Sutter Health

Sutter Coast Hospital

2013 – 2015 Implementation Strategy

Responding to the 2013 Community Health Needs Assessment

1Sutter Coast Hospital, Implementation Strategy 2013 - 2015

800 E. Washington Blvd, Crescent City, CA 95531

1Sutter Coast Hospital, Implementation Strategy 2013 - 2015

Table of Contents

Introduction

About Sutter Health

2013 Community Health Needs Assessment Summary

Definition of Community Served by the Hospital

Significant Health Needs Identified

2013 – 2015 Implementation Strategy

Lack of Access to Primary and Preventative Services

Limited Access to Mental Health Services

Limited Health Literacy and Health Education Opportunities

Needs Sutter Coast Hospital Plans Not to Address

Approval by Governing Board

Introduction

This implementation strategy describes how Sutter Coast Hospital, a Sutter Health affiliate, plans to address significant needs identified in the Community Health Needs Assessment(CHNA) publishedby the hospitalonSeptember 30, 2013. The documentdescribeshow the hospital plans to address identified needs in calendar (tax) years 2013 through 2015.

The 2013CHNA and this implementation strategywere undertaken by the hospital to understand and address community health needs, and in accordance with proposed Internal Revenue Service (IRS) regulations pursuant to the Patient Protection and Affordable Care Act of 2010.

This implementation strategy addresses the significant community health needs described in the CHNA that the Hospital plans to address in whole or in part. The hospital reserves the right to amend this implementation strategy as circumstances warrant. For example, certain needs may become more pronounced and merit enhancements to the described strategic initiatives. Alternately, other organizations in the community may decide to address certain community health needs, and the Hospital may amend its strategies and refocus on other identified significant health needs. Beyond the initiatives and programs described herein, the Hospital is addressing some of these needs simply by providing health care to the community, regardless of ability to pay.

About Sutter Health

Sutter Coast Hospital is affiliated with Sutter Health, a not-for-profit network ofhospitals, physicians, employees and volunteers who care for more than 100 Northern California towns and cities. Together, we’re creating a more integrated, seamless and affordable approach to caring for patients.

The Hospital’s mission is to enhance the well-being of people in the communities we serve through compassion and excellence in health care services.

At Sutter Health, we believe there should be no barriers to receiving top-quality medical care. We strive to provide access to excellent health care servicesfor Northern Californians, regardless of ability to pay. As part of our not-for-profit mission, Sutter Health invests millions of dollars back into the communities we serve – and beyond. Through these investments and community partnerships, we’re providing and preserving vital programs and services, thereby improving the health and well-being of the communities we serve.

In 2012, our network of physician organizations, hospitals and other health care providers invested $795 million (compared to $756 million in 2011) in health care services for low-income people, community health improvement services, and other community benefits.

For more facts and information about Sutter Coast Hospital,please visit

2013 Community Health Needs Assessment Summary

Between Januaryand August 2013, Valley Vision, Inc., conducted an assessment of the health needs of residents living in the Sutter Coast Hospital Service Area (HSA). For the purposes of the assessment, a health need was defined as “a poor health outcome and its associated driver.” A health driver was defined as “a behavioral, environmental, and/or clinical factor, as well as more upstream social economic factors, that impacts health.”

The objective of the CHNA was as follows:

To provide necessary information for Sutter Coast Hospital’s community benefit plan, to identify communities and specific groups within these communities experiencing health disparities, especially as these disparities relate to chronic disease, and to further identify contributing factors that contribute to the creation of both barriers and pathways to living healthier lives within these communities.

A community-based participatory research orientation was used to conduct the assessment, which included both primary and secondary data. Primary data collection involved gathering input from more than 65 members of the HSA, including expert interviews with 11 key informants and focus group interviews with 54 community members. In addition, a community health assets assessment collected information about 68 assets in the greater hospital service area.

Secondary data used included health outcome data, sociodemographic data, and behavioral and environmental data at the ZIP code or census tract level. Health outcome data included Emergency Department (ED) visits, hospitalization, and mortality rates related to heart disease, diabetes, stroke, hypertension, COPD, asthma, safety and mental health conditions. Sociodemographic data included data on race and ethnicity, poverty (female-headed households, families with children, people over 65 years of age), educational attainment, health insurance status, and housing arrangement (own or rent). Further, behavioral and environmental data helped describe general living conditions of the HSA, such as crime rates, access to parks, availability of healthy food, and leading causes of death.

