COMMUNITY HEALTH NEEDS ASSESSMENT 2015 · 2015. 10. 19. · COMMUNITY HEALTH NEEDS ASSESSMENT I. INTRODUCTION Executive Summary Hamilton Memorial Hospital conducted a Community Health

COMMUNITY HEALTH NEEDS ASSESSMENT

2015

A Collaborative Approach to Impacting Population Health in Hamilton and White Counties

2 I Hamilton Memorial Hospital

HAMILTON MEMORIAL HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT

TABLE OF CONTENTSI. Introduction 3

Executive Summary 3Background 4Community Health Needs Assessment Population 4Hamilton Memorial Hospital Service Area Demographics 5

II. Establishing the CHNA Infrastructure and Partnerships 11

III. Defining the Purpose and Scope 12

IV. Data Collection and Analysis 12Description of Process and Methods Used 12Description of Data Sources 13, 22

V. Identification and Prioritization of Needs 25

VI. Description of the Community Health Needs Identified 26

VII. Resources Available to Meet Priority Health Needs 27

VIII. Documenting and Communicating Results 27

IX. References 27

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infringement is a violation of federal law subject to criminal and civil penalties.

Hamilton Memorial Hospital I 3

Hamilton Memorial Hospital Community Health Needs Assessment

COMMUNITY HEALTH NEEDS ASSESSMENT

I. INTRODUCTION Executive Summary

Hamilton Memorial Hospital conducted a Community Health Needs Assessment (CHNA) spanning a period of several weeks in the Spring of 2015. The CHNA is a systematic process involving the community to identify and analyze community health needs as well as community assets and resources in order to plan and act upon priority community health needs. This assessment process results in a CHNA Report which assists the hospital in planning, implementing, and evaluating hospital strategies and community benefit activities.

The Community Health Needs Assessment was developed and conducted, in partnership with representatives from the community, by a consultant provided through the Illinois Critical Access Hospital Network (ICAHN). ICAHN is a not-for-profit 501(c)(3) corporation, established in 2003 for the purposes of sharing resources, education, promoting operational efficiencies, and improving healthcare services for member critical access hospitals and their rural communities.

The process involved the review of several hundred pages of demographic and health data specific to the Hamilton Memorial Hospital service area. The secondary data and previous public health planning conclusions draw attention to several common issues of rural demographics and economies and draw emphasis to issues related to mental health services, wellness, education, physician and specialist supply, transportation, and risky behavior with regard to substances, obesity, teen health, and related issues.

In addition, the process involved focus groups comprised of area healthcare providers and partners and persons who represent the broad interests of the community served by the hospital, including those with special knowledge of, or expertise in public health. Members of medically underserved, low-income, and minority populations served by the hospital or individuals or organizations representing the interests of such populations also provided input. The medically underserved are members of a population who experience health disparities, are at-risk of not receiving adequate medical care as a result of being uninsured or underinsured, and/or experiencing barriers to healthcare due to geographic, language, financial, or other barriers.

Three focus groups met on June 4, 2015, to discuss the overall state of health and the local delivery of healthcare and health-related services. They identified positive recent developments in local services and care and also identified issues or concerns that they felt still existed in the area.

A fourth group comprised of members or representatives of members of the focus groups then met and considered the qualitative and quantitative data gathered and estimated feasibility and effectiveness of possible interventions by the hospital to impact these health priorities; the burden, scope, severity, or urgency of the health need; the health disparities associated with the health needs; the importance the community places on addressing the health need; and other community assets and resources that could be leveraged through strategic collaboration in the hospital’s service area to address the health need.

As an outcome of the prioritization process, discussed above, several potential health needs or issues flowing from the primary and secondary data were not identified as significant current health needs and were not advanced for consideration.

Five needs were identified as significant health needs and prioritized:

1. Mental health services 2. Infant mortality3. Physician and specialist recruitment and retention4. Transportation5. Education and support for chronic diseases


Background

The Hamilton Memorial Hospital District was created by popular vote of the residents of Hamilton County in 1957. The first patient was admitted to Hamilton Memorial Hospital in 1960. Since that time, thousands of inpatients and hundreds of thousands of outpatients have turned to Hamilton Memorial Hospital to address their healthcare needs. The mission of Hamilton Memorial Hospital is to “enhance the delivery of healthcare to our community and the surrounding area by providing accessible quality healthcare services, education, and facilities.”

Provisions in the Affordable Care Act (ACA) require charitable hospitals to conduct a Community Health Needs Assessment (CHNA). Some government owned hospitals may be exempt from the CHNA process, but Hamilton Memorial Hospital has chosen to undertake the review as a matter of best practices regardless of whether or not they ultimately determine they are required to.

The CHNA is a systematic process involving the community to identify and analyze community health needs as well as community assets and resources in order to plan and act upon priority community health needs. This assessment process results in a CHNA Report which assists the hospital in planning, implementing, and evaluating hospital strategies and community benefit activities. The Community Health Needs Assessment was developed and conducted, in partnership with representatives from the community, by a consultant provided through the Illinois Critical Access Hospital Network (ICAHN).

ICAHN is a not-for-profit 501(c)(3) corporation, established in 2003 for the purposes of sharing resources, education, promoting operational efficiencies and improving healthcare services for member critical access hospitals and their rural communities. ICAHN, with 53 member hospitals, is an independent network governed by a nine-member board of directors, with standing and project development committees facilitating the overall activities of the network. ICAHN continually strives to strengthen the capacity and viability of its members and rural health providers. Hamilton Memorial Hospital is a member of the Illinois Critical Access Hospital Network. The Community Health Needs Assessment will serve as a guide for planning and implementation of healthcare initiatives that will allow the hospital and its partners to best serve the emerging health needs of McLeansboro and the surrounding area.

The population assessed included Hamilton and White counties. Data collected throughout the assessment process was supplemented with:

• a local asset review; • qualitative data gathered from broad community representation; and, • focus groups, including input from local leaders, medical professionals, health professionals, and community members who serve the needs of persons in poverty and the elderly.

