Community Health Needs Assessment (CHNA) & Action Plan Update 2015

Prepared pursuant to section 501(r) of the Internal Revenue Code and posted for public review December 2015.

Table of Contents

Page

Introduction.................................................................................................................................................... 1

Summary ....................................................................................................................................................... 1

Description of the Olmsted Medical Center .................................................................................................. 6

Table 1: OMC Medical and Surgical Services ...................................................................................... 6

Description of the Community ....................................................................................................................... 7

Figure 1: Map of Olmsted Medical Center’s Primary Service Area ...................................................... 7

Table 2: Ethnicity of Olmsted County Residents .................................................................................. 7

Table 3: Age Distribution of Olmsted County Residents ...................................................................... 7

Internal CHNA Work Group........................................................................................................................... 9

Acknowledgements ..................................................................................................................................... 10

Appendix 1: Membership of the CHNA Core Group, Data Subgroup, and HAPP group ........................... 11

Exhibit 1: Summary of the Olmsted County Community Health Improvement Plan

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Introduction

Under the provisions of the Affordable Care Act of 2010, the Olmsted Medical Center is required to conduct a formal community health needs assessment every three years. The assessment is to include identification of the most pressing healthcare issues in the community, implementation of programs to address these issues, and documentation of progress towards meeting the needs on the annual Form 990 report. The Olmsted Medical Center completed its assessment and implementation strategy in 2013, filed a summary report in 2014, and documents the details of the plan progress during 2015 in this summary report.

Summary

To arrive at a true community-based health needs assessment, Olmsted Medical Center (OMC) collaborated with Olmsted County Public Health Services (OCPHS) and Mayo Clinic. These organizations have a long history of cooperation and collaboration with each other, as well as with other community partners, in addressing local health issues. The three organizations agreed that a joint health needs assessment survey was the best strategy for the community and began discussions in early 2012 regarding the opportunity to work together on a community health needs assessment (CHNA). The collaborative is referred to as the Olmsted County CHNA Core Group. The CHNA survey was completed in 2013, and the top five community health priorities were identified as mental health, obesity, diabetes, vaccine preventable diseases, and homelessness/financial stress. OMC determined that the homelessness/financial stress priority was beyond the scope of OMC’s mission and resources; however, OMC does provide financial assistance for medical care for eligible patients and also participates in the community-wide efforts to address this most difficult issue. OMC has been involved with the monthly Olmsted County CHNA and Community Health Improvement Plan (CHIP) Core Group meetings, the monthly CHNA Data Subgroup meetings, and the quarterly Health Assessment and Planning Partnership (HAPP) meetings (see Appendix 1: Olmsted County CHNA and CHIP Core Group members, CHNA Data Subgroup members, and HAPP community partners). The above work groups are working collaboratively on a community-wide health improvement plan (CHIP) involving the top five designated community health priorities. OMC currently is an active partner with the individual work groups associated with mental health, diabetes, obesity, vaccine preventable diseases, and poverty/financial stress and homelessness. These work groups either meet monthly or quarterly. Each work group is responsible for reviewing and evaluating the CHIP summary, making recommendations to the goals and strategies, and developing appropriate measurements for community health improvement or change (see Appendix 2: Olmsted County CHIP summary). OMC developed its own internal work plan to address four of the priority health issues. The summary of that plan and its implementation during this reporting period are as follows: Mental health: OMC believes that access to mental health services, particularly early diagnosis and treatment, is a critical step in addressing mental health issues in the community. Because of the great demand for mental health services and the limited number of psychiatry and psychology clinicians, primary care clinicians are often the first clinicians to evaluate patients with mental health diagnoses. There is a growing need for primary care clinicians to be prepared to diagnose and treat those patients that can be managed in the primary care setting. OMC has been educating primary care clinicians through educational programs to improve their abilities to care for the mental health concerns of their patients. In 2015, OMC psychiatry and psychology clinicians provided educational presentations on evaluating mental health concerns for other clinicians at monthly department meetings at Olmsted Medical Center, at Clinical Case Reviews within the Department of Psychiatry/Psychology, and at Clinical Staff Meetings. Since 2013, OMC held six CME offerings related to mental health issues that included areas of chronic disease management, addiction medicine, pain management, and new developments regarding the use of medical cannabis. These areas are all closely linked to the mental health of OMC patients:

