child food insecurity rate,
(2) proportion of children that qualify for free or
reduced lunch; and (3) the proportion of households
that received food assistance exceeding the Michigan SEE FIG 8 benchmark for all counties in the service area.
FIG 8
Food Insecurity
Physical Activity Opportunities
(PA-01) aims to reduce the proportion of adults that
report a lack of leisure-time physical activity to
21.2%. None of the counties within MMCASA
achieved the PA-01 target; however, in 2017, only
Alpena (25%) and Presque Isle County (30%) had
greater proportions of inactive adults compared the
Michigan benchmark of 23%. Current levels of
physical inactivity could be impacted by the
diminished opportunities for physical activity present
throughout MMCASA. The percentage of residents
with adequate access to locations for physical activity
was below the Michigan benchmark of 85% for the
entire MMCASA (ranging from 72-75%). Issues with
the built environment were reflected in the
responses of 46.7% of community members and
stakeholder surveyed, who indicated access to
affordable physical activity opportunities are needed
and if available would improve the health of their
community.
Nicotine Product Use MMCASA continues have the highest prevalence of
adult tobacco use in Michigan. As one in four
MMCASA residents aged 18 years and older are
estimated to smoke in 2019. SEE FIG 9 In the insuring
section, maternal smoking, binge drinking and drug
treatment episodes are discussed in greater detail.
FIG 9
As a whole, what ails our community?
MORBITIY & MORTALITY
understand the impact of death within the
communities we serve, the following mortality data
were explored with regard to the top 10 leading
causes of death, life expectancy, and premature
death. Due to the small minority populations
present within MMCASA, death by race and
ethnicity was not examined as it would fail to
provide generalizable information.
Nearly one in three deaths in MMCASA were
caused by heart disease from 2017 to 2019. During
this time period, the following were found:
Cancer-attributed deaths were highest in
Alpena and Montmorency County, which
caused one in four deaths.
Chronic lower respiratory disease (CLRD) deaths
were 1.6 times higher than Michigan in Alcona
County.
were below the Michigan average of 5.3%
among all counties within MMCASA.
Stroke-attributed deaths were 1.4 times higher
than Michigan in Montmorency County.
The proportions of Alzheimer’s, diabetes, and
flu/pneumonia-attributed deaths were all below
the Michigan average.
residents under the age of 75 was higher than the
Michigan benchmark of 7,500 deaths per 100,000
except in Montmorency County. FIG 11 shows the
premature death rate for each county in MMCASA
compared to the Michigan benchmark. Among all
81 counties in Michigan, both Alcona (9th place)
and Presque County (7th place) ranked within the
top 10 that experienced the greatest potential years
of life lost, which could have been prevented.
Congruent with the findings of the Centers for
Disease Control and Prevention, concerning exces-
sive death, “rural county residents are dying from
FIG 10
ALCONA COUNTY
ALPENA COUNTY
MONTMORENCY COUNTY
MICHIGAN
3.9% 4.1% 3% 5.8%
1.5%
1.8%
2.6%
1.6% 0.8% 1.7% 1.5%
the top leading causes (i.e. cancer, health disease,
unintentional injury, chronic lower respiratory disease,
and stroke) of death more frequently than[than their
urban counter parts].”9
Life Expectancy The National Center for Health Statistics estimates that
a Michigander born between 2017 and 2019 will live
78.1 years on average. Overall, individuals
residing in MMCASA are expected to have a shorter life
span than the Michigan average based on the following
estimates: Alcona County (76.9 years), Alpena County
(77.8 years), Montmorency County
(77.5 years), and Presque Isle County (77 years).
Disparities in life expectancy within each county by
census track (CT) can be observed in FIG 12.10 The most
notable disparity for each county is the following:
7.9-year difference between CT 9504 (74.1 years)
and 9506 (82 years) in Presque Isle County.
3.9-year difference between CT 9105 (75 years)
and 9102 (78.9 years) in Montmorency County.
and 0001 (79.3years) in Alpena County.
and 9701 (78.1 years) in Alcona County.
FIG 11
FIG 12
Behavioral Health Deaths due to intentional self-harm (suicide)
continue to be the tenth leading cause of death in
Michigan. The Healthy People 2030 MHMD-01
objective seeks to reduce suicides to 12.8 per
100,000 population. From 2015 to 2019, the suicide
rate among persons aged 25-74 in Michigan was 18
per 100,000, which is greater than the Healthy
People 2030 MHMD-01 target. All counties within
the service have a suicide death rate higher than the
Healthy People 2030 and Michigan benchmark.
Alcona County experienced the greatest suicide-
attributed death rate from 2015 to 2019, with a rate
that was 2.3 times the Michigan benchmark. SEE FIG 16
Suicide Risk Factors
combination of individual, relationship, community
and societal factors contribute to the risk of suicide.
Risk factors are those characteristics associated with
suicide - they might not be direct causes.”11 The risk
factors for suicide include a history of clinical
depression and substance abuse.
being told by a doctor they had a depressive disorder
according to the 2017-2019 MIBRFSS (ranging from
19.5 to 21.5%) was below the Michigan benchmark of
22.7%. Despite this, the average number of mentally
unhealthy days reported in the past 30 days was
nearly double the Michigan benchmark of 4.7 for the
entire service area in 2018. Acknowledging the
impact of the COVID-19 pandemic, 19.8% of the
community members and stakeholders surveyed still
indicated not leading a purposeful and meaningful
life. SEE APPENDIX A
Substance Abuse “Substance abuse is the medical term used to
describe a pattern of using a substance (drug) that
causes significant problems or distress. This may be
missing work or school, using the substance in
dangerous situations, such as driving a car.”12 The
most common types of substances that are abused
include alcohol, opioids, cannabis, tobacco, and other
illicit drugs.13 As previously mentioned, abuse of the
aforementioned is a known risk factor for suicide. As
such, the prevalence of alcohol and opioid use was
examined, and the following were found:
The proportion of adults who reported drinking excessively in the past month, all counties in MMCASA were slightly higher than the Michigan benchmark of 19.9% in 2018.
