Prioritization of Community Health Needs

Addendum:

2016 Greater Cincinnati CHNA

West Chester Hospital

Prioritization of Community Health Needs

Introduction

In 2015 West Chester Hospital participated, as part of UC Health, in the collaborative development of a Community Health Needs Assessment (CHNA) for Greater Cincinnati, which incorporated considerable community input. This addendum will be published with the CHNA Report in 2016. The addendum describes the prioritization process and its results to identify significant health needs, and it also updates the status of the prior Implementation Plan.

Criteria

A hospital committee scored the community health needs identified in the CHNA by considering the following criteria:

Cause of many hospitalvisits (based on hospital utilization data from the Ohio Hospital Association)
Clear disparities/inequities (by geographic areas of disparity measured by Community Need Index score and/or health issues identified in 2011 and 2013 CDC reports)
Collective Impact priority (Collective Impact is a regional multidisciplinary approach to health improvement.)
Community prioritized it highly (based on consensus on priorities in CHNA)
Consequences if not addressed (professional judgment)
Effective/feasible intervention exists (per The Community Guide; CDC recommendations; and/or recommendations from hospital physicians and/or leaders)
Impact on other health outcomes (based on risk factors associated with issue)
Issue worse over time (based on up to 5 years’ trend data collected for CHNA)
Measurable outcome exist (based on CHNA’s data sources)
Proportion of population impacted (per incidence rate of new cases; prevalence rate; mortality rate; and/or top cause of death)
Unique approach to address problem (per recommendations from hospital physicians and/or leaders)

One criterion was weighted more heavily than the other criteria – ‘Community prioritized it highly’ – in order to retain an emphasis on what the community deemed most significant.

Process

There were two meetings held: one on December 17, 2015 to discuss and determine the prioritization process, and one on January 14, 2016 to conduct the scoring of priorities.

West Chester Hospital adapted UC Health’s Strategic Project Assessment Form, used to determine priorities for health system initiatives, which has a scoring scale of 1 to 5. For the CHNA prioritization process, a score of ‘1’ denoted ‘not a priority,’ and a score of ‘5’ meant ‘strong priority.’ A blank scoring sheet is provided as an example.

In addition to increasing the weight of the criterion, ‘Community prioritized it highly,’ two health issues were also weighted. Access to care/services and mental health were both already identified at UC Health as top priorities during its strategic planning process in 2016.

UC Health’s experience with both mental health and substance abuse also led their combination into one category, since mental health issues are a root cause for most substance abuse disorders. In the CHNA cancer and obesity were mentioned individually as well as mentioned within the broader category of chronic disease. During the prioritization process, these scores were reflected separately and combined together.

Participants

The people who scored the community health needs for West Chester Hospital were:

Tom Daskalakis, FACHE, Chief Administrative Officer
Amber Francosky, Finance Manager
Don Peak, CPA, Director of Operations Finance, UC Health
Marc Roderick, Manager, Business Development; Business Manager of Operations
Karen Shadowens, Director of Finance and Chief Financial Officer

Consideration of community input

The West Chester committee received detailed information about the health issues identified in Butler and Warren Counties by Health Commissioners, individual consumers, nonprofit agencies serving vulnerable populations, and focus group participants. The issues were:

Access to care/services
Cancer
Chronic diseases
Infant mortality
Mental health
Obesity
Substance abuse

Additional needs considered

The West Chester committee reviewed hospital utilization data, which confirmed that obesity, mental health, and substance abuse were significant issues among its patient population, consistent with the CHNA findings.The committee added diabetes to the list, which was identified strongly as a hospital and regional concern but not ranked as highly at the level of community input by county.

Top three priorities

The top priorities for West Chester Hospital were:

Chronic diseases (score = 931)
Mental health & substance abuse (score = 541)
Access to care (score = 330)

The list of priorities and their scores is provided below.

SIGNIFICANT ISSUE / SCORE BY ISSUE / TOP SCORES
Chronic diseases combined / 931.00
Mental health & substance abuse combined / 541.00
Access to care (weight x 2) / 330.00 / 330.00
Mental health (weight x 2) / 322.00
Obesity / 262.00
Cancer / 240.00
Chronic disease, general / 225.00
Substance abuse / 219.00
Diabetes / 204.00
Infant Mortality / 185.00

