Johnson Memorial Hospital
Community Health Needs Assessment
September 2013
Mission
Johnson Memorial Medical Center is the local primary health care resource for nearby communities in North Central Connecticut and Western Massachusetts. It seeks to improve the health status of the community through readily accessible emergency care, lifespan health care services, and wellness education in a warm, caring environment.
Vision
Johnson Memorial Medical Center will be the region’s health care provider and employer of choice, serving our communities with personalized care and compassion while ensuring clinical excellence, teamwork, operating efficiency and financial stability.
Values
Accessibility
Commitment
Compassion
Efficiency
Strong Integrity
Service Excellence
I. Executive Summary______
Johnson Memorial Hospital conducted a Community Health Needs Assessment for its service area, targeting the Connecticut towns of Stafford, Somers, Enfield, Ashford, Tolland, Willington, Ellington, Suffield, and Union and the Massachusetts towns of Monson, Palmer, Longmeadow, East Longmeadow, Hampden and Wilbraham.
The purpose of the assessment was to gather information about perceived health needs from the citizens and health care providers of this area.
Over the past two years, the assessment consisted of a series of interviews with local Providers, a community survey and information gathered from local health departments and community-based organizations. In addition, three focus groups were informally surveyed through the JMMC Interfaith Clergy Council, Post-Acute Care Council and Geographic Council.
Health needs identified through this process include: obesity, diabetes, behavioral health, substance abuse/alcoholism and heart failure. An Implementation Plan is being designed to address those needs with activities that align with Johnson Memorial Hospital’s mission, vision and values. In addition, other needs identified that will not be directly addressed in the Implementation Plan were: affordable healthcare and parenting classes. With the guidance of the Corporate Strategic Planning Team and identified community partners, the goals, objectives and outcome measures identified for the Implementation Plan will be reviewed annually for the positive impact and improvement of the perceived health needs of the community.
II. Service Area & Population ______
The primary service area of Johnson Memorial Hospital (JMH) encompasses eight zip codes, which relate to the towns of Stafford/Union, Somers, Enfield, Tolland, Ellington, Willington, Ashford and Suffield. The majority of these Connecticut towns are located in Tolland County; however, Enfield and Suffield are located in Hartford County and Ashford is located in Windham County. JMH’s secondary service area consists of five towns in Massachusetts all of which fall under Hampden County. The combined population for these communities is 175,449 residents. Demographics for each community are noted in Tables 1a and 1b on the following pages.
Connecticut Health Rankings by county, published by countyhealthrankings.org were reviewed for 2012 and 2013 with regard to Health Outcomes and Health Factors. Health Outcome rankings are based on mortality and morbidity measures (weighted equally) and Health Factors are weighted on scores with regard to behavioral health, clinical, social and economic and environmental factors. Tolland County is ranked #1 with regard to Health Outcomes and #2 with regard to Health Factors for both years. These rankings put Tolland County in the 90th percentile, meaning on 10% of are better.
Massachusetts Health Rankings with regard to Health Outcome sand Health Factors for 2012 and 2013 for Hampden County were not as favorable. Hampden County ranked last at number 14 in both areas for both years.