“Addictions in Pregnancy” by Dr. Charles Schauberger (external consultant), December 2013

“Child Abuse in Primary Care” by Dr. Arne Graff (external consultant), August 2014

“Smoking Cessation” by Dr. Jeffrey Poterucha (external consultant), November 2014

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“Diabetes and Psychology” led by Dr. Erin Sterenson (internal consultant), February 2015

“Minnesota’s Medical Cannibus Update” by Dr. Tom Arneson (external consultant), May 2015

“Topical Treatments for Pain Management” by Dr. Bernard Quebral (external consultant), July 2015

The OMC Psychiatry/Psychology department is located in the OMC Rochester Southeast Clinic, while outreach clinicians see patients in the OMC Rochester Southeast Family Medicine department, OMC Byron Clinic, OMC Rochester Northwest Clinic, and the OMC Women's Health Pavilion. OMC has also initiated a palliative care program that includes the services of a psychologist as part of the multispecialty consult team. Psychology consultations are also used in conjunction with bariatric surgery evaluations. Further, OMC is providing treatment for opioid and heroin addiction with Suboxone therapy. OMC has also partnered with the University of Minnesota—Rochester (UMR) to offer student psychology services at the OMC Skyway Clinic. Clinicians are also available for phone support to UMR staff. Psychiatry and psychology services have also reached OMC’s branch clinics and community nursing homes through telemedicine. Telemedicine visits for 2014 totaled 144 and reached patients in 20 different zip codes. Year-to-date telemedicine visits, as of November 2015, totaled 80 and reached patients in 12 different zip codes. In 2015, a new flow chart for assessing level of risk and steps to address imminent risk of a suicidal patient were developed and have been available to clinicians, nursing staff, and triage services. OMC has been actively recruiting more psychology and psychiatry clinicians to fill the gaps in the care for those in our community. During 2016, OMC plans to reinitiate meetings with other community mental health providers to discuss the community's most current mental health needs. OMC continues to assist in producing a comprehensive resource booklet on available mental health services and sources of care in Olmsted County. This resource is also available to OMC staff on the OMC intranet. OMC supported the Southeastern Minnesota chapter of the National Alliance on Mental Illness (www.nami.org) and the Homeless Community Network in this effort. This continues to be a resource for staff to make appropriate patient referrals to community organizations. Adult obesity: OMC believes that exercise is an important component of weight control and good health, and participates in several approaches to promote regular exercise within the community. In 2012, OMC opened its Sports Medicine and Athletic Performance (SMAP) building in Northwest Rochester and offers easily accessible exercise classes. OMC Sports Medicine and Athletic Performance department has offered group fitness classes and exercise programs at no cost to all OMC employees and their dependents through March 31, 2016. In 2014, there were 11,467 visits to SMAP (3,392 OMC employee visits and 8,075 community member visits). As of November 2015, reports show 10,306 visits (3,817 OMC employee visits and 6,489 community member visits). At community outreach events, OMC provides information regarding basic exercise facts and the relationship of regular exercise and obesity prevention to longevity and good health. OMC is working with its Health Care Home Patient Advisory committee to discuss ideas with these patient advisors. This year to date, OMC has participated in 53 community outreach events including health fairs, UMR student orientation, Healthy Kids Day at the YMCA, sports tournaments, and other special events to promote weight control and good health. OMC has used its telemedicine capabilities to offer weight management counseling services to patients from surrounding areas who are unable to travel to Rochester because of illness, disability, or financial concerns. Nutrition counseling services delivered via telemedicine totaled 13 in 2014 and 14 as of November 2015. In October 2013, OMC began identifying, monitoring, and counseling pediatric patients aged 3-17 that are above the 85th percentile for their recommended body mass index (BMI). This information is reported to Minnesota Community Measurement as a quality measure. This health management indicator has allowed clinicians to document the counseling, education, and referrals that the patient and family have received to help manage obesity. This indicator may be used in the future for the adult population to help document the management of obesity. After starting the pediatric measurements in October 2013, the number of referrals to Patient Education for nutrition counseling increased from 29 in 2013, to 109 in 2014, and 160 as of November 2015.

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Vaccine preventable diseases: Annually, OMC, Olmsted County Public Health Services, and Mayo Clinic collaborate with surrounding schools in the area to bring influenza immunizations directly to the students during their school day. Both OMC and Mayo Clinic supply support personnel to each school and administer influenza immunizations with parental permission to students in grades K-9 in public and private schools. In 2013, 4,305 immunizations in 30 schools were administered. During 2014, the number of schools was expanded to 35, and 6,126 influenza immunizations were given collectively by OMC and Mayo Clinic. In 2015, the school-based clinics were increased to 42, and 5,288 influenza immunizations were given collectively by OMC and Mayo Clinic. The immunization rates were lower in 2015 due to a delay in manufacturer supply of the FluMist immunizations. OMC did trial a Saturday public immunization clinic at its Rochester Northwest clinic in the Fall of 2013. The clinic did not have many participants and was not repeated into 2014 or 2015. In the coming years, OMC plans to continue with community-wide efforts to expand the school immunization program. OMC has worked to identify its adolescent and adult patients who lack appropriate tetanus, diphtheria, pertussis, or meningococcal immunizations, and notifies the patient and family to visit the clinic of their choice to receive the appropriate vaccine. OMC is currently using pre-visit planning to identify immunization needs of patients before their scheduled visits. Needed immunizations are administered by the nursing staff according to approved standing orders for immunizations of children over the age of 10 years (as well as adults). The Immunization Core Team makes recommendations regarding new immunization (such as PCV-13, HPV-9, Meningitis B vaccines) after verifying insurance coverage. High-risk patients, including those with diabetes, asthma, and congestive heart failure who lack recommended immunizations, are identified through chronic disease and immunization registries, and are encouraged through telephone calls or other reminders (including computer-generated letters that are sent by mail) to receive the needed immunizations. OMC will continue to use its MyOMC secure online patient portal where feasible to promote this communication. OMC clinicians continue to receive regular updates regarding the newest vaccine recommendations. In 2014, recommendations for adults changed regarding the pneumococcal conjugate vaccine (PCV-13). With ongoing education of the clinical staff on immunization recommendations, OMC has been able to work collaboratively to increase the adult immunization rates. Adult PCV-13 immunizations have improved significantly during 2014 and 2015 following the new recommendations: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2014 308 332 339 306 296 322 262 337 360 322 444

2015 500 624 864 802 752 810 696 689 697 Over the last year, the immunization numbers have doubled and, in some cases, nearly tripled. Diabetes: During the last decade, OMC has been working on improving the care of patients with diabetes and continues to make improvements in control parameters that are publicly reported through Minnesota Community Measurement (http://mncm.org/). The OMC Diabetes Core Team is led by an endocrinologist and includes an advanced-practice clinician, diabetes nurse educators, other nurses, dietitians, and quality improvement specialists. OMC maintains a registry of more than 2,500 patients with diabetes which enables management of this population through regular reviews of diabetes care during office visits, identification of gaps in care, follow-up phone calls to schedule overdue appointments and appropriate tests, and pre-visit planning to make the most efficient use of each patient’s time with the clinician. Registry information is reviewed at OMC Diabetes Core Team meetings and is shared with the Quality and Patient Safety Committee.

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During 2014, OMC Family Medicine department adopted a quality-improvement project to increase the percentage of patients with diabetes that received or maintained optimal care. Optimal care is considered to be an HgA1C < 8, HgA1C in the last 12 months, statin use, no tobacco use, blood pressure less than 140/90, and documentation of ASA/Plavix use. The goal was met for the period October 1, 2013 to October 1, 2014, and the clinical optimal care percentage increased from 31.82% (826/2596) to 37.82% (1078/2856). This improvement was due largely to the united efforts of the Diabetes Core Team, the clinical nursing staff, clinicians, and the participating patients. During 2015, OMC has continued to see overall improvement in the diabetes optimal care percentages, which rose to 42.05% (1203/2861) in 2015. In 2016, The OMC Family Medicine department plans to continue its focus on diabetes optimal management. The Internal Medicine and Family Medicine department’s 2016 performance goals also will focus on the improved management of hypertension. Improved management of hypertension will also improve our diabetes optimal care percentages, as a large portion of patients with diabetes cannot attain optimal care of diabetes because of their blood pressure readings. The Diabetes Core Team developed patient-specific action plans and standing orders for following the diabetes protocol related to laboratory monitoring. Standardized laboratory orders are in use when ordering pre-visit laboratory studies and at every clinical visit. Visit summaries include a diabetic care plan that can be completed prior to discharge to educate patients on their current lab values, their goals, and the plan to improve to optimal care. An emphasis on diabetes education has continued to be an important aspect of self-management of this chronic disease. Basic diabetes education is begun with nursing staff within the organization. Diabetes educators are available for more in-depth education. All OMC educators use the teach-back method to assess the knowledge gained by patient’s receiving formal diabetes education. Telemedicine visits are being utilized at OMC branch clinics for patients that are unable to travel to Rochester clinic locations to provide patients with diabetes education. There were 65 telemedicine diabetes education appointments in 2014 and 59 visits in 2015. The patient education department has initiated a program to evaluate patients with diabetes prior to surgery to provide education regarding diabetes management during the pre- and post-surgical periods. Additional Community Collaborative Efforts OMC is currently participating in additional collaborative efforts throughout the community. The Southeast Minnesota Partnership for Community-Based Health Promotion is a collaborative that started in 2015. This collaboration of regional stakeholders aims to facilitate and maintain sustainable clinical-community linkages for evidence-based health promotion programs. The current evidence-based program being promoted is the Chronic Disease Self-Management Program (CDSMP), also known as, Living Well with Chronic Conditions. The CDSMP is a group workshop designed to help participants build confidence in managing their chronic conditions and maintaining their health. Participants are adults with one or more chronic conditions such as arthritis, diabetes, asthma, high blood pressure, heart disease, cancer, chronic pain, anxiety, and depression among others. This program is currently offered in the community through Elder Network, a regional non-profit social service organization. The current programs offered in the 12-county region of southeastern Minnesota are underutilized, and many have been cancelled due to low participation. OMC had previously offered this program, but was unable to continue due to low participation and lack of facilitation staff. OMC is actively participating in bi-weekly meetings to improve awareness of this program in the community, has sent three clinical staff to a four-day training program so OMC can facilitate meetings within our organization and in the community, and plans to educate clinicians further about this program. OMC has partnered with Mayo Clinic, Olmsted County Public Health, Intercultural Mutual Assistance Association (IMAA), and Elder Network to develop a Community Care Team (CCT). The CCT is supported through an Accountable Communities for Health-State Innovation Model (ACH-SIM) grant through the Minnesota Department of Health. These partners form an interdisciplinary community-based team that meets with an OMC Health Care Home (HCH) patient to develop a patient-oriented action plan. The CCT helps adults and their families or support persons to manage their chronic health conditions. This is a 12-

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week program that uses a wrap-around model to connect clients to community services and health providers to improve their overall health and independence. A public health nurse and a community health worker meet with the client in their home for an initial evaluation. The team then meets with the client and a support person to develop the patient-oriented action plan. This plan is implemented over the course of the next 12 weeks, and then a second meeting is scheduled to review the outcomes and help with any additional planning. Many of these clients are unable to manage their healthcare well due to unmet basic needs (e.g., housing, food, finances, medical insurance, and social support). This program was originally limited to the HCH-enrolled patients, but in 2016, OMC’s plan is to expand this program to all primary or specialty care clinical areas. A Refugee Health Collaborative is meeting quarterly to discuss the needs and deficits seen in our systems related newly arrived refugees in our community. This collaboration includes Mayo Clinic, Olmsted County Public Health Services (OCPH), Olmsted County Community Services, and OMC. Challenges exist through the continuum of care starting with scheduling an appropriate follow-up after an initial refugee evaluation is done at OCPH. Each refugee needs to be treated as an individual and have their needs and care tailored to themselves and their family, yet this collaboration recognizes the need to help streamline primary care, mental health care, resources, and referrals. Navigation in the community and medical systems is difficult due to facility and system complexity, language barriers, barriers to sharing information between providers, and mental healthcare needs within the refugee populations. The Refugee Health Collaboration will continue to meet and collaborate to improve the care of this population in our community.

