Community Health Needs Assessment

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2016 COMMUNITY HEALTH NEEDS ASSESSMENT
Approved by the Hospital Board on October 5, 2016
Community Benefit Manager: Susan Frimmel, [email protected]
Director of Community Development – Florida Hospital West Florida Region: Mary Willis, [email protected]
TABLE OF CONTENTS
1. Executive Summary: The Community Health Needs Assessment Process
3
2. Hospital Description
5
3. Choosing the Community
6
4. Community Description & Demographics
7
5. Community Health Needs Assessment Committee (CHNAC)
8
6. Public Health
9
7. Primary & Secondary Data Sources
9
8. Asset Inventory
10
9. Data Summary & Priority Selection
12
10. Preliminary Data – High Level Findings
12
11. Aggregated Service Area Priorities
14
12. Priority Selection
15
13. Decision Tree
15
14. Key Issues to be Addressed or not Addressed
16
15. Next Steps
17
16. Written Comments
17
17. Evaluation of Strategies Undertaken in the 2013 Community Health Plan
17
Appendix A
20
Appendix B
21
2
1. Executive Summary: The Community Health Needs Assessment Process
Goals
Florida Hospital Zephyrhills (FHZ) in Zephyrhills, Florida conducted a Community Health Needs Assessment
in 2016. The goals of the assessment were to:
 Engage public health and community stakeholders including low-income, minority and other
underserved populations
 Assess and understand the community’s health issues and needs
 Understand the health behaviors, risk factors and social determinants that impact health
 Identify community resources and collaborate with community partners
 Publish this Community Health Needs Assessment
 Use Assessment findings to develop and implement a 2016-2019 Community Health Plan
(implementation strategy) based on the Hospital’s prioritized issues
Methods for Engaging the Community in the Assessment
The 2016 Community Health Needs Assessment was built on input from people representing the broad
community, as well as low-income, minority and medically underserved populations. This input was solicited
throughout 2016, and was gathered and considered in multiple ways:
1. The Hospital formed a Community Health Needs Assessment Committee (CHNAC) that included
representatives of the hospital and community (see Section 5) with a special focus on underserved
populations within the hospital community/service area. The Committee’s role was to guide the
Assessment process and select the priority issues for the hospital community. Those members of the
Committee who serve members of minority, low-income and medically underserved populations are
indicated in the listing. Specific Committee functions include:
a. Review of all primary and secondary data
b. Prioritization of key issues identified in the Assessment
c. Selection of Priority Issues to be addressed by the hospital
d. Assistance with the development of a Community Asset Inventory (see Section 8)
e. Participation in community stakeholder surveys
f. Development of the Community Health Plan (implementation strategies) to address the
Priority Issues identified in the Assessment
2. Community stakeholder interviews
3. Public Health input and expertise
a. Membership on the CHNAC
b. Reliance on Public Health input and expertise throughout the Assessment process
c. Use of Public Health data
Community Health Needs Assessment Committee (CHNAC)
In order to assure broad community input, Florida Hospital Zephyrhills created a Community Health Needs
Assessment Committee (CHNAC) to help guide the hospital through the Assessment process. The
Community Health Needs Assessment Committee included representation not only from the hospital, public
health and the broad community, but from low-income, minority and other underserved populations.
3
The CHNAC met twice in 2016. They reviewed the primary and secondary data, helped define the Priority
Issues to be addressed by the hospital, and helped develop the Community Health Plan (implementation
strategies) to address the Priority Issues. See Section 6 for a list of CHNAC members.
Data
Florida Hospital Zephyrhills collected both primary and secondary data. The primary data included
stakeholder interviews, community surveys, and internal hospital utilization data (In-patient and Emergency
Department). This internal utilization data showed the top reasons for visits to Florida Hospital Zephyrhills in
2015.
Much of the secondary data report was compiled by Community Commons/chna.org and Florida CHARTS
Pasco County and Hillsborough County Health Status Reports. Overall, secondary data sources included
publicly available state and nationally recognized data sources. See Section 8 for a list of data sources.
Asset Inventory
The next step was a Community Asset Inventory. This Inventory was designed to help Florida Hospital
Zephyrhills and the Community Health Needs Assessment Committee (1) understand existing community
efforts to address these particular issues and (2) prevent duplication of efforts as appropriate. See Section 12
for the Asset Inventory.
Selection Criteria
Using the data findings and the Community Asset Inventory, the Community Health Needs Assessment
Committee narrowed the list of 8-12 issues to 5 Priority Health and Health Behavior/Risk Factor issues
(determinants of health) utilizing a Decision Tree tool. This tool uses clearly defined criteria to select the top
Health and Health Behavior/Risk Factor issues. See Section14 for the Decision Tree.
The Decision Tree criteria included:
A. How acute is the need? (based on data and community concern)
B. What is the trend? Is the need getting worse?
C. Does the hospital provide services that relate to the priority?
D. Is someone else – or multiple groups – in the community already working on this issue?
E. If the hospital were to address this issue, are there opportunities to work with community
partners?
4
Priority Issues
The Priority Issues selected by the Community Health Needs Assessment Committee were:
1. Obesity
2. Heart Disease
3. Lack of exercise
4. Smoking Cessation
5. Nutrition/Access to healthy food
See Section 15 for an explanation of the issues chosen and not chosen – and the reasons why or why not.
Approvals
The Community Health Needs Assessment findings and selected Priority Issues were approved by the Florida
Hospital Zephyrhills Hospital Board on ____. The final Needs Assessment was posted on the hospital’s web
site prior to December 31, 2016.
Next Steps
Next, the Community Health Needs Assessment Committee will work with Florida Hospital Zephyrhills to
develop a measurable 2017-2019 Community Health Plan (implementation strategy) to address the priority
issues. The Plan will be completed and posted on the hospital’s web site prior to May 15, 2017.
2. Hospital Description
Florida Hospital Zephyrhills is a 139-bed regional medical center located in East Pasco County. It is a
member of the Florida Hospital network of Adventist Health System, one of the largest health care providers
in the state of Florida. Florida Hospital Zephyrhills has been nationally recognized by the American Heart
Association, the American Stroke Association, The Joint Commission, and HealthGrades for providing quality
patient care with emphasis on safety and patient outcomes. The award-winning Heart Institute is recognized
for the treatment of coronary intervention, heart failure, chest pain, open heart surgery, and
electrophysiology procedures and has received the Gold Plus Award for heart failure from the American
Heart Association and the American Stroke Association. The hospital offers a full range of inpatient and
outpatient surgical offerings including orthopedic services such as hip and knee replacement and
MAKOplasty® robotic partial knee replacement. The Women’s Health Center offers services for women
including gynecology, urology and pelvic floor health, labor and delivery through The Baby Place®, and
breast care through the Simpson Breast Health Center. The hospital also offers 24/7 emergency services
including a “fast track” option, imaging services, and the Center for Wound Healing. Visit FHZeph.org for
more information.
Florida Hospital Zephyrhills is part of Adventist Health System (AHS), which has 44 hospitals in 10 states. AHS
is a national leader in quality, safety and patient satisfaction. Although separated in geography, our facilities
are united by the common values of Christian mission, community wellness, quality and service excellence,
high ethical standards, compassion and cultural diversity. Our facilities practice the tradition of wholeperson care in all that we do.
5
3. Choosing the Community
Florida Hospital Zephyrhills defined its “community” as its Primary Service Area (PSA) from which 75-80% of
its patients come.
6
4. Community Description & Demographics
Florida Hospital Zephyrhills’ Primary Service Area includes zip codes in Pasco County.
Florida Hospital Zephyrhills PSA Zip Codes
33523
33525
33540
33541
33542
Demographics: Pasco County
Pasco County is located in west central Florida
directly north of Hillsborough County (home of
the city of Tampa). It is considered a rural county
but has larger cities of its far left side. Dade City is
the county seat.
As of July 1, 2015 Pasco County is estimated to
have had 497,909 residents.
89.1% of the Pasco County population is White, 5.8% is Black, 14% is Hispanic, and 2.5% is Asian. 22.7% of
residents are ages 65 or older, another 20.4% are under age 18. Overall, residents are 51.5% female and
48.5% are male. Pasco County has large numbers of winter residents, or “snowbirds.”
87.5% of Pasco residents have at least a high school diploma, but just 21.1% have a Bachelor’s degree or
higher. The median household income is $44,518. 14.7% of residents of Pasco County residents have
incomes below the poverty level.
Zephyrhills is the home of Florida Hospital Zephyrhills. Pasco’s county seat is Dade City, and its largest city is
New Port Richey.
The source for the demographics of Pasco county is the US Census Quick Facts retrieved 6/29/16 from:
http://www.census.gov/quickfacts/table/PST045215/12101.
Demographics: Primary Service Area
90.44% of the PSA population is White, 5.22% is Black, 12.35% is Hispanic, and 0.95% is Asian. 29.28% of
residents – are ages 65 or older, another 18.28% are under age 18. Overall, residents are 50.71% female and
49.29% are male.
18% of the PSA population aged 25 and older do not hold a high school diploma or equivalent. 14.7% of
residents of Pasco County residents have incomes below the poverty.
PSA Statistics taken from the Florida Hospital Zephyrhills secondary data report. The report is posted on the
Florida Hospital Zephyrhills website along with the Community Health Needs Assessment.
7
Demographics: Florida Hospital Zephyrhills’ Hospital Patients in 2015
Description
Statistic
Discharges:
8,317
Avg. Patient Age
64
Medicare Patients
67.09%
Medicaid Patients
14.19%
Self-Pay Patients
5.39%
93.6% Caucasian, 4.54% African American, 0.02% Multicultural, 0.20%
Asian, and 1.64% Other
Race
Gender Distribution
45.03% Male and 54.97% Female
Avg. Length of Stay
4.1
Capacity:
67.70%
5. Community Health Needs Assessment Committee (CHNAC)
A Community Health Needs Assessment Committee was formed to help Florida Hospital Zephyrhills conduct
a comprehensive assessment of the community. The Committee included representation from the broad
community; public health; and low-income, minority, and other underserved populations. The Committee
met regularly throughout 2016.
The Stakeholder represents:
Name
Randy Surber
Susan Frimmel
Casio Jones
Mike
Vanderbilt
Doug Higgins
Cheryl Pollock
Deanna
Krautner
Entity/Agency
Represented
Florida Hospital
Zephyrhills
Florida Hospital
Zephyrhills
Florida Hospital
Zephyrhills
Florida Hospital
Zephyrhills
Florida Hospital
Zephyrhills
Premier Community
HealthCare – federally
qualified health care
center
Pasco County Health
Department – public
health services
Title
Minority
Lowincome
Public
Health
CEO
Other
Medically
Underserved
x
Community
Benefit Manager
Director of
Wellness Center
Director of
Patient Access
x
x
x
x
x
FHZ Chaplain
x
x
Director
Community
Services
x
x
x
x
Public Info.
Health Officer
x
x
x
x
x
x
Bob Winters
Hospital Board
Representative
Hospital Board
Nick Deford
Church of the Nazarene –
church with community
service focus/initiatives
Pastor
x
8
6. Public Health
Public Health was represented in the CHNA process through their involvement on the Community Health
Needs Assessment Committee and completion of the Stakeholder Survey.
Deanna Krautner, M.Ed., CHES, is the Health Education Program Manager and Public Information Officer for
the Pasco County Department of Health. Ms. Krautner is a Certified Health Education Specialist and serves as
the agencies Public Information Officer. Her work includes health assessment and improvement planning,
agency strategic planning and performance management, as well as community collaboration.
Cheryl Ann Pollock joined Premier Community HealthCare Group (the local Federally Qualified Health
Center), Inc. as the Director of Business Development in 2012. She is a veteran project manager, grant
writer, community organizer and trainer/group facilitator with over 20 years of experience in the public
health & human services sector. Her strengths include strategic project development, public
relations/community engagement, project management, annual/capital campaign development, grantwriting and management. Cheryl also has a passion for implementing results-based programs that help
people and communities thrive. As Director of Business Development for Premier, Cheryl is responsible for
implementing strategic initiatives that further the mission of the organization. She is also responsible for
fund development, community engagement, special events, public relations and communications, and
partnership development that leverage resources and improve health care access for underserved residents.
7. Primary & Secondary Data Sources
Primary Data
a. Community Health Needs Assessment Committee
b. Stakeholder surveys (The CHNAC and community stakeholders were surveyed. See Appendix A
for a copy of the survey and see Appendix B for the survey results).
c. Community surveys (100 surveys were conducted electronically through e-mail to the
community. See Appendix A for a copy of the survey and Section 10 for the aggregated results).
d. Hospital Utilization Data (Top 10 In-patient and Emergency Department diagnoses by zip code
by payer source)
Secondary Data
a. Cardiac Arrest Registry to Enhance Survival (CARES), 2011-2012
b. Centers for Disease Control & Prevention (CDC), Behavioral Risk Factor Surveillance System
(BRFSS)
c. Centers for Disease Control & Prevention (CDC), National Center for Chronic Disease Prevention
& Health Promotion, 2012
d. Centers for Disease Control & Prevention (CDC), National Vital Statistics System
e. Centers for Disease Control (CDC), Wide-Ranging Online Data for Epidemiologic Research, 20062010
f. Dartmouth Atlas of Health Care, Clinical Practice, 2012
9
g. Dartmouth College Institute for Health Policy
h. Federal Bureau of Investigation (FBI), FBI Uniform Crime Reports with additional analysis by the
National Archive of Criminal Justice Data
i. Florida CHARTS – Pasco County Healthy Status Report
j. Healthy People 2020
k. National Institutes of Health (NIH); National Cancer Institute (NCI); Surveillance, Epidemiology
and End Results Program; State Cancer Profiles; 2007-2011
l. University of Wisconsin Population Health Institute, County Health Rankings, 2015
m. US Census Bureau, American Community Survey (ACS), 2009-2013
n. US Census Bureau, Quick Facts Pasco County Health Status Report, 2016
o. US Census Bureau, Small Area Health Insurance Estimates, 2013
p. US Dept. of Agriculture (USDA), Economic Research Service, USDA Food Access Research Atlas,
2010
q. US Dept. of Health & Human Services (HHS), Center for Medicare & Medicaid Services (CMS),
Provider of Services File, Sept. 2015
r. US Dept. of Health & Human Services (HHS), Health Indicators Warehouse
s. US Dept. of Health & Human Services (HHS), Health Resources & Services Administration (HRSA),
Area Health Resource File, 2013
t. US Dept. of Labor (DOL), Bureau of Labor Statistics, Sept. 2015
8. Asset Inventory
The following Asset Inventory includes the top health priorities for the Florida Hospital Zephyrhills community, and
shows the services related to these areas of concern both in the community and at Florida Hospital. An Asset Inventory
can help prevent the duplication of services and was therefore important to the Community Health Needs Assessment
Committee and Florida Hospital Zephyrhills staff in determining the hospital’s top health priorities.
Top 8-12 Areas of Focus defined
by Primary/Secondary Data
Current Community Programs
OBESITY
30.6% of adults age 20+ selfreport that they have a BMI
greater than 30 (obese) in our
area; #1 health problem
identified in primary data
collection.
YMCA
Weight Watchers
Various church programs
Pasco County Health Department
offers Healthiest Weight Program
DIABETES
Age-adjusted percentage of
adults with diabetes is 0.51%
higher than the state. 8,000
diagnosed in our area.