The full 2013 Community Health Needs Assessmentreport conducted by Sutter Coast Hospitalis available at

Definition of Community Served by the Hospital / The Sutter Coast Hospital service area (HSA) was identified through the collection and analysis of ZIP codes associated with patients discharged from the hospital over a six-month period. Through this analysis, it was determined that approximately 90% of all patients resided in five ZIP codes split between two counties and two states. With the exception of ZIP code 97415(Brookings, OR) all of the ZIP codes in the HSA are located in Del Norte County.
Sutter Coast Hospital is located in Del Norte County, along the Northern Coast of California. The HSA is home to more than42,000 residents. Crescent City (95531) and Brookings (97415) are the most populated areas in the HSA, while Gasquet (95543), Klamath (95548) and Smith River (95567) are smaller, more rural communities. Highway 101 links most of the communities in the HSA and serves as its major transportation corridor.
The Sutter Coast HSA is bounded by redwood forests to the east and the Pacific Ocean to the west, and also contains large sections of tribal land. National parks and beaches attract tourists during the summer months, although the area is prone to fog and rain during several months of the year.
Significant Health Needs Identified / The following significant health needs were identified by the 2013 CHNA.
Significant Community Health Need / Intends to Address
Lack of access to primary and preventative services / Yes
Contributing Factors:
  • Lack of providers who accept publically insured or uninsured patients
  • Clinics located mainly in cities and are difficult for rural population to reach
  • Patients must wait for a long time or are unable to secure appointments
  • People only seek treatment for acute conditions or serious injuries
  • The demand for services exceeds capacity

Limited access to mental health services
Contributing Factors:
  • Limited mental health services available, especially for the uninsured and youth
  • Stigmas around seeking care, especially in small communities
  • Existing programs and services have been cut due to lack of funding
  • People have difficulty building trusting relationships with providers due to high turn over
/ Yes
Limited health literacy and health education opportunities
Contributing Factors:
  • People do not make the connection between behavior, lifestyle choices and their health
  • Many people do not understand how to care for themselves or manage chronic conditions
  • Cultural beliefs and diets may not support positive health outcomes
  • People do not know how to read food labels or use fresh foods to prepare healthy meals
  • People have difficulty understanding and following written instructions
  • Fees associated with available classes are cost prohibitive
  • Classes are offered sporadically or at times that are not convenient, low attendance is an issue
  • People are often unaware of existing educational resources
/ Yes
Inability to fulfill basic needs, including food and shelter
Contributing Factors:
  • Low income families cannot afford to move from housing that is poorly maintained
  • Some housing has mold, poor interior air quality and inefficient weatherization
  • Very limited emergency transitional housing is available
  • There is a fixed homeless population in the area that resides in campgrounds and on beaches and lack access to sanitation
  • Many small communities do not have grocery stores, residents rely on gas stations for food
  • Produce is often expensive or of poor quality in rural areas
  • People with special dietary needs (diabetic, cultural) have difficulty getting necessary food
/ No
Limited access to safe and affordable places to exercise
Contributing Factors:
  • Classes, gyms and youth sports are too expensive for many low income families
  • People in rural areas must drive elsewhere to access sports and recreation activities and costs may be prohibitive
  • Many areas lack sidewalks and adequate lighting or lanes for bicycles; pedestrians do not feel safe walking in high traffic areas
  • Inclement weather deters people from exercising outdoors
  • People do not feel safe walking alone or allowing children to play outside in some areas
/ No
Limited access to reliable transportation
Contributing Factors:
  • Public transit runs infrequently or does not stop near delivery points for health care services
  • Rural areas may not have any public transit options, and people in rural areas become isolated if they cannot drive
  • Cost of gas prohibitive to accessing services, especially specialty care that requires long distance travel
  • Poor weather and limitations of available equipment create challenges with patient transport
/ No
Lack of access to dental care
Contributing Factors:
  • For uninsured adults, extraction is often the only option and dental conditions go untreated
  • People experience long wait times for dental appointments
  • Children are presenting severe dental problems at very young ages
  • People must travel out of the area for specialty services
/ No

2013 – 2015 Implementation Strategy

This implementation strategy describes how Sutter Coast Hospital plans to address significant health needs identified in its 2013 Community Health Needs Assessment and consistent with its charitable mission. The strategy describes:

  • Actions the Hospital intends to take, including programs and resources it plans to commit;
  • Anticipated impacts of these actions and a plan to evaluate impact; and
  • Any planned collaboration between the Hospital and other organizations.