The rate of drug overdose emergency department visits for the entire MMCASA ranged from 50 to 59 per 10,000 visits from October 2019 to September 2020, according to the Michigan Syndromic Surveillance System.
The rate of individuals who reside within MMCASA who were admitted for treatment of substance abuse was above the Michigan benchmark of 504 (per 1,000 population) was found in Alpena County, with a rate of 595.3 in 2019.
FIG 16
Suicide Rate in Adults 25 to 74 years (per 100,000 population), 2015-2019
CANCER
Michigan and MMCASA. The Healthy People 2030
C-1 objective seeks to reduce the overall cancer-
related deaths to 122.7 per 100,000 population.
Alcona, Alpena, and Montmorency County failed to
meet the Healthy People 2030 overall cancer
mortality objective and Michigan benchmark (162.4
per 100,000 residents), with age-adjusted morality
rates ranging from 173.8 to 208.6. Montmorency
County had the highest overall cancer mortality rate
(208.6 per 100,000 residents), which was 128%
greater than the Michigan average. Despite this, the
overall cancer mortality rate remains steady in
Alcona, Alpena, and Presque Isle County.
Breast Cancer From 2015 to 2019, the age-adjusted breast cancer
mortality rate in Alpena County at 22.3 per 100,000
was higher than the Michigan average (20.3 per
100,000 female population) and the Healthy People
2030 C-04 objective (15.3 breast cancer deaths per
100,000 females). Breast cancer mortality rates
during this time period were not calculated for the
other counties in MMCASA by the Michigan
Department of Health & Human Services, as “width
of the confidence interval would negate any
usefulness for comparative purposes, when there
are fewer than 20 events (i.e. breast cancer
attributed deaths).”
rate from 2014 to 2018 below the Michigan average
of 123.2 per 100,000 female population. In spite of
this, when examining the stage of diagnosis for
newly diagnosed cases during this same time period,
more women are being diagnosed at a later stage
(i.e., regional and distant) compared to the Michigan SEE FIG 13 average. The potential causation for the
increased late-stage breast cancer diagnosis could
stem from mammography rates that fell short of
meeting the Michigan average of 74% and the Health
People 2030 C-05 target (77.1%) for all counties.
According to a study conducted by the American
Cancer Society, the 5-year overall breast cancer
survival rate is 90%; however, the following
variations were found by stage: 99% localized, 86%
regional, and 28% distant; thus, it is particularly
concerning that Alcona, Alpena, and Presque Isle
County have a distant diagnosis rate that exceeds
the Michigan average. 14
Colorectal Cancer From 2015 to 2019, the age-adjusted cancer
mortality rate in Alpena (14.1 per 100,000
population) and Presque Isle County (16.8 per
100,000 population) was higher than the Michigan
average (13.7 per 100,000 population) and lower
than the Healthy People 2030 C-06 objective (18.3
colorectal cancer deaths per 100,000 population).
The Michigan Department of Health & Human
Services for Alcona and Montmorency County did not
calculate the colorectal cancer mortality rates during
this time period because the rates would not be
generalizable.
2018 exceeded the Michigan rate of 39.1 per 100,000
population in Alcona (39.3), Montmorency (49.6),
and Presque Isle County (47.6). The estimated 5-year
colorectal cancer survival rate is 63% with the
following variations estimated by diagnosis stage:
91% localized, 72% regional, and 14% distant.15 As
such, the increased proportion of individuals being
diagnosed at a distant stage in Alcona (28%) and
Presque Isle County (21.2%), compared to the
Michigan average (19.6%), is concerning and will lead
to greater colorectal cancer-attributed deaths. SEE FIG 14
To reduce the proportion of individuals who receive
a late-stage diagnosis, the U.S. Preventive Task Force
recommends “all adults age 50 to 75 years receive
a colorectal cancer screening.”16 Improvements in
the proportion of individuals who receive a colorectal
cancer screening are evident, as all counties (Alcona
County: 66.4%, Alpena County: 67.9%, Montmorency
County: 67.1%, and Presque Isle County: 67.3%)
within MMCASA have a colorectal screening rate that
failed to meet the Michigan average (70%) and was
below the Healthy People 2030 C-07 target of 74.4%. SEE APPENDIX A
Lung Cancer Death attributed to lung cancer between 2015 and
2019 exceeded the Michigan age-adjusted rate of
42.2 per 100,000 population in Alcona (47.2), Alpena
(50.2), and Montmorency County (56.6). The Healthy
People 2030 C-02 objective seeks to reduce lung
cancer deaths to 25.1 per 100,000 population in the
next 9 years. The overall 5-year survival rate for
FIG 14
non-small cell lung cancer is 25%. The following
relative 5-year survival rates were estimated for by
diagnosis stage: 63% localized, 35%regional, and 7%
distant.17
released new lung cancer–screening
recommendations:
“adults aged 50 to 80 years who have a 20
pack-year smoking history and currently
smoke or have quit within the past 15 years:
Screen for lung cancer with low-dose
computed tomography (CT) every year. Stop
screening once a person has not smoked for
15 years or has a health problem that limits
life.”18
proportion of adults who qualify to receive a lung
cancer screening. Nonetheless, 7.6% of individuals
within MMCASA qualified but did not receive a lung
cancer screening in 2016-2017.19 A lung cancer
health disparity is present within the MMCASA, as
adults are more likely to:
smoke and use nicotine products,
need a lung cancer screening,
be diagnosed at a late stage, and
have diminished five-year relative survival rate
compared other regionals and counties within
Michigan. SEE FIG 15
Prostate Cancer Deaths attributed to prostate cancer in 2015 to 2019
were 18.4 per 100,000 male population in Michigan,
which was above the Healthy People 2030 C-08
target of 16.9 prostate cancer deaths per 100,000
males. Prostate cancer mortality rates during this
time period were not calculated by the Michigan
Department of Health & Human Services for the
entire MMCASA because the rates would not be
generalizable.