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Description of the Olmsted Medical Center

Located in Rochester, Minnesota and surrounding communities, Olmsted Medical Center (http://www.olmstedmedicalcenter.org) is an integrated community healthcare provider known for convenient, easily accessible, and personalized primary care delivered in small clinic and hospital settings. Olmsted Medical Center offers the services of more than 20 medical and surgical specialists (Table 1). By written policy, OMC accepts all patients regardless of race, religion, age, gender, sexual orientation, source of payment, or ability to pay. As a 501(c)3 tax exempt healthcare organization, OMC cares for patients regardless of their ability to pay, and in 2014 provided community benefits of over $49 million (29.39% of total operating expenses). OMC employs 156 clinicians and nearly 1,200 staff who provide healthcare services at 18 locations including two multi-specialty outpatient clinics in Rochester; physical and occupational therapy and sports medicine facilities; two walk-in FastCare® retail clinics; a clinic in downtown Rochester providing care to the general public and University of Minnesota—Rochester students; a Level IV trauma hospital licensed for 61 beds with a 24-hour emergency department and BirthCenter; and primary-care branch clinics in 10 southeastern Minnesota municipalities (Figure 1). OMC is the sole healthcare provider in eight of these communities. During 2014, OMC provided over 296,000 clinician visits for 80,452 individual patients, delivered 873 babies, and performed over 3,800 surgical procedures.

Our Mission: The delivery of exceptional patient care focusing on caring, quality, safety, and service.

Our Vision: To be the healthcare provider of choice in our service area by leading in quality, access, and service.

Our Core Values: Our patients come first. Every employee is a caregiver. Our employees are the key to our success. OMC is an active, contributing partner in the communities it serves. We have a duty to position and prepare OMC for the future.

Table 1: OMC Medical and Surgical Services

Advanced Wound Healing

Anesthesiology

Anticoagulation

Asthma & Allergy

Audiology

Bariatric Surgery

Cardiology

Dermatology

Ear, Nose and Throat

Emergency Medicine

Endocrinology

Family Medicine

General Surgery

Internal Medicine

Neurology

Obstetrics/Gynecology

Occupational Health

Ophthalmology

Optometry

Orthopedics & Sports Medicine

Pain Management

Pediatrics

Plastic Surgery

Podiatry

Psychiatry/Psychology

Radiology

Rehabilitation Services

Respiratory Therapy

Sleep Medicine

Sports Medicine & Athletic Performance

Travel and Immunization

Urology

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Figure 1: Map of Olmsted Medical Center’s Primary Service Area

Table 2: Ethnicity of Olmsted County Residents

Caucasian ........................................................................... 87%

Asian .................................................................................. 5.6%

Black .................................................................................. 5.3%

Latino ................................................................................. 4.3%

American Indian and Alaska Native ................................... 0.3%

Hawaiian and Pacific Islander ........................................... 0.1% Source: http://quickfacts.census.gov/qfd/states/27/27109.html)

Description of the Community

OMC considers the community it serves to be all of those patients who elect to receive services at its clinics and hospital, and estimates that 92,000 patients in its service area receive most or all of their primary care at OMC, although all patients are not seen annually. The majority of these patients reside in Olmsted County. OMC also believes that it has a duty to serve the community at large by working with the Olmsted County Public Health Service, other county health services, and other local organizations on health issues of general interest. The community health needs assessment described here involves Olmsted County, Minnesota, which includes the cities of Rochester (population 106,769), Byron (population 4,914), Chatfield (population 1,206), Dover (population 735), Eyota (population 1,977), Oronoco (population 1,300), Pine Island (population 703), and Stewartville (population 5,916). The total population of the county was estimated at 147,066 in 2012. About 70% of Olmsted County residents live in the city of Rochester. The ethnicity of the county population is shown in Table 2, and the age distribution is shown in Table 3. The demographics and ethnicity of the small communities that OMC serves outside of Olmsted County are similar except for an average age of about 10 years older than the Olmsted County population and less racial and ethnic diversity. For the years 2007-2011, 8.1% of Olmsted County residents lived at or below the national poverty level. Of note is that minorities now make up over 17% of the Olmsted County population; and 12.4% of the people over the age of 5 speak a language other than English in their homes. The Olmsted County School District reports that the most prevalent languages are Somali, Spanish, Cambodian (Khmer), Arabic, Vietnamese, Chinese, Lao, and Bosnian.