Hamilton Memorial Hospital is a not-for-profit district hospital.

COMMUNITY HEALTH NEEDS ASSESSMENT POPULATIONFor the purpose of this CHNA, Hamilton Memorial Hospital defined its primary service area and populations as the general population within the geographic area in and surrounding the City of McLeansboro defined in detail below. The hospital’s patient population includes all who receive care without regard to insurance coverage or eligibility for assistance. Zip codes reported by the hospital as its service area indicate that Hamilton Memorial Hospital District serves portions of Hamilton and White counties. Demographics are discussed in terms of the defined service area and at the county level.



DEMOGRAPHICSHamilton Memorial Hospital’s service area is comprised of approximately 929.19 square miles with a population of approximately 23,043 and a population density of 24.80 per square mile. The service area consists of the following rural communities:

Illustration 1. Hamilton Memorial Hospital Service Area

ESRI – 2015

McLeansboro

Cities and Towns VillagesCarmi Broughton

McLeansboro DahlgrenGrayville Macedonia

Belle Prairie City (Town) Burnt PrairieCrossville

EnfieldMaunie

Mill ShoalsNorris City

PhillipstownSpringerton


Report Area Total Population Ages 0-4 Ages 5-17 Ages 18-24 Ages 25-34

Service Area Estimates 23,043 1,414 3,646 1,630 2,570

Hamilton County 8,413 494 1,433 587 950

White County 14,630 920 2,213 1,043 1,620

Illinois 12,848,554 820,771 2,265,645 1,252,399 1,778,128

TOTAL POPULATION CHANGE, 2000-2010According to the U.S. Census data, the population in the region declined from 23,992 to 23,122 between the years 2000 and 2010, a 3.63% decrease.

Data Source: Community Commons

In Hamilton County, the Hispanic population increased by 50 (90.91%) and increased in White County by 55 (53.4%).

In Hamilton County, additional population changes were as follows: White -1.95%, Black -46.55%, American Indian/Alaska Native -9.09%, Asian 72.73%, and Native Hawaiian/Pacific Islander 0%.

In White County, additional population changes were as follows: White -4.66%, Black 40%, American Indian/Alaska Native -11.32%, Asian 24%, and Native Hawaiian/Pacific Islander 500%.

Report Area Total Population2000 Census

Total Population2010 Census

Total PopulationChange, 2000-2010

Percentage Population Change,

2000-2010

Service Area Estimates 23,992 23,122 -870 -3.63%

Hamilton County 8,621 8,457 -164 -1.9%

White County 15,371 14,665 -706 -4.59%

Illinois 12,419,231 12,830,632 411,401 -3.31%

POPULATION BY GENDER AND AGE GROUPSPopulation by gender is 48.26% male and 51.74% female. The region has the following population numbers by age groups:


Report Area Continued Ages 35-44 Ages 45-54 Ages 55-64 Ages 65+

Service Area Estimates 2,551 3,335 3,159 4,738

Hamilton County 43 1,167 1,168 1,671

White County 1,608 2,168 1,991 3,067

Illinois 1,711,098 1,842,487 1,521,168 1,656,858



2020 Population by Age

Number Percent

Ages 0-4 1,249 5.4%

Ages 5-9 1,278 5.6%

Ages 10-14 1,366 5.9%

Ages 15-19 1,276 5.5%

Ages 20-24 982 4.3%

Ages 25-34 2,469 10.7%

Ages 35-44 2,554 11.1%

Ages 45-54 2,721 11.8%

Ages 55-64 3,391 14.7%

Ages 65-74 3,077 13.4%

Ages 75-84 1,809 7.9%

Ages 85+ 839 3.6%

POPULATION WITHOUT A HIGH SCHOOL DIPLOMA (Ages 25 and Older)

Within the report area, there are 2,480 persons aged 25 and older without a high school diploma (or equivalent) or higher. This represents 15.17% of the total population aged 25 and older. This indicator is relevant because educational attainment is linked to positive health outcomes.

Report Area Population Age 25+ Population Age 25+ With No HS Diploma

% Population Age 25+With No HS Diploma

Service Area Estimates 16,353 2,480 15.17%

Hamilton County 5,899 956 16.21%

White County 10,454 1,524 14.58%

Illinois 8,509,739 1,082,381 12.72%


Number Percent

Ages 0-4 1,383 6.0%

Ages 5-9 1,382 6.0%

Ages 10-14 1,361 5.9%

Ages 15-19 1,402 6.1%

Ages 20-24 1,112 4.8%

Ages 25-34 2,583 11.2%

Ages 35-44 2,491 10.8%

Ages 45-54 3,533 15.3%

Ages 55-64 3,130 13.5%

Ages 65-74 2,359 10.2%

Ages 75-84 1,601 6.9%

Ages 85+ 785 3.4%

POPULATION PROJECTIONS BY AGE – COMBINED COUNTIESThe median age in this area is 45.4 years of age, compared to the U.S. median age of 37.9.

ESRI, 2015

Note: This indicator is compared with the state average. Data Source: Community Commons


Number Percent

Ages 0-4 1,298 5.6%

Ages 5-9 1,333 5.8%

Ages 10-14 1,313 5.7%

Ages 15-19 1,229 5.3%

Ages 20-24 1,194 5.2%

Ages 25-34 2,625 11.4%

Ages 35-44 2,403 10.4%

Ages 45-54 3,095 13.4%

Ages 55-64 3,372 14.6%

Ages 65-74 2,728 11.8%

Ages 75-84 1,605 7.0%

Ages 85+ 830 3.6%


HIGH SCHOOL GRADUATION RATES (NCES)Report Area Average Freshman

Base EnrollmentEstimated Numberof Diplomas Issued

On-Time Graduation Rates

Service Area Estimates 304 259 85.7

Hamilton County 101 97 95.5

White County 201 162 80.8

Illinois 169,361 131,670 77.7

Within the report area, 85.7% of students are receiving their high school diploma within four years. This is greater than the Healthy People 2020 target of 82.4%. Healthy People is a federal health initiative which provides science-based, 10-year national objectives for improving the health of all Americans. For three decades, Healthy People has established benchmarks and monitored progress over time in order to:

• Encourage collaborations across communities and sectors.• Empower individuals toward making informed health decisions.• Measure the impact of prevention activities

Healthy People 2020 (HP2020) continues in this tradition with the launch on December 2, 2010 of its ambitious, yet achiev-able, 10-year agenda for improving the nation’s health. Healthy People 2020 is the result of a multi-year process that reflects input from a diverse group of individuals and organizations.

POPULATION IN POVERTY(100% FPL and 200% FPL)

Poverty is considered a key driver of health status. Within the report area 16.15% or 3,643 individuals are living in households with income below 100% of the Federal Poverty Level (FPL). This is higher than the statewide poverty level of 14.13%. Within the report area, 37.53% or 8,467 individuals are living in a household with income below 200% of the Federal Poverty Level (FPL). This is higher than the statewide poverty level of 31.51%. This indicator is relevant because poverty creates barriers to access including health services, nutritional food, and other necessities that may impact health status.

Report Area Total Population Population Below100% FPL Population Below 200% FPL

Service Area Estimates 22,562 3,643 8,467

Hamilton County 8,276 1,413 3,149

White County 14,286 2,230 5,318

Illinois 12,547,066 1,772,333 3,954,161



POPULATION WITH ANY DISABILITY

Within the report area, 17.02% or 3,849 individuals are disabled in some way. This is higher than the statewide disabled population level of 10.48%. This indicator is relevant because disabled individuals comprise a vulnerable population that requires targeted services and outreach by providers.

Report Area Total Population (For Whom Disability Status is Determined)

Total Population With a Disability

Percent Population With a Disability


Hamilton County 8,320 1,353 16.26%

White County 14,293 2,496 17.46%

Illinois 12,668,117 1,327,536 10.48%Note: This indicator is compared with the state average. Data Source: Community Commons



CHILDREN ELIGIBLE FOR FREE/REDUCED PRICE LUNCHWithin the report area, 1,891 public school students (51.37%) are eligible for free/reduced price lunch out of 3,681 total students enrolled. This is slightly higher than the statewide free/reduced price lunch of 50.56%. This indicator is relevant because it assesses vulnerable populations which are more likely to have multiple health access, health status, and social support needs. Additionally, when combined with poverty data, providers can use this measure to identify gaps in eligibility and enrollment.

Report Area Total Students Number Free/Reduced Price Eligible

% of Free/Reduced PriceLunch Eligible



White County 2,576 1,308 50.78%

Illinois 2,055,502 1,027,336 50.56%


INCOME – PER CAPITA INCOMEThe per capita income for the report area is $24,127. This includes all reported income from wages and salaries as well as income from self-employment, interest or dividends, public assistance, retirement, and other sources. The per capita income in this report area is the average (mean) income computed for every man, woman, and child in the specified area.

Report Area Total Population Total Income ($) Per CapitaIncome ($)

Service Area Estimates 23,043 $555,976,400 $24,127

Hamilton County 8,413 $184,746,096 $21,959

White County 14,630 $371,230,304 $25,374

Illinois 12,848,554 $381,170,546,736 $29,666


INSURANCE – POPULATION RECEIVING MEDICAID

This indicator reports the percentage of the population with insurance enrolled in Medicaid (or other means-tested public health insurance). This indicator is relevant because it assesses vulnerable populations which are more likely to have multiple health access, health status, and social support needs. When combined with poverty data, providers can use this measure to identify gaps in eligibility and enrollment.

Report Area Total Population (For Whom Insurance Status is Determined)

Population With Any Health Insurance

Population Receiving Medicaid

% of Insured Population Receiving Medicaid

Service Area Estimates 22,613 20,086 4,095 24.42%

Hamilton County 8,320 7,317 1,698 23,21%

White County 14,293 12,769 3,207 25.12%

Illinois 12,668,117 11,021,355 2,212,779 20.08%



POPULATION RECEIVING SNAP BENEFITS (ACS)This indicator reports the estimated percentage of households receiving the Supplemental Nutrition Assistance Program (SNAP) benefits. This indicator is relevant because it assesses vulnerable populations which are more likely to have multiple health access, health status, and social support needs. When combined with poverty data, providers can use this measure to identify gaps in eligibility and enrollment.

Report Area Total Households Households Receiving SNAP Benefits

% of HouseholdsReceiving SNAP Benefits



White County 6,240 743 11.91%

Illinois 4,772,723 564,185 11.82%


POPULATION WITH LOW FOOD ACCESSThis indicator reports the percentage of the population living in census tracts designated as food deserts. A food desert is defined as a low-income census tract where a substantial number or share of residents has low access to a supermarket or large grocery store. This indicator is relevant because it highlights populations and geographies facing food insecurity.

Report Area Total Population Population With Low Food Access

% Population WithLow Food Access


Hamilton County 8,457 1,735 20.52%

White County 14,665 4,633 31.59%

Illinois 12,830,632 2,623,048 20.44%


LOW INCOME POPULATION WITH LOW FOOD ACCESS

Report Area Total Population Low Income PopulationWith Low Food Access

% Low Income Population WithLow Food Access



White County 14,665 2,169 14.79%

Illinois 12,830,632 584,658 4.56%


This indicator reports the percentage of population of low income residents that have low food access. It further focuses data provided for the entire population in the chart above.



ACCESS TO PRIMARY CAREThis indicator reports the number of primary care physicians per 100,000 population. Doctors classified as “primary care physicians” by the AMA include: General Family Medicine MDs and DOs, General Practice MDs and DOs, General Internal Medicine MDs and General Pediatrics MDs. Physicians age 75 and over and practicing physicians practicing subspecialties within the listed specialties are excluded. This indicator is relevant because a shortage of health professionals contributes to access and health status issues.

Report Area Total Population2012

Primary Care Physicians2012

Primary Care Physicians, Rate Per 100,000 Population



White County 14,568 2,169 14.79%

Illinois 12,875,255 584,658 4.56%


ACCESS TO DENTISTSThis indicator reports the number of dentists per 100,000 population. This indicator includes all dentists qualified as having a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), who are licensed by the state to practice dentistry and who are practicing within the scope of that license.