Lack of Access to Primary and Preventative Services

Name of Program, Initiative or Activity / Retention
Description / Retention is often the biggest issue faced when thinking in terms of access to primary and preventative services. The local team is committed to enhancing retention efforts. Some of the ideas include: increasing connection of the school district for providers with children; connecting new providers (and current) with the Chamber/Visitors Bureau to get more ingrained into the community; looking at social capital and the opportunities for spouses of providers to have enhanced opportunities in the local job market. Plan to review exit surveys of providers leaving the community to develop an appropriate retention plan. Work with current providers and local community groups to develop strong physician/provider networks. Identify a lead liaison between the physicians and the community.
Anticipated Impact and Plan to Evaluate / Retaining providers to our community is anticipated to improve access to primary and preventative services. The Hospital will evaluate the success of the program by tracking exits from the community. The Hospital will continue to address total numbers of providers needed in the community and will revisit this significant health need in its next Implementation Plan.
Name of Program, Initiative or Activity / Recruitment
Description / Sutter Coast Hospital (SCH) and Open Door Community Health Center are the two main constituents who recruit new providers into the service area. SCH is currently contracted with two outside physician recruiting firms with the goal of finding one or more family practice physicians and one or more pediatricians. SCH just successfully recruited two new OB/GYN physicians who start in December of 2013 and February of 2014. Our internal team will continue to recruit and work with the external team to bring providers to this area. SCH partners with Open Door and United Health Indian Services as possible to assist with recruitment efforts.
Further the goal is to determine what exists in the current recruitment fund that was created some years ago as a partnership with several groups, including the Del Norte Health Care District, Sutter Coast Hospital and the California Endowment. Plan to put a task force together to put this back at the forefront. The fund currently has $250k in it to aid in the recruitment efforts.
Work to help develop a task force to determine what new guidelines need to be developed to use and grow this fund. Consider any special perks for private practice providers.
Look at recruitment in colleges and emphasis of the HPSA and National Health Scholars opportunities for new graduates with student loan debt.
Teams to first identify all barriers to recruitment and retention and then to work to develop and implement a mitigation plan when it comes to new providers – and saving current providers.
Anticipated Impact and Plan to Evaluate / Recruiting new providers to our community is anticipated to improve access to primary and preventative services. The Hospital will evaluate the success of the program by annually tracking the number of new providers brought in to the community, as well as any providers leaving the community. An anticipated task force will work on not only identifying why those have chosen to leave, but also why the ones who remain, choose to stay. Begin a process of evaluation, which includes mid-evaluation.
The Hospital will continue to address total numbers of providers needed in the community and will revisit this significant health need in its next Implementation Plan.

Limited Access to Mental Health Services

Name of Program, Initiative or Activity / Partnership Development
Description / In addition of the Hospital/Del Norte Community Health Center partnership to recruit a new psychiatrist to town, work with the current providers of mental health services to develop a more detailed partnership.
Plan will be drafted of new collegial group focused on the mental health needs of this community. Goal will be to have five or more local groups participate with measureable plans and outcomes.
Anticipated Impact and Plan to Evaluate / Identified members of the partnership include: Sutter Coast Hospital, Del Norte Community Health Center, DHHS and the Del Norte Health Care District.
Looking for additional avenues – in addition to current recruitment efforts for a psychiatrist – and the development of a plan following recruiting. Also, better utilization of telemedicine in mental health services.

Limited Health Literacy and Health Education Opportunities

Name of Program, Initiative or Activity / Education
Description / Sutter Coast Hospital currently offers a variety of health education programs. There are programs on diabetes in both communities – Del Norte County, California and Curry County, Oregon. There are programs for healthy pregnancy, breast feeding, weight management, childhood development and more.
Further, our education opportunities will include other items identified, but not addressed in year 1 from our Community Health Needs Assessment including, but not limited to: access to dental care, basic needs and safe and affordable places to exercise. An additional identified need – that being lack of transportation – will be taken into consideration with any new education program development.
Anticipated Impact and Plan to Evaluate / Work to better align programs offered with identified health needs of community – including chronic conditions and heart disease. Measure participation rates, numbers educated ability to integrate transportation and addition of providers to serve as instructors.
Name of Program, Initiative or Activity / Literacy
Description / We understand that literacy is a much bigger issue than simple health education. Literacy encompasses the level of understanding of our clients. This includes things as simple as do they understand and know how to follow basic discharge instructions to as complex as how and when to take which medications – for what, when, etc.
Literacy is looking at the “whys” in our community. With an approximate eighth grade learning level, we have the promise of strong partners to insure success.
Anticipated Impact and Plan to Evaluate / Identify the key partners to develop a plan for health literacy. This is no small feat, but one in which this community has energy. The measurements will be healthier citizens with less ER admissions for misusing prescription medication, fewer re-admissions, measurable results from home health and surgery follow up calls.

Needs Sutter Coast Hospital Plans Not to Address

No hospital can address all of the health needs present in its community. Sutter Coast Hospital is committed to serving the community by adhering to its mission, using its skills and capabilities, and remaining a strong organization so that it can continue to provide a wide range of community benefits. This implementation strategy does not include specific plans to address the following significant health needs that were identified in the 2013 Community Health Needs Assessment: