Community Health Needs Assessment Table of Contents I. Executive Summary II. Methodology a) CHNA Scope and Purpose b) Local Collaborating CHNA Parties (The identity of any and all organizations with which the organization collaborated and third parties that engaged to assist with the CHNA) c) CHNA and Town Hall Research Process (A description of the process and methods used to conduct the CHNA, a description of how the organization considered the input of persons representing the community, and an explanation of the process / criteria used in prioritizing such needs) d) Community Profile (A description of the community served by the facility and how the community was determined) III. Community Health Status a) Town Hall CHNA Findings: Areas of Strengths and Areas to Change and/or Improve b) County Health Area of Future Focus (A prioritized description of all of the community needs identified by the CHNA) c) Historical Health Statistics IV. Inventory of Existing County Health Resources a) A description of the existing health care facilities and other resources within the community available to meet the needs identified through the CHNA V. Detail Exhibits a) Patient Origin and Access to Care b) Town Hall Attendees, Notes and Feedback (Who attended with qualifications) c) Public Notice and News d) Primary Research Detail 1 1 *Shaded lines note IRS requirements 1 I. Executive Summary [VVV Consultants LLC] 2 I. Executive Summary Appanoose County, IA - 2016 Community Health Needs Assessment (CHNA) Creating healthy communities requires a high level of mutual understanding and collaboration among community leaders. The development of this assessment brings together community health leaders and providers, along with local residents, to research and prioritize county health needs and document community health delivery successes. This health assessment will serve as the foundation for community health improvement efforts for the next three years. The last CHNA for Appanoose County, IA was published in June of 2013. (Note: The Patient Protection and Affordable Care Act (ACA) requires not-for-profit hospitals to conduct a CHNA every three years and adopt an implementation strategy to meet the needs identified by the CHNA). This assessment was coordinated and produced by VVV Consultants LLC (Olathe, Kansas) under the direction of Vince Vandehaar, MBA. Important CHNA benefits for both the local hospital and health department, as well as for the community, are as follows: 1) Increases knowledge of community health needs and resources 2) Creates a common understanding of the priorities of the community's health needs 3) Enhances relationships and mutual understanding between and among stakeholders 4) Provides a basis upon which community stakeholders can make decisions about how they can contribute to improving the health of the community 5) Provides rationale for current and potential funders to support efforts to improve the health of the community 6) Creates opportunities for collaboration in delivery of services to the community and 7) Provides guidance to the hospital and local health department for how they can align their services and community benefit programs to best meet needs. Town Hall “Community Health Strengths” cited for Mercy Medical Center—Centerville’s Primary Service Area are as follows: Appanoose County, IA - Community Health "Strengths" Topic Topic 1 On-site CT Scan and MRI 14 Have a hospital in our community 2 Mental health services are starting to 15 Health and wellness coalition at the hospital improve due to new access 3 Community involvement in health 16 River Hills offers services to the under-served 4New,youngprovidersinthe 17 Local hospice community 5 EMS services 18 Support groups (Parkinson's and Diabetes) 6 Providers are engaged, trustworthy and 19 All levels of care are available in our build relationships community 7 Good schools 20 Good VA health 8Improvedhomecareservices21 YMCA 9 Availability of healthcare education to 22 Hospitalist program the public 10 Community Resources meeting every 23 Outdoor activities two months 11 Church involvement for poor and 24 Focus on oral health in elementary schools elderly 12 Oak Place mental health stabilization 25 Sustainable agriculture program at the house Community College 13 Social hosting ordinance was passed 3 Town Hall “Community Health Changes and/or Improvements Ranking” cited for Mercy Medical Center—Centerville’s Primary Service Area are as follows: Town Hall Community Health Needs - Year 2016 Mercy Medical Center- Centerville PSA 56 Town Hall Attendees, 220 Votes # Health Needs to Change and/or Improve Votes % Accum 1 After Hours Clinic / Urgent Care Services 45 20.5% 20.5% Increased Visiting Specialists Clinics (Orthopedics, Wound Care, 