Report Area Total Population2013

Total Dentists2013

Dentists, Rate Per 100,000 Population

Service Area Estimates 22,917 6 26.18

Hamilton County 8,368 1 11.95

White County 14,549 5 34.37

Illinois 12,882,135 8,865 68.81


POPULATION LIVING IN A HEALTH PROFESSIONAL SHORTAGE AREAThis indicator reports the percentage of the population that is living in a geographic area designated as a “Health Professional Shortage Area” (HPSA), defined as having a shortage of primary medical care, dental, or mental health professionals. This indicator is relevant because a shortage of health professionals contributes to access and health status issues.

Report Area Total Population Population Living in a HPSA

% of Population Living in a HPSA

Service Area Estimates 23,122 23,122 100%

Hamilton County 8,457 8,457 100%

White County 14,665 14,665 100%

Illinois 12,830,632 5,894,575 45.94%


Hamilton and White Counties are both designated shortage areas for primary medical care, dental, and mental health professionals.


III. DEFINING THE PURPOSE AND SCOPEThe purpose of the CHNA was to 1) evaluate current health needs of the hospital’s service area, and 2) identify resources and assets available to support initiatives to address the health priorities identified.

IV. DATA COLLECTION AND ANALYSISThe overarching framework used to guide the CHNA planning and implementation is consistent with the Catholic Health Association’s (CHA) Community Commons CHNA flow chart shown on the next page:

II. ESTABLISHING THE CHNA INFRASTRUCTURE AND PARTNERSHIPSHamilton Memorial Hospital led the planning, implementation, and completion of the Community Health Needs Assessment through a consulting arrangement with the Illinois Critical Access Hospital Network. Terry Madsen, an ICAHN consultant, attorney, and former educator and community development specialist met with hospital executive staff to define the community, scope of the project, and special needs and concerns. An internal working group, possible local sources for sec-ondary data and key external contacts were identified, and a timeline was established.

InternalHamilton Memorial Hospital undertook a three-month planning and implementation effort to develop the CHNA and to identify and prioritize community health needs for its service area. These planning and development activities included the following steps:

• The project was overseen at the operational level by the Director of Marketing, Public Relations and Foundation, reporting directly to the Chief Executive Officer.

• Arrangements were made with ICAHN to facilitate three focus groups, a meeting to identify and prioritize significant needs, and a session to develop an implementation strategy to address the prioritized needs. ICAHN was also engaged to collect, analyze, and present secondary data, and to prepare a final report for submission to Hamilton

Memorial Hospital. • The Community Education Coordinator worked closely with ICAHN’s consultant to identify and engage key

community partners and to coordinate local meetings and group activities.ExternalHamilton Memorial Hospital also leveraged existing relationships that provided diverse input for a comprehensive review and analysis of community health needs in the hospital’s service area. These external components steps:

• The Director of Marketing, Public Relations and Foundation secured the participation of a diverse group representatives from the community and the health profession.• The ICAHN consultant provided secondary data from multiple sources set out below in the quantitative data list.• Participation included representatives of both county health departments serving the area served by the hospital.



Starter Tools & Resources

Why do a CHNA?(broken out by stakeholder)

Where to begin?

Effective Processes& Practices

Guidelines& Checklists

References

FAQ

Choose Geographic Partners

Data Collection & Interpretation

Implementation Strategy Development

Identification,Prioritization & Selection of Health

NeedsMetropolitan

Statistical Area

ServiceArea

State

County

Zip Code

Custom

HealthOutcomes

Data

Drivers ofHealthData

DemographicsKey

DriverData

• Drawn from exemplary data sets

CHNA Data Platform

Data PlatformReport

Community Assets &

Resources

Other Secondary

Data

Community Input

Public Health

Expert Input

Data Interpretation

Process Community Health Needs

PrioritizationProcess

Prioritized Community

Health Needs

CHNA Report

Selectionof NeedsHealth

OutcomesData

Drivers ofHealthData

Needs thatwill be

addressed

Needs thatwill not beaddressed

Implementation Strategy Report

Applying Evidence,

Leveraging Resources

DESCRIPTION OF DATA SOURCES Quantitative

Source Description

Behavioral Risk Factor Surveillance System The BRFSS is the largest, continuously conducted telephone health survey in the world. It enables the Center for Disease

Control and Prevention (CDC), state health departments, and other health agencies to monitor modifiable risk factors for

chronic diseases and other leading causes of death.

US Census National census data is collected by the US Census Bureau every 10 years.

Centers for Disease Control Through the CDC’s National Vital Statistics System, states collect and disseminate vital statistics as part of the US’s oldest and most successful intergovernmental

public health data sharing system.

County Health Rankings Each year, the overall health of each county in all 50 states is assessed and ranked using the latest publicly available data through

a collaboration of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

Community Commons Community Commons is an interactive mapping, networking, and learning utility for the broad-based healthy, sustainable,

and livable communities’ movement.

Illinois Department of Employment Security The Illinois Department of Employment Security is the state’s employment agency. It collects

and analyzes employment information.


County Health Rankings, University of Wisconsin/Robert Wood Johnson Foundation, 2015

SECONDARY DATA DISCUSSIONThe County Health Rankings rank the health of nearly every county in the nation and show that much of what affects health occurs outside of the doctor’s office. The County Health Rankings confirm the critical role that factors such as education, jobs, income, and environment play in how healthy people are and how long they live.

Published by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation, the Rankings help counties understand what influences how healthy residents are and how long they will live. The Rankings look at a variety of measures that affect health such as the rate of people dying before age 75, high school graduation rates, access to healthier foods, air pollution levels, income, and rates of smoking, obesity and teen births. The Rankings, based on the latest data publicly available for each county, are unique in their ability to measure the overall health of each county in all 50 states on the multiple factors that influence health. (County Health Rankings and Roadmaps, 2015)

Hamilton County is ranked 81st out of the 102 Illinois counties in the Rankings released in April 2015. White County is ranked 88th out of the 102 Illinois counties in the Rankings released in April 2015. The following table highlights area of interest from the County Health Rankings.