5-year relative survival rate; however, the survival
rate drastically decreases to 30% for men diagnosed
at a distant stage.20 As such, the proportion of men
aged 50 years and older in Alcona County who
reported receiving a prostate screening (23.5%)
must increase to reduce the chances of receiving a
late-stage diagnosis and meet/exceed the Michigan
average (37.3%).SEE APPENDIX A
FIG 15
Michigan and accounted for 2.9% of all deaths from
2015 to 2019. Less than 2.8% of all deaths in
MMCASA during this time period were caused by
diabetes. The Healthy People 2030 D-09 target
strives to reduce the diabetes death rate to 13.7
deaths per 100,000 population. With 26.2 deaths,
Alpena County had a diabetes death rate 1.9 times
higher than the Healthy People 2030 target, whereas
Presque Isle County had a death rate that was 1.5
times higher from 2015 to 2019. When examining
the diabetes-related deaths, where diabetes was
found to be either the underlying or related cause of
death, all counties within MMCASA exceeded the
Michigan age-adjusted average of 65.9 deaths per
100,000 population between 2017 and 2019.
Prevalence & Incidence
Obesity is a risk factor for the development of type
2 diabetes. The Healthy People 2030 NWS-03
objective seeks to reduce the proportion of adults
considered obese to 36% or less. The proportion of
adults who had a body mass index greater than or
equal to 30 was higher than that in Michigan
(32.4%), as nearly four in ten adults in the MMCASA
were considered to be obese in 2018. In Michigan,
10.1% of the population has been diagnosed with
diabetes. According to the Centers for Disease
Control in 2018, 10.2% of adults in Montmorency
County were diabetic. Among adults newly diagnosed
with diabetes in 2017 in Michigan, the Centers for
Disease Control estimated the following for every
1,000 residents in Alcona (5.2), Alpena, (8.6),
Montmorency (14.9), and Presque Isle County (7.7).
Health Care Utilization Regarding inpatient stays for diabetes, the
hospitalization rate per 100,000 residents in Alpena
(53.6), Montmorency (51.6), and Presque Isle County
(64.4) exceeded the Michigan average of 50.4 in
2019. To gain an understanding of the elevated
diabetes hospitalization rates, the 2019 outcomes of
the following three preventative health indicators
were explored for all Medicare recipients’ short-term
diabetes complications (PQI #1), long-term diabetes
complications (PQI #3), and the rate of lower
extremity amputations among patients with diabetes
(PQI #16). SEE FIG 16 Alpena County, with a rate of 170
(per 100,000 Medicare beneficiaries), had 1.6 times
more Medicare beneficiaries who experienced a
short-term diabetes complication than the Michigan
average. The long-term diabetes rate among all
beneficiaries in MMCASA was lower than the
Michigan rate of 297. Lastly, lower extremity
amputations among diabetic Medicare beneficiaries
in Presque Isle County exceeded the Michigan rate
with 95 per 100,000 Medicare beneficiaries.
FIG 17
Diabetes Complications in Medicare Beneficiaries
Heart Disease
25% of all deaths in Michigan were caused by heart
disease; however, in MMCASA, one in three deaths
were attributed to heart disease from 2015 to 2019.
Alpena and Montmorency County had the highest
mortality rates in MMCASA, which were 17% greater
than Michigan. The Healthy People 2030 HDS-02
objective seeks to reduce coronary heart disease
deaths to 71.7 per 100,000 population. If Michigan
and MMCASA are to achieve the HDS-02 target in the
next nine years, massive efforts must be undertaken,
as the observed death rate was at least 270% greater. SEE FIG 19
In 2018, the Center for Disease Control estimated
that one in ten Michigan adults were diagnosed with
cardiovascular disease. The estimated cardiovascular
disease prevalence in MMCASA was 50% greater than
Michigan during this same time period. Individuals
living in MMCASA are more likely to be diagnosed
with, hospitalized, and die as a result of heart
disease. All counties within MMCASA had a
congestive heart failure hospitalization rate in 2019
higher than the Michigan benchmark of 19.1
hospitalizations per 10,000 population; however,
among Medicare beneficiaries, the hospitalization
rate was better than the Michigan benchmark in
2019.SEE FIG 19
deaths in Michigan, making it the fifth-leading cause
of death from 2017 to 2019. None of the counties in
MMCASA meet the Healthy People 2030 HSD-03
objective to reduce the stroke death rate to 33.4 per
100,000 people. Depicted in FIG 19, the stroke death
rate for each county in MMCASA was greater than for
Michigan. Montmorency County’s stroke death rate
of 58.4 per 100,000 was 1.5 times greater than
Michigan’s and 1.75 times greater than the Healthy
People 2030 HSD-03 target.
27.7%; however, over a third of adults in Michigan
and in MMCASA are estimated to be hypertensive in
2018. Among Medicare beneficiaries in MMCASA,
hypertension prevalence increased to one in two
individuals. Despite this, the hypertension
hospitalization rate for Medicare beneficiaries in
MMCASA was below Michigan’s benchmark in 2019. SEE FIG 19
FIG 19
Cardiovascular and Cerebrovascular Outcomes, 2015-2019
Maternal & Infant Health
better understand infant and maternal health
outcomes within the communities we serve, the
following rates were examined: (1) teenage
pregnancy, (2) prenatal care, (3) breastfeeding, (4)
low birth weight, (5) maternal tobacco use, and (6)
infant mortality.
to reduce the rate of all infant deaths within one
year of birth to 5 deaths per 1,000 live births. From
2015 to 2019, Michigan’s infant death rate was 6.6
deaths per 1,000 live births. During this same time
period, Presque Isle County had an infant death rate
230% (15 deaths per 1,000 live births) greater than
Michigan’s. In contrast, Alpena County had an infant
death rate of 4.6 deaths per 1,000 live births. Infant
mortality data was unavailable for Alcona and
Montmorency County from 2015-2019.