Table 3: Age Distribution of Olmsted County Residents

Under age 5 ....................................................... 7.3%

Under age 18 ...................................................... 25%

Age 19-64 ........................................................ 54.8%

Over 65 ............................................................ 12.9% Source: http://www.co.olmsted.mn.us/yourgovernment/demographics/Documents/DemographicsWorkforce2011statewide.pdf

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In addition to the Olmsted Medical Center, there are several other healthcare resources and providers in Olmsted County as follows:

The Bluestem Center (www.bluestemcenter.com) provides multidisciplinary evaluation with long-term follow-up for children, adolescents, and adults, with close integration of school and community support services. Bluestem specializes in complex learning and behavior problems, including neuro-developmental disorders. Examples include adolescent mental health, attachment issues, Attention Deficit/Hyperactivity Disorder, Autism and Asperger’s Disorder, habit and tic disorders of childhood, interdisciplinary treatment planning, pervasive developmental disorders, play therapy, Post Traumatic Stress Disorder, and Tourette’s Syndrome.

The Mayo Clinic (http://www.mayoclinic.org) is a well-known healthcare system with locations in southeast Minnesota, southwestern Wisconsin, and northern Iowa. It operates two hospitals in Rochester and a very busy emergency department and trauma center serving all residents in Olmsted County, including uninsured and under-insured patients. OMC and Mayo Clinic share many patients and have a long-standing collaborative and cooperative relationship.

The Migrant Health Clinic (http://www.migranthealthservice.org/en/rochestermn) serves migrant farm workers and their families in the community who are visiting Rochester and Olmsted County as migrant farm workers. OMC provides physician supervision for the physician assistant who staffs the Migrant Health Clinic.

The Olmsted County Public Health Department (http://www.co.olmsted.mn.us/ocphs/Pages/default.aspx) provides a broad spectrum of health and social services to residents of Olmsted County. In particular, OCPHS has received grants from the Minnesota Department of Health for work on the State Health Improvement Project, which concentrates efforts to address the problems of tobacco use, nutrition including infant nutrition, obesity, and physical activity. OMC has been a significant partner with OCPHS regarding infant nutrition and breastfeeding.

The Salvation Army Good Samaritan Clinic (http://salvationarmynorth.org/community/rochester/) offers free medical and dental services to uninsured residents and refers many patients needing additional medical services to the Olmsted Medical Center.

The Zumbro Valley Health Center (http://zumbromhc.org/) provides adult and child psychotherapy, chemical dependency counseling, case management, crisis services, pharmaceutical services, emergency housing services, and a dental clinic to underinsured residents of Olmsted County. OMC shares many patients with the Zumbro Valley Mental Health Center.

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2015 OMC Community Health Needs Assessment Work Group

Jamie Breuer, Obesity CHIP work group

Brenda Brown, MD

CHNA/CHIP core group, Diabetes CHIP work group lead, Mental Health CHIP work group

Shelli DeGeus

Vaccine preventable disease CHIP work group

Lisa Dieser

Vaccine preventable disease CHIP work group

Erica Hansen

Poverty, financial stress and homelessness CHIP work group

Lynne Hemann

Obesity CHIP work group

Randy Hemann, MD

Kevin Higgins

Jeffrey Gursky, MD

Mental health CHIP work group

Kathryn Lombardo, MD

Michelle Maeder-Hickey

Chuck Meyer

Kalpana Muthusamy, MD

Diabetes CHIP work group

Kelly Owens

Matthew Peterson

Gary Ryba

Jeremy Salucka

CHNA/CHIP core group

Wendy Scheckel

Tricia Schilling, LICSW

Kasey Trageser

Stacey Vanden Heuvel

CHNA/CHIP core group

Elizabeth Vermilya

Obesity CHIP work group

Tim Weir

Linda Williams, MD

CHNA data subgroup

Barbara Yawn, MD

CHNA data subgroup

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Acknowledgements

The Olmsted Medical Center wishes to express its thanks to the Olmsted County Public Health Service, Mayo Clinic, and all of the other participating organizations for their valuable contributions in the planning and conduct of this community health needs assessment. This was a genuine community effort that resulted in the strengthening of existing relationships and the formation of new relationships that will serve the community well as the organizations continue to work together to address the most significant health problems facing the people of this county.