Table 1a - JMH Service Area Population Demographic - Connecticut (based upon 2010 Census data)
Stafford/ Union / Somers / Enfield / Tolland / Ellington / Willington / Ashford / SuffieldTotal Population / 12,659 / 11,645 / 44,654 / 15,067 / 15,547 / 6,041 / 4,454 / 12,413
Total Household / 5,060 / 3,344 / 16,794 / 5,318 / 6,236 / 2,423 / 1,773 / 3,867
Population under 5 yrs / 676 / 413 / 2,206 / 793 / 913 / 209 / 240 / 446
Population 5-19 yrs / 2,417 / 1,987 / 7,537 / 3,520 / 3,119 / 1,022 / 851 / 2,403
Population 20-34 yrs / 2,024 / 2,083 / 9,379 / 1,786 / 2,443 / 1,606 / 745 / 2,340
Population 35-64 yrs / 5,929 / 5,526 / 18,769 / 7,229 / 7,249 / 2,557 / 2,122 / 5,529
Population 65+ yrs / 1,613 / 1,636 / 6,763 / 1,739 / 1,823 / 647 / 496 / 1,695
Median Family Income / $ 65,570.00 / $ 100,573.00 / $ 67,809.00 / $ 102,370.00 / $ 84,758.00 / $ 67,736.00 / $ 71,346.00 / $ 109,085.00
# of People in Poverty / 6.1% / 4.4% / 7.2% / 3.2% / 2.8% / 5.1% / 5.0% / 2.2%
Unemployment Rate / 7.5% / 7.6% / 7.7% / 5.8% / 5.0% / 5.1% / 5.9% / 7.7%
White / 12,079 / 9,764 / 38,497 / 14,264 / 14,321 / 5,632 / 4,188 / 10,292
Black/African American / 87 / 995 / 2,755 / 173 / 300 / 48 / 46 / 1,195
Asian / 136 / 91 / 869 / 353 / 514 / 202 / 58 / 182
Spanish/Latino / 378 / 851 / 3,006 / 336 / 398 / 206 / 164 / 824
Table 1b - JMH Service Area Population Demographic – Massachusetts (based upon 2010 Census data)
Longmeadow / East Longmeadow / Hampden / Monson / WilbrahamTotal Population / 15,784 / 15,720 / 5,139 / 2,107 / 14,219
Total Household / 5,741 / 5,851 / 1,898 / 881 / 5,309
Population under 5 yrs / 735 / 728 / 191 / 106 / 571
Population 5-19 yrs / 3,707 / 3,213 / 1,021 / 451 / 3,118
Population 20-34 yrs / 1,432 / 1,893 / 574 / 375 / 1,431
Population 35-64 yrs / 6,919 / 6,722 / 2,406 / 900 / 6,422
Population 65+ yrs / 2,991 / 3,164 / 947 / 275 / 2,677
Median Family Income / $ 111,803.00 / $ 89,570.00 / $ 103,173.00 / $ 86,333.00 / $ 107,871.00
# of People in Poverty / 3.4% / 4.5% / 2.4% / 8.9% / 4.1%
Unemployment Rate / 3.5% / 5.4% / 7.1% / 9.1% / 7.9%
White / 14,587 / 14,858 / 4,986 / 2,030 / 13,367
Black/African American / 167 / 222 / 23 / 13 / 307
Asian / 745 / 377 / 70 / 17 / 286
Spanish/Latino / 370 / 357 / 75 / 42 / 393
III. Community Health Needs Assessment Methodology & Process ______
The process began with the development of a master list of Providers and other providers with specialties in family medicine, internal medicine and pediatrics within the JMH service area. In addition, a master list of other key informants was developed, to include local leaders, business people, health department representatives and employees. A series of questions as outlined in Table 2 below were developed. Participants were then recruited from the master list by written invitation to participate in the process. Follow-up phone calls were placed to schedule date, time and location of individual and/or group interviews.
As part of the Interfaith Clergy Council, Post-Acute Care Council and Geographic Council meetings, participants were asked similar questions to those presented to the Providers and key informants during the interview process. The responses were then reviewed, analyzed and summarized for inclusion in the following report.
Table 2 – Provider & Key Informant Questions:
Provider Questions / Key Informant Questions /What is the most frequent health-related complaint you hear from your patients? / Can you tell me a little bit about what you do?
a) What organization do you work for?
b) Describe the community and population you serve?
· Does it have any special health care needs?
c) It is important that we understand any affiliations you may have with health care providers in the community that may have helped form your opinions on these issues. Do you serve on boards or participate in any organizations that deliver health care services? (Other than the one you work for)
What do you see as the three most important health issues in the community? / What do you see as the most prevalent health issues that affect your constituents/clients?
a) Children/Adolescents
b) Adults
c) Seniors
What causes directly contribute to these health issues? / Do you believe that these healthcare issues are also the most pressing in this community, and, if not, what health issues are?
How can these causes be addressed? / Please comment on the types of services that you believe are important for addressing the health issues you’ve identified.
a) Please identify current programs that are targeting these issues.
b) Are the services you have identified able to meet the health needs of the community?
c) What services are lacking in this community to address these health issues?
d) Are the current services accessible to all and if not, what are the main barriers for access to care?
What is the most preventable health problem you see? / Are there specific populations you feel are underserved in this area?
a) In your experience, what are the best ways to reach out to these populations?
What resources would help you and/or your patients better address these preventable health problems? / Are there any issues that are affecting the overall well-being of the residents of this community?
What emerging health or environmental concerns in the area worry you? / What emerging health or environmental issues in the area concern you?
Are there any other comments you would like to make regarding health care services or lack thereof in this area?