Teenage Pregnancy The live birth rate among women aged 15 to 19
years in Michigan between 2017 and 2019 was 15.7
per 1,000 women. The live birth rate among women
aged 15 to 19 was highest in Alpena County, with
19.4 births per 1,000 women during this same time
period. Regarding teen pregnancy rates from 2015
to 2019, all counties in MMCASA except Alpena
(32.1) had a teen pregnancy rate lower than the
Michigan average of 28.1 births per 1,000 women.
Prenatal Care
2017 to 2019 fell short as only 73.9% of pregnant
women received early prenatal care. None of the
counties in MMCASA met the Healthy People 2030
target. Compared to the Michigan average (73.9%),
Montmorency County (64.2%) had the lowest
proportion of pregnant women seeking early
prenatal care, followed by Alcona County (73.5%).
Breastfeeding Every county within MMCASA exceeded Michigan’s
breastfeeding initiation benchmark (47%) and
Healthy People 2030 MICH-15 objective (42.4%);
evident among all live births from 2015-2019:
63.3% in Alcona, 69.9% in Alpena, 59.6%
Montmorency, and 64.3% in Presque Isle County
were breastfeeding was reported to be initiated.
Low Birth Weight From 2017 to 2019, 8.8% of infants in Michigan
weighed under 2,500 grams at birth. One in ten
infants born in Montmorency County had a low
birth weight, as did 9% of births in Alpena County.
Maternal Tobacco Use Tobacco use by expectant mothers negatively
impacts infant health by increasing the risk for
premature birth, low birth weight, and infant
mortality. The Healthy People 2030 MICH-10
objective seeks to reduce the proportion of
expectant mothers who smoked to 4.3%. Overall,
14.4% of expectant mothers in Michigan smoked
from 2017 to 2019. Like Michigan, none of the
counties within MMCASA met the Healthy People
2030 target. Compared to the Michigan average,
the percentage of expectant mothers who smoked
within MMCASA was almost three times higher in
Montmorency County (39.4%) and twice as high in
Alcona (32.6%) and Alpena County (30.7%). Despite
this, a reduction in the proportion of mothers that
smoked while pregnant can be observed when SEE FIG 20 comparing 2014-2016 to 2017-2019 rates.
FIG 20
Decreasing Maternal Nicotine Use, 2014-2016 vs. 2017-2019
Respiratory Health
“chronic respiratory diseases are chronic diseases
of the airways and other structures of the lung.
Some of the most common are: asthma, chronic
obstructive pulmonary disease (COPD),
hypertension.”21
issues due to airflow blockages present in the
lungs. Asthma, emphysema, and chronic bronchitis
are among the group of diseases known to cause
COPD. COPD caused 5.8% of deaths from 2015 to
2019 and is the third leading cause of death in
Michigan. In MMCASA, the COPD death rate from
2015 to 2019 were:
Isle County, with 42.9 deaths per 100,000, and
higher than the Michigan average in Alcona
(62.2), Alpena (49.7), and Montmorency County
(60.5) .
reported being told by a doctor that they had
COPD, emphysema, and chronic bronchitis in 2018.
Nearly one in 10 adults aged 18 years and older
were diagnosed with COPD throughout
MMCASA, which was higher than Michigan. From
2017 to 2019, 11.1% of Michigan adults reported
being told they had asthma by a health care
provider. Among the counties that comprise the
MMCASA, only Alcona County at 13.1% exceeded
the Michigan asthma diagnosis rate.
Health Care Utilization The overall hospitalization rates attributed to
asthma, COPD, and pneumonia were examined
to understand the management and deaths
surrounding COPD:
The COPD hospitalization rate in 2019 was higher
than the Michigan average of 21.9 inpatient stays per 10,000 population in Alcona, Montmorency,
and Presque Isle County. SEE FIG 18
Montmorency County had a pneumonia
hospitalization rate that was 2.2 times higher
than the Michigan average of 18.9 per 10,000
population. SEE FIG 18
beneficiaries hospitalized for COPD (PQI#5)
increased in Alcona (43%), Montmorency (2%), and
Presque Isle County (34%) compared to the 22%
reduction throughout Michigan overall. During this
same time period, hospitalizations among Medicare
beneficiaries resulting from bacterial pneumonia
(PQI #11) decreased by 42% in Michigan. Congruent
with the downward trend in Michigan’s bacterial
pneumonia hospitalization rate, a reduction was
observed among all counties served by MMCASA;
Montmorency County was the largest of which, with
a 64% decline, followed by Alpena County, which
experienced a 57% decrease.
2021 Community Health Needs Assessment I MidMichigan Medical Center Alpena 28
SECTION IV
Assessment Methodology & Priori. za on Results
How were significant health needs iden fied and priori zed by MidMichigan Health?
ASSESSMENT METHODOLOGY
The primary purpose for the CHNA completed by
MidMichigan Medical Center - Alpena is to share
ownership in the health of our communities. The
CHNA provides a snapshot of the health needs and
strengths through review of available public health
data sets and input from persons representing the
board interests of MMCASA. By better understanding
the places where residents in our communities live,
work, and play, we are able to identify the factors
impacting health and develop a three-year strategy
to improve future health outcomes.
Phase I: Pre-Planning
identification of health system and community
stakeholders in order to ensure alignment of health
improvement efforts. The Community Health
Supervisor for MidMichigan Medical Center - Alpena
participates in health-focused community
groups are comprised of local organizations for each
of the respective communities and includes
non-profits, health departments, human service and
other government agency representatives. Despite
differences in the CHNA completion timelines among
various community organizations within the Alpena
Service Area, the Community Health Supervisor for
MidMichigan Medical Center - Alpena aids in the
CHNAs of other community stakeholders to establish
mutual goals that will be used to enact
comprehensive strategies in our shared service
areas.
employed to better understand the health needs
of MMCASA through collection of primary and
secondary data. The data collected was integrated
to generate common focus areas and health needs
for MMCASA as a whole and on the county level.