American Diabetes Association
outreach and educational materials
Health Department Diabetes
Education Program
Premier FQHC diabetes management
Current Hospital Programs
CREATION Health 8 Week Program
CREATION Health Wellness Center
CREATION Health Fitness/Walking Trail
open to public
CREATION Health Community Garden
Free community education classes, cooking
demonstrations and annual 5K run
Heart Healthy Nutrition Classes
Diabetes Education Program
Diabetes Support Group
Walgreens Rx Partnership Program
Free diabetes screenings at various
community events
10
Top 8-12 Areas of Focus defined
by Primary/Secondary Data
Current Community Programs
HEART DISEASE
8.6% of adults ages 18+
diagnosed with heart disease
compared to state rates at 5.6%
and national rates at 4.4%.
American Heart Association outreach
and educational materials
Pasco County School Board has A
Million Hearts Campaign to
encourage employees and their
families to take care of their hearts
EHAC educational materials distributed at
community events
Life coach/CREATION Health Program for
cardiac patients
Cardiac Rehabilitation Program
CREATION Health Wellness Center
Annual Heart Expo for community with
education & screenings
Heart education talks and screenings at
55+ communities
CREATION Health Fitness/Walking Trail
open to public
Accredited Chest Pain Center with PCI
AHA Get With the Guidelines recognition
for heart and stroke
Stroke and A-fib Support Groups
Heart Healthy Nutrition Classes & cooking
demonstrations
SMOKING
25.7% of adults age 18+ selfreport that they currently smoke
cigarettes some days or everyday
which is 7.7% higher than the
state.
Gulfcoast North AHEC offers IQuit
Tobacco Program. Pasco County
Health Department offers the
resources for groups looking to
change policies and connects smokers
to resources. Premier Community
HealthCare provides smoking Healthy
Start Program (pregnant women who
smoke) cessation. Quitline available
for resources.
Students Working Against Tobacco (a
youth advocacy program in middle
and high schools)
Partner with AHEC to provide minimum of
four to six iQuit classes each year on FHZ
campus
LOW-INCOME
FAMILIES/POVERTY
Our PSA percentage of
population in poverty is 17.4%
which is higher than the state at
16.34% and nation at 15.37%.
Premier Community Healthcare
Group serves the underprivileged
providing behavioral health, dental,
family medicine, pediatrics and
women's health.
Pasco County Health Department
Partner with Premier Community
Healthcare Group to provide a full-time
navigator in hospital's ER to assist
uninsured with scheduling follow-up
appointments with Premier. Also extend
this service to inpatient care
Medicaid enrollment assistance available in
ER and registration
Charity care- provide free health screenings
throughout the year to community
Current Hospital Programs
11
Top 8-12 Areas of Focus defined
by Primary/Secondary Data
Current Community Programs
LACK OF EXERCISE
23.9% of the PSA adults aged 20
and older self-reported no leisure
time for activity.
NUTRITION/ACCESS TO FOOD
The food insecurity rate for the
PSA is 15.1% of population.
26.29% of the PSA population
have low food access.
9.
Current Hospital Programs
FHZ has a walking trail on the campus
which is free to the community.
Annual 5K run
FHZ has a Creation Health Wellness Center
and membership is open to the
community.
Local Food Banks
DOH SNAP program
Data Summary & Priority Selection
The Community Health Needs Assessment Committee for Florida Hospital Zephyrhills reviewed the data
from each of the data primary and secondary sources described above. They aggregated those findings into
a list (next page) that reflected all data sources.
The Committee then looked at the acuity of each issue, determined who in the community was working on
the issue, and discussed the “fit” with hospital services. Based on those criteria, they narrowed the list to the
Florida Hospital Zephyrhills’ top needs. Those needs would be addressed in the Florida Hospital Zephyrhills
Community Health Plan (Implementation Strategies) also posted on this website.
10. Preliminary Data – High Level Findings regarding Top Health Issues
Note: The health priorities for all sources are ranking in random, not priority, order.
List the 8-10 health priorities determined by Primary Data from Community Stakeholder Interviews/Surveys (including
the Community Health Needs Assessment Committee)
1 Obesity
6 Mental health
2 Diabetes
7 Lack of exercise
3 Substance abuse-drugs
8 Heart disease
4 Poor nutrition
9 Cancer
5 High blood pressure/cholesterol
10 Substance abuse - alcohol
List the 8-10 health priorities determined by Primary Data from Community Surveys
1 Obesity (77.7%)
6 Lack of exercise (46.7%)
2 Heart disease (76.8%)
7 Smoking (37.23%)
3 Diabetes (72.6%)
8 Cancer (30.5%)
4 High blood pressure/cholesterol (60%)
9 Low-income families/Poverty (90.3%) social determinant
5 Aging population (52.1%)
10 Lack of health insurance/Affordable care (61.3%) social determinant
12
List the 8-10 health priorities determined by Primary Data from 2015 Florida Hospital Zephyrhills Hospital Utilization data
(Emergency Department (ED) and In-patient (IP) by top conditions by zip code)
1 ED – Urinary Tract Infection
6 IP – Septicemia
2 ED – Middle ear infection
7 IP – Atrial fibrillation
3 ED – Bronchitis
8 IP – Acute kidney failure
4 ED – Headache
9 IP – Coronary Atherosclerosis
5 ED – Pharyngitis
10 IP – Bronchitis
List the 8-10 health priorities determined by Primary Data from 2015 Florida Hospital Zephyrhills Hospital Utilization
data (Emergency Dept. All Patients, not based on discharge diagnosis from hospital utilization data)
1 ED - Chest Pain
6 ED - COPD
2 ED - Urinary Tract Infection
7 ED - Abdominal Pain
3 ED - Bronchitis
8 ED - Headache
4 ED - Upper Respiratory Infection
9 ED - Vomiting
5 ED - Pharyngitis
10 ED - Middle ear infection
List the 8-10 health priorities determined by Secondary Data from the Florida Hospital Zephyrhills Secondary Data
Report (posted on the FHZ website along with the CHNA report)
1 Heart disease
6 High blood pressure prevalence
2 High cholesterol
7 Obesity – adult/Overweight - adult
3 Colon and Rectum Cancer Incidence
8 Physical inactivity - adult
4 Diabetes
9 Poverty rate
5 Heart Disease Mortality
10 Tobacco usage – current smokers
List the top 8-10 health priorities determined by Secondary Data collected from Florida CHARTS Pasco County Health
Status Report.
1 Smokers (Adults)
6
2 High Blood Pressure (Adults)
7
3 Adult Female cervical cancer screening (pap)
8
4 Asthma age-adjusted hospitalization rate
9
5 Infectious Diseases
10
13
11. Aggregated Service Area Priorities based on the Issues listed above
Florida Hospital Zephyrhills’ staff aggregated the above priorities into the following list. The Community
Health Needs Assessment Committee reviewed the list to determine its accuracy, and then prioritized
Florida Hospital Zephyrhills’ top community priorities.
1
Priority Issue
Obesity
Age Group
Children and Adults
Specific Geographic Area
33523, 33525, 33540,
33541, 33542
Adults aged 25 or
older
33523, 33525, 33540,
33541, 33542
Adults/Seniors
33523, 33525, 33540,
33541, 33542
Lack of Exercise
Ethnic Group
State’s percentage of overweight
adults is 36.76% white; 34.59% black,
37.87% Hispanic or Latino and 37.7%
other
18% of the PSA population aged 25
and older does not have a high-school
diploma or equivalent. Of the
population without a high-school
diploma or equivalent, 18.20% are
Latino or Hispanic. 17.82% are White,
23.03% are Black or African American,
3.7% are Native American/Alaska
Native, 15.6% are Asian, 19.73% are
Some Other Race, and 22.72% are
Multiple Race
Heart disease age-adjusted mortality
rates per 100,000 population are 169
White, 145 Black, 60 Asian, and 104
Hispanic or Latino.
All groups
2
Education/Literacy
3
Heart Disease
4
Children and Adults
5
Transportation
All groups
All groups
6
Low-Income/Poverty
Adults
7
Smoking Cessation
Of those in poverty, 80.14% white,
12.45% black, 3.98% multiple race,
1.91% other, 0.99% Asian and .53%
North American/Alaska native
All groups.
33523, 33525, 33540,
33541, 33542
33523, 33525, 33540,
33541, 33542
33523, 33525, 33540,
33541, 33542
8
Nutrition/Access to
Healthy Food
Access to Programs
and Healthcare
9
All groups
All groups
Teens and Adults
25.75% of Adults age
18 and older report
cigarette smoking.
Children, Adults and
Seniors
All groups
33523, 33525, 33540,
33541, 33542
33523, 33525, 33540,
33541, 33542
33523, 33525, 33540,
33541, 33542
14
12. Priority Selection
As noted in the DATA SUMMARY section above, the primary and secondary data, along with the ASSET
INVENTORY, were used to narrow down the top areas of significant community health need for Florida
Hospital Zephyrhills. This discussion and decisions took place at the Florida Hospital Zephyrhills Community
Health Needs Assessment Committee in July, 2016.
The Committee used a “decision tree” format to prioritize the top needs down that Florida Hospital
Zephyrhills will address in its Community Health Plan.
13. Decision Tree
The Community Health Needs Assessment Committee used the decision tree to narrow down the
aggregated priorities (above) into three priority areas. The decision tree criteria for inclusion included:
1. How acute is the identified issue in the region?
2. How acute is the identified issue in the primary service area, the immediate area around Florida
Hospital Zephyrhills, and the over-65 population?
3. Are other community resources/organizations already addressing the need? (see Section 8 Asset
Inventory)
4. Can Florida Hospital Zephyrhills effectively influence the issue?
a. Does Florida Hospital Zephyrhills offer related services?
b. Does Florida Hospital Zephyrhills have the ability to influence the issue through the
implementation/expansion of programs, services, and other actions?
Identified Need:
E.g., Low
Birthweight Babies
YES.
We provide
OB and/or
prenatal
services
What other groups
are working on this
need?
NO.
We do not
provide OB
and/or
prenatal
services.
What other groups
are working on this
need?
Many
Consider
collaborating with
others
Few
Seriously
consider this
as a Priority
Many
Hospital has
no role
Few
Encourage/support
others who are
meeting this need
Is the hospital able
to effectively meet
this need?
15
14. Key Issues to be Addressed or not Addressed – Committee Worksheet
(High, Medium, Low)
Health Issue
Acuity
Level in
PSA
Acuity
Level in
Pasco
County
Addressed
by other
Community
Groups?
FHT
Capacity
to
Impact?
Issue
Selected
Yes or No
Rationale Yes or No
Obesity/Lack of Exercise
H
H
Y
Y
Y
Obesity is related to
diabetes, heart disease
and cancer
Heart Disease
H
H
Y
Y
Y
Risk-factors are lifestyle
related
Y
Adults often use
hospital ER’s for
primary care/dental
care. Health literacy is a
key factor in
understanding health
risk factors and disease.
Hospital has
opportunity to partner
with community
agencies
Low-Income/Poverty/
Health Education/Access
to programs & Healthcare
H
H
Y
Y
Smoking Cessation
H
H
Y
Y
Y
Smoking is a risk factor
for lung cancer and
other respiratory
conditions
Nutrition/Access to
Healthy Food
H
H
Y
Y
Y
Nutrition is key to
health
Transportation
H
H
N
N
N
No FHZ capacity
16
15. Next Steps
After identifying the priority issues for Florida Hospital Zephyrhills, the Community Health Needs
Assessment Committee developed a Community Health Plan (implementation strategies) to address the top
priorities defined in the Needs Assessment.
16. Written Comments
Florida Hospital Zephyrhills did not receive any written comments from the public regarding the 2013 Needs
Assessment nor 2013 Community Health Plan.
17. Evaluation of the Strategies Undertaken in the 2013 Community Health Plan
The Hospital conducts an annual Evaluation of the progress made on its Community Health Plan
(Implementation Strategies). The Evaluation is reported to the IRS in the hospital’s Form 990. The following
narrative is a copy of the 2015 Community Health Plan Evaluation as noted in Form 990, Schedule H, Part V,
Section B, Line 11.
Issue: Stroke Awareness
2013 Description of the Issue: Florida Hospital Zephyrhills's service area has the fourth highest three-year,
age-adjusted stroke rates in the state. The American Stoke Association and other community organizations
provide outreach and educational materials on stroke prevention and warning signs.
2015 Update: Because of the high numbers of older residents and the high rate of strokes in the community,
Florida Hospital Zephyrhills has a Joint Commission-accredited primary stroke center. Through that center,
we provided American Stroke Association "Get with the Guidelines" staff education to 52 team members (66
were educated in 2014). Get with the Guidelines focuses on recognizing the signs of stroke. In 2015, these
staff members had over 2,500 patient encounters.
In addition, the hospital provided 10 community lectures related to stroke awareness and prevention, and
distributed over 900 stroke education wallet cards at health fairs and community events. We also offered
no-cost Stroke support groups that are open to the public.
Issue: Heart Disease
2013 Description of the Issue: The Pasco County three-year, age-adjusted death rate for heart disease is
higher than the rest of Florida for the white population; it is the second-highest in the state for the black
population. In addition, tobacco use is higher in Pasco County (21%) than in the state of Florida (17.1%).
2015 Update: Florida Hospital Zephyrhills focused its Heart Disease efforts on early detection and screenings
for heart disease. The hospital held Heart Health community education programs related to heart disease
prevention and treatment; the 12 lectures reached over 230 people. We also held six community events that
offered free cardiac screenings including cholesterol and hypertension, free EKGs, and 13 heart nutrition
classes that reached 152 people.
17
The hospital offers a free Heart Failure support group, and supports the annual AHA Heart Walk and 5K
Run/Walk for the Hills. Employees and the community are urged to participate. We held 11 Smoking
Cessation classes with 107 participants.
Our Life Coach/CREATION Health programs for cardiac patients are open to the public and focus on the
principles of Choice, Rest, Environment, Activity, Trust, Interpersonal Relationships, Outlook and Nutrition.
Issue: Uncontrolled Diabetes
2013 Description of the Issue: The age-adjusted rate for diabetes in Pasco County is higher than in the rest of
the state: the county rate is 2314.8 per 100,000 vs. the state rate of 2260.3 per 100,000. Stroke and heart
disease are often associated with undetected and/or uncontrolled diabetes.
2015 Update: Florida Hospital Zephyrhills offer free diabetes classes to uninsured people with diabetes. The
goal was 10 two-part classes; the actual was 21 two-part classes. Nearly 270 uninsured people participated.
We also provided 70 blood glucose screenings and ADA-based diabetes risk assessments (the goal was 50).
People with elevated blood sugars were referred to their family doctors and/or the Premier Community
Healthcare Clinic (FQHC) that sees uninsured people on a sliding fee scale basis.
The hospital has a partnership with Walgreens Rx for highly discounted diabetes medications and supplies.
Monthly no-cost diabetes support groups had 230 participants.
Our Life Coach/CREATION Health programs for cardiac patients are open to the public and focus on the
principles of Choice, Rest, Environment, Activity, Trust, Interpersonal Relationships, Outlook and Nutrition.
Issue: Access to Health Care/Rate of Uninsured
2013 Description of the Issue: The 12% unemployment rate in Pasco County is worse than the state of
Florida rate of 10.5%. Our Needs Assessment cited this as the second-highest behavioral risk factor for a lack
of access to affordable health care. In addition, Pasco County has many small employers who do not provide
health coverage to their workers. The overall uninsured rate in the hospital's service area is 20%.