Source Description

National Cancer Institute The National Cancer Institute coordinates the National Cancer Program, which conducts and supports research, training, health information

dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients.

Illinois Department of Public Health The Illinois Department of Public Health is the state agency responsible for preventing and controlling disease and injury, regulating medical

practitioners, and promoting sanitation.

HRSA The Health Resources and Services Administration of the U.S. Department of Health and Human Services develops health professional shortage criteria

for the nation and uses that data to determine the location of Health Professional Shortage Areas and Medically Underserved Areas and Populations.

Local IPLANS The Illinois Project for Local Assessment of Needs (IPLAN) is a community health assessment and planning process that is conducted every five years

by local health jurisdictions in Illinois.

ESRI ESRI (Environmental Systems Research Institute) is an international supplier of Geographic Information System (GIS) software, web GIS and geodatabase

management applications. ESRI allows for specialized inquiries at the zip code, or other defined, level.

Illinois State Board of Education The Illinois State Board of Education administers public education in the state of Illinois. Each year, it releases school “report cards” which analyze the

makeup, needs, and performance of local schools.



Observation Hamilton County White County Illinois

Adults reporting poor or fair health Not available Not Available 15%

Adults reporting no leisure time physical activity

27% 28% 23%

Adult obesity 29% 32% 27%

Children under 18 living in poverty 24% 24% 21%

Uninsured 13% 13% 15%

Adult smoking Not available 27% 18%

Teen birth rate (ages 15-19) 44/1,000 55/1,000 35/1,000

Motor vehicle crash death rate Not available 17/100,000 9/100,000

Alcohol crash deaths/total crash deaths

100% 25% 37%

Unemployment 8.1% 8.1% 9.2%

HEALTH RANKING OBSERVATIONSTable 1. Health Ranking Observations – Hamilton and White Counties

Diagnosis of arthritis and high blood pressure has exceeded the state level in the past decade. Diagnosis of asthma and diabetes has increased to exceed the state level. Reports of diagnosis of high blood pressure have continued to increase. Reports of diagnosis of arthritis have decreased in the recent past.

37%

32%

36%

26%

11%

18%

13%

33%

36%

36%

29%

8% 8% 8%10%

Arthritis Asthma High Blood Pressure Diabetes

2003 2006 2009 Illinois

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

9%


The Illinois Behavioral Risk Factor Surveillance System provides health data trends through the Illinois Department of Public Health in cooperation with the Center for Disease Control and Prevention, Office of Surveillance, Epidemiology, and Laboratory Services.The following tables reflect information from the IBRFSS that indicate areas of likely healthcare needs.

Table 2. Diagnosed Disease Factors – Hamilton County

IBFRSS, 2015


Table 3. Diagnosed Disease Factors – White County

Arthritis Asthma High Blood Pressure Diabetes

2009 Illinois

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

36%

41%

31%

26%

10%

15% 15%13%

39%

35%

31%29%

12% 13%

10%8%

2003 2006

Diagnosis of arthritis, high blood pressure, and diabetes exceeded the state level in the past decade and are all decreasing. Diagnosis of asthma increased over the last decade to exceed the state level.

Table 4. Health Risk Factors – Hamilton County

IBFRSS, 2015

IBFRSS, 2015

Tobacco use, for the most part, has exceeded the state level in the past decade and is increasing. The rate of persons reporting obesity is just above the state level in the IBRFSS. Teen birth rates (ages 15-19), as noted in Table 1, exceed the state rate.

0%

5%

10%

15%

20%

25%

30%

Tobacco Obesity

Illinois200920062003

26%

15%

20%18%

26%28% 28%

27%



Table 5. Health Risk Factors – White County

IBFRSS, 2015

Tobacco use has consistently exceeded the state levels. The rate of persons reporting obesity has increased to exceed the state level in the IBRFSS and the more recent data from the County Health Rankings. Teen birth rates (ages 15-19), as noted in Table 1, exceed the state rate.

0%

5%

10%

15%

20%

25%

30%

Tobacco Obesity

Illinois200920062003

32%

22%

29%

18%

23%

32%30%

26%

35%

CANCER PROFILESCancer Incidence – Colon and Rectum

Report Area Total Population Average New Cases Per Year

Annual Incidence Rate(Per 100,000 Population)

Report Area 23,188 20 53.85

Hamilton County, IL 8,441 9 70

White County, IL 14,747 11 45.3

Illinois 12,790,182 6,495 48.6

United States 306,603,776 142,173 43.3

HP 2020 Target - - 38.7

Report Area (53.85)

Illinois (48.6)

United States (43.3)

Note: This indicator is compared with the state average. Data Source: National Institutes of Health, National Cancer Institute, Surveillance, Epidemiology, and the End Results Program State Cancer Profiles: 2007-2011. Source Geography: County

Annual Colon and Rectum Cancer Incidence Rate (per 100,000 Population)

Community Commons, 2015

Red numbers indicate over state levels. The green highlights that the indicated service area is not experiencing a problem. The color scheme clarifies where there are differences in the percentages within the reporting area.


Cancer Incidence – LungThe indicator reports the age adjusted incidence rate (cases per 100,000 population per year) of colon and rectum cancer ad-justed to 2000 U.S. standard population age groups (under age 1, 1-4, 5-9, ..., 80-84, 85 and older). This indicator is relevant because cancer is a leading cause of death, and it is important to identify cancers separately to better target interventions.

Report Area Total Population Average New Cases Per Year

Annual Incidence Rate(Per 100,000 Population)

Report Area 23,188 29 83.03

Hamilton County, IL 8,441 8 63.2

White County, IL 14,747 21 94.3

Illinois 12,790,182 9,336 70.6

United States 306,603,776 212,768 64.9

Report Area (83.03)

Illinois (70.6)


Note: This indicator is compared with the state average. Data Source: National Institutes of Health, National Cancer Institute, Surveillance, Epidemiology, and the End Results Program State Cancer Profiles: 2007-2011. Source Geography: County

Annual Lung Cancer Incidence Rate (per 100,000 Population)


Table 6. Mortality – Hamilton and White Counties

The Illinois Department of Health releases county-wide mortality tables from time to time. The most recent table available for Hamilton and White Counties showing the causes of the death within the counties, is set out below.