Primary Data
low-income and other underserved populations
within our service area. Multiple attempts were
made between 2/1/2021 through 4/30/2020 to
obtain community input through the Community
Wellbeing Survey. SEE APPENDIX B
FIG 21
Prioritization Process Stage One & Two
Secondary Data
determine the demographics and health status of
each county in MMCASA. For each health indicator,
a comparison was made between the most recent
available community data and benchmarks from the
State of Michigan and Healthy People 2030. A health
need was identified when an indicator failed to meet
the state’s comparative benchmark. For a complete
list of health indicators and data sources, see
Appendix A.
Data Interpretation Each source used to collect data was synthesized to
identify areas of need or focus areas. Focus areas
were generated for MMCASA as a whole and by
county. Only focus areas jointly identified as an area
of need by both community members and
stakeholders, also identified in secondary data, were
submitted to the Community Advisory Committee,
Executive Team of MidMichigan Medical Center -
Alpena, and other internal MidMichigan Health
Departments for prioritization.
Phase III: Prioritization Process The process of identifying and prioritizing health
needs to determine the focus areas for our
Community Health Improvement Plan occurred in
three stages. During stage one, a review of public
health data sets (quantitative data) and
survey results (qualitative data) was executed to
identify potential health needs. SEE FIG 21
All health needs identified during stage one of the
prioritization process, were then subjected to the
Hanlon Method for further prioritization (stage two).
The National Association of County and City Health
Officials recognize the Hanlon Method for its
effectiveness in prioritizing complex health concerns.
FIG 22
The Hanlon Method uses a quantitative technique
to rate health needs. Figure 23 shows the results of
the Hanlon Method. Each health need on a scale
from zero through ten is assigned a rate based on
the following criteria: (1) size of the health need,
(2)seriousness of health need, and
(3) ineffectiveness/lack of available health
interventions. Thereafter, a priority score was
calculated for each health need. Each health need
was then ranked by priority score, highest to
lowest. FIG 23 shows the results of the Hanlon
Method. SEE APPENDIX C
health needs were presented to MidMichigan
Medical Center - Alpena’s Board of Directors for
approval. As many of the health needs (cancer,
diabetes, cerebrovascular & cardiovascular health,
of Directors agreed to focus on chronic disease
prevention and treatment instead. SEE FIG 22 On June
22, 2021 the Board of Directors of MidMichigan
Medical Center - Alpena approved the following
three focus areas:
access to care, behavioral health, and chronic disease prevention and treatment.
FIG 23
Part II: Community Health Improvement Plan
The MidMichigan Medical Center - Alpena Community Health Improvement Plan for 2021-2024 was built upon previous plans to further reflect MidMichigan Health’s Mission, Vision, and Core Values, as well as collaborative efforts with the community. The underlying premise for each MidMichigan Health subsidiary in completing previous plans was shared ownership for community health. While our previous CHNA’s helped us identify focus areas for health improvement, the IRS legislation mandating collaborative efforts provided an opportunity to revisit our needs assessment and strategic planning processes. Part one of the Community Health Needs Assessment included a detailed investigation of quantitative and qualitative data from which areas for health improvement were chosen.
The following plan includes goals and evidenced based strategies to address three focus areas for health improvement, approved by MidMichigan Medical Center - Alpena Board of Directors on October 26, 2021. This document reflects input from designated individuals in each community inclusive of, but not limited to, public health experts, representatives of low-income and medically underserved populations, and those suffering from chronic disease. The broadened scope from which we plan to function is inherent in the strategies which include internal health improvement initiatives of MidMichigan Medical Center - Alpena and MidMichigan Health, as well as collaborative efforts of the hospital with public health, the University of Michigan, and our community partners. The following pages outline the Community Health Improvement Plan for MidMichigan Medical Center - Alpena.
33
34
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2021 Community Health Needs Assessment I MidMichigan Medical Center Alpena 32
SECTION V
20182021 Community Health Improvement Plan Results
An evalua on of MidMichigan Health’s ac ons taken since 2018 to improve the health of our community
2018-2021 COMMUNITY HEALTH IMPROVMENT PLAN
This section presents initiatives MidMichigan Medical Center-Alpena intended to deliver, fund or collaborate with others to address the priority health needs identified in the 2018 community health needs assessment (CHNA). All planned initiatives are consistent with MidMichigan Health’s mission, purpose, and capabilities. Please note, all initiatives were implemented by the plans completion date of June 30, 2021. The table below presents the strategies MidMichigan Medical Center-Alpena used to address the priority health needs identified in the 2018 CHNA: 1. access to care, 2. chronic disease prevention and treatment, 3.mental health, and 4. substance use. They are organized by health need and included a statement of anticipated impact, description and results.
Chronic Disease Prevention and Treatment Goal I: Improve health behaviors and increase access to environmental supports needed to manage and prevent/delay the onset of chronic disease. Objective I: Provide education and programs focused on prevention of chronic disease with an emphasis on nutrition, physical activity, and weight management.
Strategy Description Anticipated Impact Results 1.1 Explore providing the National Diabetes Prevention Program (NDPP) to those at-risk for developing type 2 diabetes
A yearlong lifestyle change program for those at-risk for develop type 2 diabetes
Prevention and/or delayed onset of type 2 diabetes
The Diabetes Center, has agreed to be the home for the NDPP. Community Health worked with the Diabetes Center to develop a business plan and providing technical assistance as needed; however, the NDPP was not implemented by 6/30/21.
1.2 Provide education on healthy eating, fitness and weight management through MidMichigan Health’s Speakers Bureau
Educational presentations to community groups provided upon request
Improved knowledge of healthy eating, fitness, and weight management principals
The community did not submit any Speakers Bureau requests concerning health behaviors.