IV. Community Health Needs Identified in Assessment______
The needs identified were classified into three categories – financial, education and wellness/prevention and access to care.
· Financial Concerns - lack of health care insurance, the cost of prescriptions and medical care, which many times results in personal medical debts and unemployment/ underemployment.
· Education, wellness/prevention - lack of understanding or availability of education programs.
· Access to care - lack of availability of specialty providers, such as urologist and neurologists in the service area.
The top health concerns conveyed by the survey interviewees of the JMH service area included obesity, diabetes, behavioral health, and substance abuse (including alcoholism and tobacco use).
1. Obesity – Although Connecticut has one of the lowest obesity rates in the nation, ranked 42 and tied with Nevada and New York at 24.5%, it remains a key concern among providers. As of 2009, Tolland County’s obesity rate was 22.5% up from 21.1% in 2007. In 2011, based upon the U.S. Centers for Disease Control and Prevention, 24.5% of adults in Connecticut were obese. The results of a study published by Healthy Americans.org in 2012, if trends continue on their current trajectories, Connecticut could reach a 46.5% Obesity rate by 2030. Approximately 10.4% of high school students and 21% of adults are obese in Connecticut.
2. Diabetes – In many cases Diabetes can be directly connected to obesity and some of the initiatives to address one with also pertain to the other. The prevalence of diabetes in Connecticut has significantly increased since late the late 1990’s/early 2000’s and is the eighth leading cause of death in Connecticut (2008 data). There are approximately 186,000 adults in Connecticut with diagnosed diabetes and an estimated 93,000 undiagnosed cases. The highest rate of diabetes is found in older adults, low-income adults and racial and ethnic minorities. Risk factors for diabetes are both modifiable and non-modifiable, with the main modifiable risk factor being obesity. It is estimated that 82% of adults with diabetes in Connecticut are obese. Non-modifiable factors include age, family history and pregnancy.
3. Behavioral/Mental Health – Approximately 109,000 adults and 39,00 children of Connecticut’s estimated 3.5 million residents deal with mental health conditions. In 2006 alone, there were 292 suicides in Connecticut, which is almost always a direct result of untreated or undertreated mental health issues. Many Connecticut youth dealing with mental health issues, some receiving special education services, drop out of school and many of those are eventually incarcerated. In 2006, only 2.6% of the total state spending was for mental health agency services. Many individuals with mental health issues turn to drugs and alcohol in an effort to self-medicate.
4. Alcoholism/Substance Abuse – Connecticut is one of the top ten states for dependence upon drugs among young adults ages 18 to 25 (National Survey on Drug Use and Health 2007-2008), with Heroin being the most commonly identified drug for those admitted to drug treatment facilities in Connecticut. In the most recent results issued by the National Survey on Drug Use and Health (NSDUH), 8.23% (National Average is 8.02%) of Connecticut residents admitted using illicit drugs within the past 30 days. In addition. 3.26% (National Average is 3.58%) of Connecticut residents admitted using illicit drugs (other than marijuana) in the past 30 days. As a direct result of drug use, 444 Connecticut residents died in 2007, compared to 309 deaths as a result of motor vehicle accidents and 149 from firearms.
V. Implementation Strategy ______
The health needs that were acknowledged by the Community Health Needs Assessment will be integrated into a three-year community outreach plan in the format noted below. After reviewing current community collaborations and partnerships, and internal resources, JMH will identify its strengths and weaknesses for the four prioritized health needs. By utilizing existing resources, strengthening partnerships and creating innovative programs on both the hospital campus and within the community, JMH hopes to make a positive impact on these identified needs.
A. Needs that JMH Directly Address
Johnson Memorial Hospital Community Health 2013 Implementation Plan /Problem Statement / JMH Strategies / JMH Activities /
Problem / Why? / How? / How, Specifically? /
Obesity
Diabetes
Behavioral Health
Alcoholism/Substance Abuse
B. Needs JMH will not Directly Address
Although JMH recognizes the importance of all needs identified by the community, such as affordable healthcare coverage, and parenting classes for single parents, JMH will not directly design strategies for these issues in the implementation plan; however we will explore the possibility of addressing these concerns either directly or through partnerships with local organizations as appropriate. For example, the concern about affordable healthcare coverage is being addressed on a national and state level. JMH has programs available to facilitate enrollment into Medicaid, application to community (charity) care funds and payment plans.