West Chester Hospital Addendum

Evaluation of Impact of 2013 Implementation Plan

Community Health Need / Initiative / Performance Metric(s) / Action Steps / Action Step Completion Date / Status / Notes
Access to Healthcare / Increase number of clinic visits and % of visits that are charity care to the West Chester Hospital Ambulatory Care Clinics (hospital-based) / Increase number of clinic visits (cumulative):
FY14: 5%
FY15: 10%
FY16: 5%
Increase level of charity care provided (cumulative) by the hospital-based clinics:
FY14: 2.5%
FY15: 2.9%
FY16: 2.9% / 1. Provide specialty clinic access to community residents. / Ongoing / Due to Medicaid expansion, the percentage of charity care charges has decreased. West Chester Hospital, however, continues to provide access to primary care.
Ambulatory Care Clinics include: Orthopedics, Cardiology, Endocrinology, Gastrointestinal, Infectious Disease, Nephrology, Hematology/Oncology, Sleep Medicine, Neurology, Vascular and Pharmacy - Outpatient Pharmacotherapy/Anti N Coagulation, Pulmonary.
2. Increasing scope of specialty care available to local residents. Four new clinic will be added to the hospital campus in July 2013 in addition to the existing eight clinics. / August 1, 2013 (Completed)
3. Reassess physician recruitment needs by February 2015. Explore needs based on available space and completion goal. / February 2015 (Completed)
4. Complete space renovations to accommodate volume increase. / June 30, 2014 (Completed)
5. Complete community awareness initiatives (open houses, advertising, education, seminars, etc.) / Ongoing
Access to Healthcare / Increase number of primary care physician offices within Butler and Warren Counties / Open at least one new practice location per year (FY 14 - FY 16) / 1. Open new Liberty Township Office (Indian Springs or Bridgewater Falls area). / March 31, 2014 (Completed) /
2. Open new location within the Springboro region. / Original Estimate
June 30, 2015 /
3. Open new, additional location within West Chester area (MOB South Building). / Dec. 31, 2016 (Estimated) /
Community Health Need / Initiative / Performance Metric(s) / Action Steps / Action Step Completion Date / Status / Notes
Access to Healthcare / Decrease wait time for patients wishing to schedule appointments within hospital-based clinics / Lag-time reduction (in days) by 10% / 1. Complete construction of new clinic spaces. / June 30, 2015 (Completed) /
2. Recruit physicians. / Ongoing /
3. Utilize UCMC for overflow. / June 30, 2015 (Completed) /
Healthy Lifestyle / Prevention / Establish Mid-Life Women's Center to expand access to primary care and preventative care / education to all women age 35-65 in the community / Minimum 2 Education Sessions per year / 1. Form a center Community Advisory Committee to assist with developing, promoting and conducting educational seminars twice per year open to the community. / June 30, 2016 (Accomplished) / Actual performance:
FY 14: 2 educational sessions
FY 15: 2 educational sessions
FY 16: 4 educational sessions
70,000 Center Visits Overall
Recruitment of 4.0 Primary Care FTEs
19,000 Primary Care Visits / 2. Recruit primary care physicians and increase number of primary care visits. / June 30, 2016 (Accomplished) / Actual Center Visits: 97,712 (FY 14-YTD, plus projection for Jan. 1 - June 30, 2016)
Currently have 5.0 Primary Care FTEs
Actual Primary Care Visits: 21,891 (FY 14-YTD, plus projection for Jan. 1 - June 30, 2016)
2,000 Integrative Medicine / Wellness Visits / 3. Establish practitioners to address wellness through integrative medicine practices. / June 30, 2016 (Accomplished) / Actual Visits: 2,514 (FY 14-YTD, plus projection for Jan. 1 - June 30, 2016)
Community Health Need / Initiative / Performance Metric(s) / Action Steps / Action Step Completion Date / Status / Notes
Healthy Lifestyle / Prevention, continued / 4 Endocrinology / Bone Specialist sessions per week in the Center / 4. Install and implement DEXA scanning equipment in the Center. / Sept. 2014 (Completed) /
5. Establish bone health screenings in the Center. / June 30, 2016 (Progress on track) / Actual Endocrinology sessions:
FY 14 - FY 15: 2 per week
FY 16: 3 per week
DEXA screenings/readings on track
Sexually Transmitted Infections / Increase awareness of the HIV Prevention Clinic and prophylactic use of Truvada for high-risk individuals. / Full utilization of current clinic capacity (1/2 day per month) / 1. Dr. Feinberg speaks to UC Physicians at scheduled meetings to educate primary care physicians and raise awareness of clinic. / June 30, 2104 (Not completed) /
2. Identify opportunities to raise community awareness through earned media. / Ongoing /
3. Create clinic brochures for distribution in areas frequented by high-risk individuals and via community channels. / June 30, 2104 (Completed) /
4. Conduct outreach and networking opportunities with other community-based social service organizations to raise awareness about the clinic. / Ongoing /

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Date approved by Audit and Compliance Committee of UC Health Board of Directors

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Date approved by UC Health Board of Directors

West Chester Hospital Addendum