1.3 Partner with Alpena Schools on wellness activities
Provide speakers, technical assistance, and supports where needed to support school wellness activities
Improved health knowledge and behaviors of students and staff
In partnership with Bay Athletic and various MidMichigan Health departments (Community Health, Diabetes Center and Employee Wellness), a diabetes awareness week was held for students and staff at Thunder Bay Junior High School in 2018 and 2019. Due to the onset of the COVID-19 pandemic, the event was not held in 2020.
Chronic Disease Prevention and Treatment – CONT. Objective I: Provide education and programs focused on prevention of chronic disease with an emphasis on nutrition, physical activity, and weight management.
Strategy Description Anticipated Impact Results 2.1 Partner with the University of Michigan to identify the current state of care available for persons with chronic disease to increase disease management
To increase the capacity of PCMH to manage chronic disease and prevent unnecessary hospital utilizations
Improved chronic disease management
The study has been completed and a report generate. In 2020, the study was submitted to the New England Journal of Medicine for peer-review and potential publication.
2.2 Provide insulin pump support group
A quarterly support group to provide education for those that use an insulin pump to manage their diabetes
Improved diabetes self-management
Quarterly sessions were held in 2018 and 2019; however, due to low attendance, facilitator availability coupled with COVID-19, the insulin pump support group was not held in 2020 or 2021.
2.3 Provide diabetes support group “Joining People with Diabetes”
A quarterly support group to provide self-management education for to those with diabetes
Improved diabetes self-management
Quarterly sessions were held in 2018 and 2019; however, due to low attendance, facilitator availability coupled with COVID-19, the insulin pump support group was not held in 2020 or 2021.
2.4 Provide “Breathing Easy” support group
A monthly support group to provide self-management education for those with COPD
Improved self- management of COPD
The Breathing Easy support group was launched in February 2019;however, the monthly support group meeting was not held in 2020 or 2021 because of the COVID pandemic.
Chronic Disease Prevention and Treatment – CONT.
Objective III: Develop strategies to increase access and consumption of fresh fruits and vegetables.
Strategy Description Anticipated Impact Results
3.1 Explore support of the Alpena Farmers Market and Double Up
Promote programs among patients
Increased fruit and vegetable consumption
Community Health and local community organizations are working to develop a Northeast Michigan Food & Farming Network. In partnership with the network, Hillman Community Schools and FoodCorps of Michigan, a service site was established. Through our sponsorships and charitable contributions process, $5,000 was awarded to the FoodCorps of Michigan. A full-time nutrition educator was placed in Hillman Community Schools to provide nutrition and physical activity education. As part of the nutrition educator’s efforts, work will be executed to establish/revise Hillman’s nutrition
Food Bucks Program policies.
The network is working to develop a food hub in Northeast Michigan, while promoting and expanding the Double Up Food Bucks accepting vendors, and other policies that promote consumption and purchase of local produce.
3.2 Partner with the Food Bank of Eastern Michigan to host community
Hosts produce distributions throughout the growing season
Increased fruit and vegetable consumption
In 2020 Community Health supported five food distributions by providing volunteers, MidMichigan Health branded grocery totes, and lunch for volunteers. Due to the success of the Feed the Need initiative launched during the COVID pandemic, the Food Bank of Eastern Michigan has a sponsor for every monthly mobile food distribution for the next year.
Five hundred dollars was provided to the Food Bank of Eastern produce distributions Michigan to support Rock the Crock in 2019. Rock the Crock is
a nutrition education program aimed at the homeless and individuals that lack adequate cooking facilities; however, the COVID pandemic postponed the program’s launch.
3.3 Refer expectant mothers to home visiting
Refer expectant mothers to the Maternal Infant
All Medicaid insured mothers are automatically referred to the Maternal Infant Health Program offered by District Health
programs [i.e. Maternal Health Program and Increased maternal Department #2 and #4. Additionally, all childbirth education Infant Health Program Healthy Beginnings infant health outcomes participants receive education about available home visiting and Healthy Beginnings Program for WIC and/or program from local Health Department WIC nurse. Program] SNAP enrollment
Chronic Disease Prevention and Treatment – CONT. Objective IV: Develop strategies to increase opportunities for physical activity.
4.1 Explore providing Walking with Ease
A six week program aimed to increase physical activity among those with arthritis.
Increased physical activity
Due to resource limitations, Walking with Ease was not implemented.
4.2 Provide fall prevention classes biannually
Provide A Matter of Balance or ThinkFirst to Prevent Falls
Increased physical activity; trauma prevention
A Matter of Balance and ThinkFirst to Prevent Falls sessions were not implemented due to lack of resources and community interest; however, Rehab Service held two fall prevention education at the Rogers City and Onaway Senior Center in 2019.
4.3 Provide bicycle helmets to community
Give bicycle helmets away at Brown Trout Family Day and/or another community event
Increased physical activity; trauma prevention
At community events, free bike helmets and fittings were provided to more than 900 individuals in 2018 and 2019.
4.4 Provide support for Girls on the Run Sunrise Side
A 10-week afterschool running program for girls
In 2019, Girls on the Run was awarded $500 to support program scholarships for the 2019-2020 school year.
4.5 Provide support for Boys and Girls Club of Alpena
Provide support for after-school and summer programming
In 2019, $500 was provided to the Boys and Girls Club of Alpena to provide program scholarships for needy families.
Chronic Disease Prevention and Treatment – CONT. Objective V: Decrease cardiovascular disease risk factors and prevent death from sudden cardiac arrest.
5.1 Provide community CPR and AED trainings
Provide community members with CPR training
Increased knowledge and the skills needed to resuscitate children, teens, and adults suffering from sudden cardiac arrest
As part of Brown Trout Festival’s Family Day activities, Education Services and Community Health provide hand-only CPR instruction to families in 2018 and 2019.
5.2 Develop a clinical treatment pathway for tobacco cessation
Standardize provider counseling resources, educational handouts for patients, billing process, and refer patients to the MI Quitline through Epic
Decreased nicotine product use among adults, teens, and pregnant women
Community Health worked with ConnectCare Medical Officer and Population Health Manager to develop an auto-fax pathway in Epic to the MI Quitline. Currently, two health system practices are piloting the auto-fax referral option; however, none are within the Alpena Service Area.
5.3 Provide education on diabetes, cardiovascular and cerebrovascular health through MidMichigan Health’s Speakers Bureau
Improved knowledge of diabetes risk factors, cardiovascular and cerebrovascular health
The community did not submit any Speakers Bureau requests concerning diabetes, cardiovascular and cerebrovascular health in 2018, 2019, or 2020.
Chronic Disease Prevention and Treatment – CONT. Objective VI: Provide early detection screenings and promote vaccinations focused on cancer prevention.
6.1 Provide financial assistance for women with obtainment of mammograms
Provide financial assistance and scheduling to women in need of mammograms through MidMichigan Health’s Breast Health Program.
Increased early detection and treatment of breast cancer
Of the 184 women system-wide, 14 women in the Alpena Service received financial assistance needed to obtain a mammogram through MidMichigan Health’s Mammography Fund.
6.2 Referrals to the Michigan Department of Health & Human Services’ Breast and Cervical Cancer Control Navigation Program (BCCCNP)
Refer ALICE/low- income women to BCCCNP to cover cost of breast/cervical cancer screening/ diagnostic/treatment services
Increased early detection and treatment of breast and cervical cancer
The Breast Health Navigator helps qualifying patients obtain coverage for ongoing breast cancer screening/diagnostic /treatment services through BCCCNP.
6.3 Promote and provide education on the HPV vaccination
Provide education on the HPV vaccine at various community events and on social media
Prevention of cervical cancer
HPV vaccination was promoted at Project Connects in Alcona and Montmorency counties in 2018 and 2019. In addition, the Marketing Department promoted HPV vaccination on all MidMichigan Health social media platforms.
6.4 Provide online colorectal risk assessment and free FIT kits
Promote the online colorectal cancer risk assessment and provide FIT kits to those deemed at high risk
Increased awareness of colorectal cancer and screening; Increased early detection of colorectal cancer
As part of various project connects and other health events, Community Health promoted MidMichigan Health’s online colorectal health risk assessment.
6.5 Provide education on cancer detection screenings and prevention through MidMichigan Health’s Speakers Bureau
Improved knowledge on cancer screenings and the HPV vaccine
Alpena’s Breast Health Navigator and Genetic Counselor provided breast health education to the Alpena Senior Center and Association of Lifelong Learners in 2019.
Mental Health and Substance Use Goal II: Increase the proportion of individuals in the Northern Region who have access to and receive mental health and substance use services. Objective VII: Improve the quality and availability of mental health and substance use services.
7.1 Explore launch of a Project ECHO focused on chronic pain and opioids
A knowledge sharing network that connects clinicians with specialist to provide treatment for individuals with complex health conditions
Increased access and quality of care Project ECHO has launched in 2019.
7.2 Explore Implementation of Project ASSET
Case management program for those seeking substance use treatment provided in the ED/inpatient setting
Improved care coordination and access to substance use treatment
Funding was obtain by Catholic Human Services to place two MSW trained social workers and a peer recovery coach in the Emergency Department to aid individuals seeking substance use treatment. Peer recovery coach training was held in January 2020. Due to THE COVID-19 pandemic, the number of individuals assisted by the peer recovery coach was limited.
7.3 Partner with the University of Michigan to identify the current state of care available for persons with a substance use disorders
Improve care coordination surrounding substance use
Improved substance use treatment
Implementation of Project ASSERT was recommended and enacted, see 7.2 for details.
7.4 Develop a clinical treatment pathway for tobacco cessation
Same as strategy 5.2
7.5 Provide support for Friends Together’ s (FT) cancer support groups
Promote and provide support for FT’s five weekly and two bi- weekly cancer support groups
Improved coping skills and reduced anxiety
The Oncology Services awarded $81,000 to Friends Together to provide support groups, transportation assistance, and housing for individuals touched by cancer in Northeast Michigan in 2018, 2019, and 2020.
Mental Health and Substance Use – CONT. Objective VIII: Increase awareness of mental health disorders and opioid use.
8.1 Participate in public awareness campaign to reduce stigma associated with mental illness
Utilize MidMichigan Health’s social media platforms to promote awareness of and education about mental health disorders
Increased knowledge and awareness of mental health disorders
As part of various project connects and other health events, Community Health promoted MidMichigan Health’s online depression risk assessment. Promotion of the depression risk assessment on MidMichigan Health’s social media platforms sought to reduce stigma and encourage individuals to seek care.
8.2 Provide education on mental health and opioid use through MidMichigan Health’s Speakers Bureau
Educational presentations to community groups provided upon request.
Improved knowledge mental health disorders and opioids
The community did not submit any Speakers Bureau requests concerning mental health and opioid use in 2018, 2019, and 2020.
Access to Care
Goal III: Improve the proportion of individuals in the Alpena Services Area that have access to and receive health care services. Objective IX: Increase the availability and affordability of health care services.
9.1 Provide support for transportation services provided by Friend Together
9.2 Offer financial assistance to those unable to afford the cost of care
The Patient Financial Assistance Program provides discounts to financially needy for qualified medical services
Improved access to care
Financial assistance was provided to qualifying patients in 2018, 2019 and 2020. See page 8.
9.3 Expansion of Telemedicine Program
Improve the availability of specialized care through implementation of a maternal fetal telemedicine program
Improved access to care
Expansion of the maternal fetal telemedicine program was completed in 2019.
Access to Care – CONT.
Objective IX: Increase the availability and affordability of health care services.