2 Oncology, Podiatry, Pain Management, Cardiac and 29 13.2% 33.6% Rheumatology) 3 Poverty 26 11.8% 45.5% 4 Personal Health Accountability 24 10.9% 56.4% 5 Rural Ambulance Service (911 Mapping Updates) 18 8.2% 64.5% 6 Healthcare Transportation 17 7.7% 72.3% 7 DHS Presence in Centerville 14 6.4% 78.6% 8 Communication of Available Healthcare Services 12 5.5% 84.1% Total Town Hall Votes 220 100.0% Other Items Noted: Pediatric Mental Health, Inpatient Detox, Depression, Activities/Jobs for the Handi-Capped, Teen Sex Education, Activities for Seniors, Nutrition, Provider Recruitment Starting in Schools, Cost of Healthcare Services, Family Planning Services and Radon. Key Community Health Needs Assessment Conclusions from secondary research for Mercy Medical Center—Centerville’s Primary Service Area are as follows: IA HEALTH RANKINGS: According to the 2016 RWJ County Health Rankings study, Appanoose County’s highest State of Iowa rankings (of 99 counties) were in Physical Environment. TAB 1. Demographic Profile TAB 2. Economic/Business Profile TAB 3. Educational Profile TAB 4. Maternal and Infant Health Profile TAB 5. Hospitalization / Providers Profile TAB6.BehavioralHealthProfile TAB 7. Risk Indicators & Factors TAB 8. Uninsured Profile TAB 9. Mortality Profile TAB 10. Preventative Quality Measures x TAB 1: Appanoose County has a population of 12,661 residents as of 2014. The percent change in population in Appanoose County from April 1, 2010 to July 1, 2014 is -1.8%. The percent of languages spoken in the home other than English in Appanoose County is 2.3%, lower than the Iowa rural norm of 5.2%. The are 1,045 veterans in Appanoose County, lower than the Iowa rural norm of 1,173. The percent of children living in single- parent households in Appanoose County is 33%, higher than the Iowa rural norm of 25.9%. The percent of poverty levels in Appanoose County is 16.3%, higher than the Iowa rural norm of 12.7%. The voter turnout in Appanoose County is 48.5%, lower than the Iowa rural norm of 53.6%. 4 x TAB 2: The per capita money income in the past 12 months in Appanoose County is $21,599, lower than the Iowa rural norm of $24,657. The percent of housing units in multi-unit structures in Appanoose County is 12%, higher than the Iowa rural norm of 10.5%. The percent of severe housing problems in Appanoose County is 13%, higher than the Iowa rural norm of 10.6%. The unemployment rate in Appanoose County is 6.4%, higher than the Iowa rural norm of 4.8%. The child food insecurity rate in Appanoose County is 14.4%, higher than the Iowa rural norm of 12.4%. The percent of persons with a long commute driving alone in Appanoose County is 20%, lower than the Iowa rural norm of 24.9%. x TAB 3: In Appanoose County, 35.7% of students are eligible for free lunch, higher than the Iowa rural norm of 29.4%. 12% of child are in poverty in Clay County, lower than the Missouri metro norm of 19.1%. The 4-year high school graduation rate in Appanoose County is 123, lower than the Iowa rural norm of 145. x TAB 4: The rate of mothers smoking during pregnancy in Appanoose County is 80, higher than the Iowa norm of 62. The rate of mothers under age 20 in Appanoose County is 36, higher than the Iowa rural norm of 28. The rate of out-of-wedlock births in Appanoose County is 131, higher than the Iowa rural norm of 104. x TAB 5: The ratio of the population in Appanoose County to primary care physicians is 1,270, lower than the Iowa rural norm of 1,987. The percent of patients in Appanoose County who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest) is 72%, lower than the Iowa rural norm of 74.3%. The percent of patients in Appanoose County who reported yes, they would definitely recommend the hospital is 63%, lower than the Iowa rural norm of 72.6%. x TAB 6: The percent of the Medicare population in Appanoose County with depression is 15.4%, higher than the Iowa rural norm of 14%. The percent of alcohol-impaired driving deaths in Appanoose County is 18%, lower than the Iowa rural norm of 22.9%. x TAB 7: The adult obesity percent in Appanoose County is 30%, higher than the Iowa rural norm of 31%. The percent of adult smoking in Appanoose County is 28%, higher than the Iowa rural norm of 19%. The percent of excessive drinking in Appanoose County is 23%, higher than the Iowa rural norm of 19.8%. The percent of physical inactivity in Appanoose County is 31%, higher than the Iowa rural norm of 26.4%. The number of poor physical health days in Appanoose County is 5.4, higher than the Iowa rural norm of 2.9. The rate of sexually transmitted infections in Appanoose County is 181, lower than the Iowa rural norm of 226. The percent of the Medicare population in Appanoose County with Hypertension is 57.6%, higher than the Iowa rural norm of 52.8%.