2015 Update: While the State of Florida did not expand Medicaid, Florida Hospital Zephyrhills has worked to
increase the rate of insurance through Inpatients and ED referrals to Marketplace Enrollment Navigators. In
addition, the hospital actively enrolled eligible patients in Medicaid, worked with the Pasco Medicaid
Enrollment Office, and helped eligible patients access the Pasco County Health Department.
The hospital also maintained its strong partnership with the Premier Community Healthcare Clinic (FQHC)
that sees uninsured people on a sliding fee scale basis. The hospital held discussions with Premier about
some sort of contractual agreement, but that process was not completed in 2015. In addition, Florida
Hospital Zephyrhills provided free Back-to-School physicals for 124 children, and recruited three new
primary care practices to the community (Pasco County is a federally designated Medically Underserved
Area as well a Health Professionals Shortage Area).
18
Because the unemployment rate is high in Pasco County, hospital Leadership is active in the Pasco Economic
Development Commission (PEDC). The PEDC is working on large scale economic development efforts with
the intent of positively impacting future employment opportunities in the county.
Issue: Healthy Living and Obesity
2013 Description of the Issue: The number of adults who are overweight/obese is higher in Pasco County
than in the state of Florida. Overweight/obesity are linked to chronic diseases including diabetes, heart
disease and stroke.
2015 Update: Florida Hospital Zephyrhills offered healthy living programs to supplement the disease-specific
activities noted above. Three CREATION Health programs focused on the healthy living principles of Choice,
Rest, Environment, Activity, Trust, Interpersonal Relationships, Outlook and Nutrition. 316 people
participated. Over 100 CREATION Health Student Guides were distributed, and CREATION Health
educational materials were distributed at 26 other community events.
The hospital has an on-site Wellness Center, and the hospital's walking trail is open to the public.
Issues Considered but Not Addressed
Cancer: Although Cancer is the number one killer for all races and ethnicities (as noted in the three-year,
age-adjusted death rate for Pasco County), and the number four health problem identified in primary
research, it was not selected as a priority because Florida Hospital Zephyrhills does not provide cancer
treatment services. And, while we have a Simpson Breast Health Center, it serves primarily as a diagnostic
service and is not set up to manage cancer on a broader scale. We have a solid transfer agreement in place
with Moffitt Cancer Center; this ensures access to cancer care for our patients.
19
Appendix A
Below is the survey utilized by Florida Hospital Zephyrhills to survey the Community members and Stakeholders.
Primary Data Collection
Sample Questions for Stakeholder Interviews, Focus Groups or Surveys
1. How would you rate the following?
Excellent
Good
Fair
Poor
Very Poor
Overall community health status
Your personal health status
Community understanding of health risks
Your own understanding of health risks
Community quality of life
Your own quality of life
2. What do you see as the greatest health problems/conditions in our community? (circle 3)
Cancer
Mental Health disorders
Heart disease
Immunizations – children
High blood pressure / cholesterol
Immunizations – adults
Respiratory disease – adults
Teen pregnancy rates / low birth-weight babies
Asthma – children
Diabetes
Other (describe)
3. Which health behaviors/risk factors are the most common in our community? (circle 3)
Obesity
Substance abuse – alcohol
Lack of exercise
Substance abuse – drugs
Smoking
Lack of family / religious support systems
Poor nutrition
Risky sexual behaviors
Seatbelt use
Aging population
Firearms in homes
Other (describe)
4. Which community conditions most impact the health of people in our community? (circle 3)
Unemployment
Lack of grocery stores / access to healthy food
Low-income families / poverty
Lack of health insurance / affordable care
Crime / violence
Access to dental care
Homelessness
Air & water quality
Low education levels/literacy
Other (describe)
Inadequate transportation
5.
Who in our community promotes good health?
6.
What are one or two things that they do that are effective?
7.
If you were in charge of promoting good health, what would you do first?
8.
Who else should we talk to?
20
Appendix B
The Stakeholder Interview findings below note the interviewees’ role in the community; how they represented
public health and/or low-income, minority, elderly and other underserved populations; and their perception of
the three greatest health needs in the Florida Hospital Zephyrhills service area.
Primary Data Collection
2016 Stakeholder Interview Log
Date
Name
(optional)
Agency or
Affiliation
(as
appropriate)
Who does Stakeholder
represent?
(check all that apply)
Minority
5/12/16
5/12/16
5/12/16
5/12/16
5/12/16
Terry Luna
Jody
Armstrong
Pat
Pennington
Amanda
Markiewicz
Aubrey Hall
Pregnancy
Care Ctr. –
pregnancy
health
information
and support
Disability
Achievement
Center – notfor-profit
focused on
services,
advocacy, and
education to
promote the
individual’s
highest level
of
independence
and wellbeing
Greater
Zephyrhills
Chamber of
Commerce –
Sunrise of
Pasco domestic and
sexual
violence
center
Sunrise of
Pasco domestic and
sexual
violence
center
LowIncome
Public
Health
X
Identified Issues
Top 3
Community
Conditions
LowIncome/Poverty,
Low Education,
Inadequate
Transportation
Top 3 Health
Conditions
Top 3 Health
Behaviors
Cancer,
Diabetes,
Mental Health
Poor Nutrition,
Drugs, Lack of
Family Support
High Blood
Pressure/
Cholesterol,
Diabetes,
Mental Health
Obesity, Alcohol,
Drugs
Unemployment,
Inadequate
Transportation,
Low Education
Heart Disease,
High Blood
Pressure/
Cholesterol,
Teen Pregnancy
Mental Health,
Violence (Other)
Obesity, Lack of
Exercise, Drugs
Poverty, Low
Education, Lack
of Health
Insurance,
Affordable Care
Unemployment,
Poverty,
Inadequate
Transportation
Cancer, Mental
Health, Teen
Pregnancy
Obesity, Lack of
Exercise, Poor
Nutrition
X
X
X
X
X
X
X
Alcohol, Drugs,
Aging Population
X
X
Poverty, Low
Education, Lack
of Grocery Stores
21
Primary Data Collection
2016 Stakeholder Interview Log
Date
Name
(optional)
Agency or
Affiliation
(as
appropriate)
Who does Stakeholder
represent?