9.4 Develop a clinical treatment pathway for tobacco cessation Same as strategy 5.2 & 7.4
9.5 Explore implementation of Project ASSET Same as strategy 7.2
9.6 Provide financial assistance for women with obtainment of mammogram Same as strategy 6.1
9.7 Referrals to Michigan Department of Health & Human Services’ Breast and Cervical Cancer Control Navigation Program
9.8 Provide online colorectal cancer risk assessment and free FIT kits Same as strategy 6.4
9.9 Partner with the University of Michigan to identify the current of care available Same as strategy 7.1 & 7.3
SECTION VI
Community Health Needs Assessment Indicators
POPULATION
Individuals Age 65+
Michigan 9,986,857 3,935,041 566,442 1,577,491 6,077,523 1,765,401 39.7 80.4% 15% 0.9% 3.7% 5.3%
Alcona County 10,405 4,988 307 1,006 5,331 3,761 56.1 97.7% 1% 0.8% 0.5% 1.6%
Alpena County 28,405 12,752 1,393 3,921 16,310 6,781 48.1 97.7% 1% 0.7% 0.7% 1.5%
Montmorency County 9,328 4,452 324 1,056 4,884 3,064 58.2 97.8% 1% 0.9% 0.3% 1.4%
Presque Isle County 12,592 5,797 501 1,452 6,544 4,095 55 97.3% 1% 1% 0.7% 1.5%
Source:
of Health & Human Services
Site: MDHHS CB MDHHS MDHHS MDHHS MDHHS CB MDHHS MDHHS MDHHS MDHHS MDHHS
Source Notes: 2019 Es mates
20152019 Es mates
Uninsured Adults
Uninsured Children
Persons without
Health Insurance
Medicaid Insured
Medicare Insured
Care Providers
Ra o
Ra o Annual
Annual Den st
Visit Michigan 7.7% 3.2% 7% 20.3% 21% 1,270:1 880:1 360:1 1,310:1 77.8% * * 14.8% 70.5%
Alcona County 9.7% 1.5% 8.8% 20.4% 42% 1,730:1 1,300:1 1,730:1 10,410:1 75.5% 24.7% 23.4% 21.6% 64.7%
Alpena County 7.2% 2.9% 6.3% 22.2% 31.4% 1,490:1 650:1 300:1 1,090:1 75.8% 25.4% 23.3% 14.3% 66.7%
Montmorency County 9.2% 6.5% 8.1% 22.4% 42.2% 1,320:1 620:1 670:1 1,550:1 75.6% 25.5% 22.4% 14.3% 65.5%
Presque Isle County 9.2% 7.7% 8.3% 19.6% 38.9% 4,250:1 1,400:1 4,200:1 4,200:1 75.9% 23.6% 23.5% 14.3% 65.9%
Source:
Resource Files)
Resource Files)
Michigan Department of Health &
Centers for Disease
Control & Preven on
Site: CB CB CB MDHHS CMS HRSA CMS CMS HRSA CDC CDC CDC MDHHS CDC
Source Notes: 2018 Percentage of adults age 19
64 without health
insurance
20152019 Percentage of children under age 19 who do not have any
form of health insurance
insured between June
2020 May 2021
A and B
2020 Ra o of
providers other than physicians
2020 Ra o of
providers
2018 Ageadjusted
older
2018 Ageadjusted
20172019 The
reported that they did not have anyone
that they thought of as
their personal doctor or
older
Opportuni es 85%
Physical Inac vity
Tooth Loss 39%
Alcona County 72% 17% 39% 15% 4.3% 7.3 16.5% 20.4% 61.8% 13.6% 15.5%
Alpena County 75% 19% 40% 15% 2.3% 7.8 14.9% 14.9% 58.4% 15.6% 13.7%
Montmorency County 72% 16% 39% 15% 1.1% 7.3 18% 24.8% 61.1% 12.4% 16%
Presque Isle County 72% 21% 39% 14% 8.1% 7.1 15% 18.8% 65% 10% 14.1%
Source: Census Bureau (TIGER/Line)
Gap)
Michigan Department of
Census Bureau (American
Centers for Disease
Control & Preven on
Site: CB CDC CDC CDC USDA USDA FM FM MDE CB CDC
Source Notes: 2010 & 2019 Percentage of
popula on with adequate access to loca ons for physical ac vity
2018 Percentage of adults age 20
and over repor ng no leisure me
physical ac vity
2018 Percentage of
adults who report fewer than 7 hours of sleep on
average
of poor physical
health per month
a county with low
from a supermarket
or large grocery
or more than 10
miles from a supermarket
20152018 Index of factors that contribute
to a healthy food environment, 0 (worst) to 10
(best)
lunch
aged >=65 years
Substance of Abuse
Drug Overdose Mortality
Uninten onal Injury Death
Rate Michigan 18.9% 14.4% 19.9% 10.8 58 504 26 * * 29% 49.9
Alcona County 24% 30.7% 20% * 12.7 421.5 * * 33% 50% 47.5
Alpena County 23.8% 32.6% 21.1% 14.8 57.4 592.3 16 * * 50% 42.9
Montmorency County 25.7% 39.4% 20.2% * 21.7 413.2 * 4 * 75% 49.8
Presque Isle County 23.6% 28% 20% * 25.2 357.8 * 2 1% 44% 32.1
Source:
Treatment Episode Dataset,
Health & Human Services
Files)
Planning
Repor ng System)
Health & Human Services
Site: CDC MDHSS CDC MDHSS CDC TED NCHS MOHSP MOHSP NHTSA MDHSS
Source Notes: 2019 Ageadjusted
es mated prevalence of
and older
2018 Ageadjusted
es mated prevalence of binge drinking among adults 18 years and
older
rate per 100,000
persons
for treatment in 2019 for a drug related primary
substance of abuse per 1,000
popula on
county that involved drugs
2019 Percentage of
the total fatali es from crashes that were drug involved in that county
20152019 Percentage of driving deaths with alcohol involvement
20152019 Ageadjusted death rate per
100,000 popula on
Per Capita
Income Income
Inequity Michigan 9.2% 28.9% 23.4% 9.4% 17.7% 11.4% 82.1% 66.2% 28.3% $59,522 $31,713 4.6
Al

Documents

2021 Community Health Needs Assesment