Disease Type Hamilton County White County

Diseases of the Heart 39 48

Malignant Neoplasms 31 50

Lower Respiratory Systems 5 5

Cardiovascular Diseases (Stroke) 3 15

Accidents 2 7

Alzheimer’s’ Disease 2 2

Diabetes Mellitus 3 2

Nephritis, Nephrotic Syndrome, and Nephrosis

8 8

Influenza and Pneumonia 2 8

Septicemia 1 4

Intentional Self-Harm (Suicide) 1 0

Chronic Liver Disease, Cirrhosis 1 0

All Other Causes 16 42

Total Deaths 114 191

IDPH, 2011 data

The mortality numbers are much as one would expect with diseases of the heart and cancer as the leading causes of death in each county. These numbers are consistent with the mortality reports from other rural Illinois counties. Specific comparisons of causes of death are set out below. The infant mortality numbers seem higher in Hamilton County than might be expected. In reviewing the information below it is important to remember that it is measured in rates involving large numbers of incidents.



Mortality – CancerThis indicator reports the rate of death due to malignant neoplasm (cancer) per 100,000 population. Figures are reported as crude rates and as rates age-adjusted to year 2000 standards. Rates are resummarized to the report area from county level data, only where data is available. This indicator is relevant because cancer is a leading cause of death in the United States.

Report Area (221.12)

Illinois (181.31)


Note: This indicator is compared with the state average. Data Source: Centers for Disease Control and Prevention, National Vital Statistics System, Access via CDC WONDER - Centers for Disease Control and Prevention, Wide-Ranging Online Data for Epidemiologic Research, 2007-2011. Source Geography: County

Cancer Mortality, Age-Adjusted Death Rate (per 100,000 Population)


Report Area Total Population Average Annual Deaths, 2007-2011

Crude Death Rate(Per 100,000 Population)

Age-Adjusted Death Rate (Per 100,000 Population)

Service Area Estimates 23,192 79 342.36 221.12

Hamilton County 8,440 28 334.12 223.65

White County 14,752 51 347.08 219.66

Illinois 12, 787,914 24,135 188.74 181.31

United States 306,486,831 569,481 185.81 174.08

HP 2020 Target - - - 160.6

Infant MortalityThis indicator reports the rate of deaths to infants less than one year of age per 1,000 births. This indicator is relevant because high rates of infant mortality indicate the existence of broader issues pertaining to access to care and maternal and child health.

Report Area Total Births Total Infant Deaths Infant Mortality Rate (Per 1,000 Births)

Report Area 1,365 13 9.52

Hamilton County, IL 475 7 14.7

White County, IL 890 6 6.8

Illinois 879,035 6,065 6.9

United States 20,913,535 136,369 6.52

HP 2020 Target - - 6.0

Report Area (9.52)

Illinois (6.9)


Note: This indicator is compared with the state average. Data Source: Centers for Disease Control and Prevention, National Vital Statistics System. Access via CDC WONDER - Centers for Disease Control and Prevention, Wide-Ranging Online Data for Epidemiologic Research, 2005-2010. Source Geography: County

Infant Mortality Rate (per 1,000 Births)



Mortality – SuicideThis indicator reports the rate of death due to intentional self-harm (suicide) per 100,000 population. Figures are reported as crude rates and as rates age-adjusted to year 2000 standards. Rates are resummarized for report areas from county level data, only where data is available. This indicator is relevant because suicide is an indicator of poor mental health.

Report Area (19.88)

Illinois (9.05)



Suicide, Age-Adjusted Death Rate (per 100,000 Population)






Hamilton County 8,440 No data No data No data

White County 14,752 3 20.34 19.88

Illinois 12, 787,914 1,177 9.21 9.05

United States 306,486,831 37,065 12.1 11.82

HP 2020 Target - - - 10.2

Mortality – Unintentional InjuryThis indicator reports the rate of death due to unintentional injury (accident) per 100,000 population. Figures are reported as crude rates and as rates age-adjusted to year 2000 standards. Rates are resummarized for report areas from county level data, only where data is available. This indicator is relevant because accidents are a leading cause of death in the U.S.

Report Area (47.93)

Illinois (31.77)



Unintentional Injury (Accident) Mortality, Age-Adjusted Death Rate (per 100,000 Population)






Hamilton County 8,440 4 42.65 42.82

White County 14,752 9 59.65 50.88

Illinois 12, 787,914 4,142 32.39 31.77

United States 306,486,831 122,185 39.87 38.85

HP 2020 Target - - - 36.0



Mortality – Heart DiseaseWithin the report area, the rate of death due to coronary heart disease per 100,000 population is 252.45. Figures are reported as crude rates and as rates age-adjusted to year 2000 standard. Rates are resummarized for report areas from county level data, only where data is available. This indicator is relevant because heart disease is a leading cause of death in the United States.

Report Area (252.45)

Illinois (186.84)



Heart Disease Mortality, Age-Adjusted Death Rate (per 100,000 Population)






Hamilton County 8,440 43 514.22 328.1

White County 14,752 55 375.55 209.15

Illinois 12, 787,914 25,354 198.26 186.84

United States 306,486,831 605,315 197.5 184.55

The State Cancer Profiles compiled by the National Cancer Institute lists Hamilton and White Counties at Level 4 for all cancers, which means the cancer rate overall is above the U.S. rate and is stable over the recent past. This is confirmed by the local cancer data set out on the information below and the pages to follow.

PUBLIC HEALTH PLANNINGLocal health departments conduct health needs assessments for their counties on five year intervals under the IPLAN (Illinois Project for Local Assessment of Needs) program of the Illinois Department of Public Health. The latest published report for Hamilton County Health Department indicates that in 2011 their review concluded that the leading health concerns in the area were:

1. Cardiovascular Disease2. Cancer3. Obesity

White County is served by Egyptian Health Department, which provides public health services to five area counties. Egyptian Health Department identified and prioritized four health concerns:

1. Substance Abuse2. Heart Disease and Stroke3. Obesity4. Cancer


SYNTHESIZED SECONDARY DATAThe demographics for Hamilton Memorial Hospital’s service area reflect similar income levels when compared to many other rural areas that are lower than Illinois overall. At least portions of the service area report a higher percentage of population diagnosed with arthritis, asthma, diabetes, and high blood pressure than state percentages. Diseases of the heart and cancer are the two leading causes of death throughout the service area. Obesity and tobacco use are above state levels.

Death from motor vehicle crashes is reported as being higher in White County than statewide. In Hamilton County, the ratio of alcohol-related deaths in crashes compared to all deaths in crashes is 100%. During the identification and prioritization session, it was suggested that there was only one motor vehicle crash resulting in death in the county during the likely reporting period. This crash involved an impaired driver. Infant mortality and teen birth rates are high, but there is insufficient information to determine if those circumstances are related. Adults reporting no leisure time physical activity exceed the state levels. Teen birth rates are high.

SUMMARYThe secondary data and previous public health planning conclusions draw attention to several common issues of rural demographics and economies and draw emphasis to issues related to mental health services, wellness, education, physician and specialist supply, transportation, and risky behavior with regard to substances, obesity, teen health, and related issues.

DESCRIPTION OF DATA SOURCESQualitative Sources

Qualitative data was reviewed to help validate the selection of health priorities. In alignment with IRS Treasury Notice 2011-52.2 and the subsequent final rules reported at 79 FR 78953, the qualitative/primary data received and reviewed included primary input from (1) at least one state, local, tribal, or regional governmental public health department (or equivalent department or agency) with knowledge, information, or expertise relevant to the health needs of the community] and, (2) members of medically underserved, low-income, and minority populations in the community, or individuals or organizations serving or representing the interests of such populations. The organizations and persons that participated are detailed on the following page.

There is no recent prior CHNA to compare against or to report comments regarding.

Data was also gathered representing the broad interests of the community.

The hospital took into account input from persons who represent the broad interests of the community served by the hospital, including those with special knowledge of, or expertise in public health (local, regional, state and/or tribal). Members of medically underserved, low-income, and minority populations served by the hospital or individuals or organizations representing the interests of such populations also provided input. The medically underserved are members of a population who experience health disparities, are at risk of not receiving adequate medical care as a result of being uninsured or underinsured, and/or experiencing barriers to health care due to geographic, language, financial, or other barriers.



Members of the CHNA Steering Committee, those who both participated in focus groups and the needs identification and prioritization process, were chosen based on their unique expertise and experience, informed perspectives, and involvement with the community. The CHNA Steering Committee members included:

CHNA Steering Committee Member and Area of Expertise

Fred Vallowe, McLeansboro City ClerkLaDonna Lasaster, Hamilton County Health DepartmentLoretta Wheeler, Hamilton Memorial Hospital Social Services

Others providing input included through the focus groups included:

Lisa Barnard, York PharmacyRochelle Wilkerson, Egyptian Health DepartmentJanice Crow, Hamilton County Family Resource CenterLinda Zarek, Comprehensive ConnectionAndrea May, Wabash Christian RetirementTiffany Cox, Hamilton Memorial Hospital Senior EnrichmentTeresa Miller, Licensed Clinical Social WorkerDebbie Short, Wabash Area Development Inc.Nancy Prather, community memberMark Auten, Trade IndustriesChristina Schuster, Hamilton County Housing AuthorityVince Mitchell, retired educatorSarah Bilderbeck, community memberNolene Rubenacker, community member

FOCUS GROUPS – HMH MEDICAL PROFESSIONALS AND PARTNERS Three focus groups were convened at Hamilton Hospital on June 4, 2015. The Medical Professionals and Partners group included a pharmacist, representatives of senior services, mental health services and two local public health departments.The group was first asked to report any particularly positive changes they have observed in the delivery of healthcare and services over the past three to five years. They responded with the following:

• Renovation and expansion of Hamilton Memorial Hospital• Physician recruitment/specialist recruitment• Telepsychiatry program• Addition of a psychiatric nurse practitioner• Senior enrichment program• White County clinic at Carmi• School system has done a good job with health education• Regional collaboration among agencies and providers is improved• There is a dentist in Carmi that accepts Medicaid cards• The Hospital Auxiliary provides support for needs at HMH• Hospitalist at HMH• Hamilton/White Senior Services Network that meets monthly

The group was then asked to identify needs and concerns regarding the delivery of healthcare and services and health issues in the community. They responded with the following:

• Diabetes education beyond the hospitalo Assistance and guidance for compliance with care planso Support groupso Certified educator


• Non-emergency transportation for short notice and off-schedule calls; also, affordable short notice transportation even if more expensive than current public rates

• Convenient transportation for dialysis patients• Access to additional specialty services

o Dermatologisto Pediatriciano Endocrinologisto Urologisto Neurologisto Psychiatrist

• Wellness in general, including: o Obesity and childhood obesityo Availability of healthy foodso Access to healthy activities, recreation, and general activities for seniors, including arts and crafts

and technology education• There are not enough psychiatric beds, local or available for transfers• Mental health support groups for bipolar, Alzheimers, and other mental health issues • Mental health counseling for pregnant women and post-partum moms – this a need across the board,

but especially for low income and uninsured/underinsured patients• Information about available health services and regulations impacting access for persons with Medicare and Medicaid • Customer service in healthcare, including polite contacts and improved follow-through • Ambulances for out-of-area transfers• Housing (not just low income)• Services for homeless• Abuse of controlled substances, especially,

o Resale of prescription drugso Abuse of prescriptions by patientso Theft of prescription medicineso Methamphetamineso Synthetic drugs

There were two Community Leaders and Representatives Groups. These groups included a local government official, business leaders, a representative of a local housing authority, a retired educator and others. Each group was first asked to report any particularly positive changes they have observed in the delivery of healthcare and health related services over the past three to five years. They responded with the following:

• Better outreach to the service area• Better cooperation among HMH, local agencies, and providers• Availability of lab services and x-rays at the new Carmi Clinic• Senior Enrichment Center• Better communication from HMH to the community• Enhanced 911• Air evacuation memberships are included in electric bills for part of Hamilton County• Local access to services from HMH• Access to immunizations at clinics, in addition to health departments• Community support for HMH• Aquatics program at HMH• There are more specialists• The hospital gift shop is unique



The groups were then asked to identify needs and concerns regarding the delivery of healthcare and services and health issues in the community. They responded with the following:

• Mental health, including:o All levels of counseling, initial and referrals o Pediatric mental healtho Counseling for developmental disabilities is hard to connect with

• Longer hours for the clinic• Education on management of juvenile diabetes• Physician retention• Planning for physician succession• Specialists

o Dermatologisto Pediatrician

• Education and care for asthma• Air pollution/air quality is a concern• Local resources to assist senior with prescription costs• Women’s health• Healthcare and general community information for new coal mine workers• Dietitian services• More volunteers are needed in the community • Access to dental care for low income, underinsured and uninsured, and new patients• Cancer support groups• Length of hospital stays for elderly patients seems short sometimes• Anticipated decreases from state budget issues

o Transportationo Utility bill supporto In-home senior careo Nursing home placement

• Substance abuseo Methamphetamineso Marijuanao Access to substance treatment

V. IDENTIFICATION AND PRIORITIZATION OF NEEDSAs part of the identification and prioritization of health needs, the CHNA Steering Committee considered the qualitative and quantitative data gathered and estimated feasibility and effectiveness of possible interventions by the hospital to impact these health priorities; the burden, scope, severity, or urgency of the health need; the health disparities associated with the health needs; the importance the community places on addressing the health need; and other community assets and resources that could be leveraged through strategic collaboration in the hospital’s service area to address the health need. The identification and prioritization group included steering committee members and others, including a representative of the Hamilton County Health Department.

As an outcome of the prioritization process, discussed above, several potential health needs or issues flowing from the primary and secondary data were not identified as significant current health needs and were not advanced to be highlighted.


VI. DESCRIPTION OF COMMUNITY HEALTH NEEDS IDENTIFIED AND PRIORITIZEDThe following needs were identified as significant health needs and prioritized:

1. MENTAL HEALTH SERVICES

Both focus groups indicated concerns with local access to mental health services. Issues raised included availability of local crisis care, intervention counseling, access to transfer, and addressing substance abuse issues – especially prescription drug abuse and use of synthetic drugs. Secondary data considered by the identification and prioritization group supported the needs raised by the focus groups.

2. INFANT MORTALITY

This issue emerged from analysis of secondary data. The identification and prioritization group felt that this merited further exploration to determine the true scope of infant mortality, especially in Hamilton County, and possible avenues to address this issue.

3. PHYSICIAN AND SPECIALIST RECRUITMENT AND RETENTION

This issue was raised by both focus groups and is supported by the secondary data. Both counties are identified as Health Professional Shortage Areas for physicians, mental health professionals, and dental care providers. Local specialist access shortages were identified by the focus groups as dermatologist, pediatrician, endocrinologist, urologist, neurologist, and psychiatrist. Concern was also expressed about retention and recruitment of primary care physicians and recruitment of dentists.

4. TRANSPORTATION

Both focus groups identified the need for better availability of short notice transportation and better schedules for public transportation. The identification and prioritization group felt that public transportation was improving but that unresolved issues remained for persons needing transportation related to their healthcare. The group expressed the need for continued improvement of public transportation to create meaningful options for accommodations for patients and others.

5. EDUCATION AND SUPPORT FOR CHRONIC DISEASES

Focus groups identified needs for education and support groups for patients and families facing cancer, heart disease, diabetes and asthma. The identification and support group agreed that these concerns impacted many patients and felt that they presented a significant area of need in delivery of local health services.



VII. RESOURCES AVAILABLE TO MEET PRIORITY HEALTH NEEDSMajor Centers and Services at Hamilton Memorial Hospital

• Carmi Family Clinic• McLeansboro Family Clinic • Emergency Room • Laboratory • Radiology • Rehabilitation Services• Swing Bed Short-Term Rehab• Respiratory Therapy• Social Services• Surgery

Community Organizations, Health Partners, and Government Agencies

Organizations identified through the process that were current or potential partners for addressing health needs and related issues include:

• Egyptian Health Department• Hamilton County Health Department

Approval

The Community Health Needs Assessment of Hamilton Memorial Hospital was approved by the Hamilton Memorial Hospital Board of Directors on the ___________ day of __________.

IX. DOCUMENTING AND COMMUNICATING RESULTSThis CHNA Report will be available to the community on the hospital’s public website: www.hmhosp.org. A hard copy may be reviewed at the hospital by inquiring at the information desk at the main entrance.

XI. REFERENCES

• County Health Rankings, 2014 • Community Commons, 2014• Illinois Department of Employment Security, 2015• National Cancer Institute, 2015 (data through 2011)• Illinois Department of Public Health, 2015• Health Professional Shortage Areas (HRSA) and Medically Underserved Areas/Populations, 2015• Egyptian Health Department, IPLAN• ESRI, 2015• Illinois State Board of Education, Illinois Report Card, 2013-14• USDA, Atlas of Rural and Small Town America

Support documentation on file and available upon request.

Community Health Needs Assessment I 2015Hamilton Memorial Hospital I 611 S. Marshall Avenue I McLeansboro, IL 62859 I 618-643-2361 I www.hmhospital.org

Documents

COMMUNITY HEALTH NEEDS ASSESSMENT 2015 · 2015. 10. 19. · COMMUNITY HEALTH NEEDS ASSESSMENT I. INTRODUCTION Executive Summary Hamilton Memorial Hospital conducted a Community Health