(check all that apply)
Minority
5/12/16
5/13/16
5/13/16
5/26/16
6/7/16
5/12/16
Amanda
Keith
Beth Aker
Teresa
Figueroa
Deanna
Krautner
Cheryl
Pollock
Anonymous
Thomas
Promise
Foundation –
backpack
weekend
meals for
school
children
Meals on
Wheels –
home
delivered
meals
Pasco City
Health Dept.
– public
health
services
Pasco City
Health Dept.
– public
health
services
Premier
Community
HealthCare –
federally
qualified
health care
center
Local
Ministerial
Association
Members –
faith
community
leadership
X
X
X
X
X
X
LowIncome
Public
Health
X
X
X
X
X
X
X
Identified Issues
Top 3 Health
Conditions
Cancer, High
Blood
Pressure/Choles
terol Diabetes
Obesity, Lack of
Exercise, Poor
Nutrition
Other: Aging
with Dignity,
Tremendous
Amount of
Illnesses,
Limited Financial
Resources
Aging Population,
Substance Abuse
(Alcohol and
Drugs), Poor
Nutrition
High Blood
Pressure/
Cholesterol,
Diabetes,
Children's
Immunizations
Cancer, Heart
Disease, Mental
Health Disorders
Obesity, Lack of
Exercise,
Smoking
High Blood
Pressure/
Cholesterol,
Diabetes,
Mental Health
Disorders
Obesity, Poor
Nutrition,
Substance AbuseDrugs
Heart Disease,
Respiratory
Disease,
Diabetes
Smoking, Poor
Nutrition,
Substance AbuseDrugs
X
X
Top 3 Health
Behaviors
Obesity, Lack of
Exercise,
Substance AbuseAlcohol
Top 3
Community
Conditions
Poverty,
Homelessness,
Lack of Grocery
Stores
Low –
Income/Poverty,
Inadequate
Transportation,
Homelessness
Unemployment,
Low-Income/
Poverty,
Inadequate
Transportation
Low-Income
Families/Poverty,
Lack of Grocery
Stores/Access
Healthy Food,
Lack of Support
Systems
Low-Income
Families/Poverty,
Homelessness,
Lack of Health
Insurance
Low-Income
Families/Poverty
Low Education
Levels, Lack of
Health Insurance
22
Primary Data Collection
2016 Stakeholder Interview Log
Date
Name
(optional)
Agency or
Affiliation
(as
appropriate)
Who does Stakeholder
represent?
(check all that apply)
Minority
Anonymous
Anonymous
Anonymous
Anonymous
Anonymous
Anonymous
Local
Ministerial
Association
Members –
faith
community
leadership
Local
Ministerial
Association
Members –
faith
community
leadership
Local
Ministerial
Association
Members –
faith
community
leadership
Local
Ministerial
Association
Members –
faith
community
leadership
Local
Ministerial
Association
Members –
faith
community
leadership
Local
Ministerial
Association
Members –
faith
community
leadership
X
X
X
X
X
X
LowIncome
X
X
Public
Health
Identified Issues
Top 3 Health
Conditions
Obesity,
Smoking, Poor
Nutrition
Cancer, High
Blood Pressure/
Cholesterol,
Mental Health
Disorders
Substance Abuse
- Alcohol/Drugs,
Aging Population
Low-Income
Families/Poverty,
Crime/Violence
Cancer, Heart
Disease,
Diabetes
Obesity, Poor
Nutrition,
Substance AbuseDrugs/Alcohol
Unemployment
Low-Income
Families/Poverty
Homelessness
Heart Disease,
HBH/Cholesterol
, Mental Health
Disorders
Obesity, Lack of
Exercise,
Substance AbuseDrugs
Low-Income
Families/Poverty
Crime/Violence,
Low Education
Levels
Cancer, HBP/
Cholesterol,
Diabetes
Obesity, lack of
Exercise,
Substance AbuseDrugs
Unemployment
Low-Income
Families/Poverty
Homelessness
Heart Disease,
Respiratory
Disease,
Diabetes
Obesity, Lack of
Exercise,
Smoking
Unemployment
Low-Income
Families/Poverty
Homelessness
X
X
Top 3
Community
Conditions
Unemployment,
Low-Income
Families/Poverty
Low Education
Levels
Heart Disease,
High Blood
Pressure/
Cholesterol,
Diabetes
X
X
Top 3 Health
Behaviors
23

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