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Appendix 1: Membership of the Olmsted County CHNA Core Group, Data Subgroup, and the Health Assessment and Planning Partnership CHNA Core Group Membership Organizations Olmsted County Public Health Services Olmsted Medical Center Mayo Clinic United Way of Olmsted County Data Subgroup Membership Organizations Olmsted County Public Health Services Olmsted County Community Services Olmsted Medical Center Mayo Clinic Olmsted County Planning Department United Way of Olmsted County Health Assessment and Planning Partnership (HAPP) Membership Organizations Channel One Regional Food Bank Diversity Council Elder Network

Families First of Minnesota (Childcare Resource and Referral/Head Start)

Family Service Rochester IMAA Migrant Health Services National Alliance on Mental Illness (NAMI) of SE Minnesota Olmsted County Community Services Olmsted County Public Health Services Olmsted Medical Center Mayo Clinic Migrant Health Rochester Area Family Y Rochester Area Foundation Rochester Center for Autism Rochester Community and Technical College Rochester Public Library Rochester Public Schools Salvation Army Seasons Hospice Southeastern Minnesota Area Agency on Aging United Way University of Minnesota—Rochester Zumbro Valley Health Center

e-mail: omc@olmmed.org

Community Health Improvement Plan

2015 – 2017

Olmsted County, Minnesota

Making the Healthy Choice the Easy Choice

Prepared by: Olmsted County Public Health ServicesUpdated September 8, 2015

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Table of Contents

Executive Summary ........................................................................................................................................................................................................4 Introduction ...................................................................................................................................................................................................................5 Olmsted County Community ...........................................................................................................................................................................................6

Demographics ........................................................................................................................................................................................................6 Collaborative Nature ..............................................................................................................................................................................................7

Community Health Improvement Plan Context ...............................................................................................................................................................8 Purpose .............................................................................................................................................................................................................8 Framework .......................................................................................................................................................................................................9 Process ..............................................................................................................................................................................................................9 Timeline .............................................................................................................................................................................................................11

Health Assessment and Planning Partnership ..................................................................................................................................................................12 Partnership Representation ....................................................................................................................................................................................12 Team Vision and Goals ............................................................................................................................................................................................12

Community Health Priorities and Strategies ....................................................................................................................................................................13 Prioritization Process ..............................................................................................................................................................................................13 Community Priorities ..............................................................................................................................................................................................14

Obesity ..............................................................................................................................................................................................................17 Diabetes ............................................................................................................................................................................................................21 Mental Health ....................................................................................................................................................................................................25 Vaccine Preventable Diseases .............................................................................................................................................................................29 Financial Stress/Homelessness ...........................................................................................................................................................................33

Overarching Strategies ............................................................................................................................................................................................36 Alignment with State and National Priorities ...........................................................................................................................................................37

Our Future Health: From Planning to Action ...................................................................................................................................................................38 Implementation ......................................................................................................................................................................................................39 Monitoring and Evaluation .....................................................................................................................................................................................40 Sustainability ..........................................................................................................................................................................................................41

Record of Changes and Updates .....................................................................................................................................................................................42 List of Appendices ...........................................................................................................................................................................................................43

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Health and overall well-being are not confined solely within medical offices – in fact, the introduction starts in our homes, schools, places of work,and communities. There are many influences to good health: eating well and staying active, refraining from unhealthy behaviors, adhering to therecommended immunizations and screening tests schedules, and managing stress levels. However, overall health is also determined by numeroussocial and economic factors: the resources and supports available in our homes and communities (i.e., financial, educational, social and health care);the cleanliness of our water, food and air; the perception and true safety of our communities; and the nature of social relationships.

Olmsted County residents all deserve an equal opportunity to make the choices that lead to good health – and to ultimately: make the healthychoice, the easy choice. To ensure that that opportunity proceeds with success, advances are needed not only in health care and public health, butalso across and throughout the entire community, including: education, housing, community services and planning, and infrastructure.

The current Community Health Improvement Plan (CHIP) serves as the first step towards true community-centered planning, integration, andimplementation of strategies to improve our community’s health. CHIP partners and additional community organizations will work together topromote health equity throughout diverse populations and address social determinants of health to improve health outcomes in five priority areas:Obesity, Diabetes, Mental Health, Vaccine Preventable Diseases, and Financial Stress / Homelessness.

Executive Summary

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Public health departments across the nation have a long history ofmonitoring, reporting on, and improving the health of localcommunities, and this holds true for Olmsted County Public HealthServices. Additionally, local public health departments are heldresponsible for the prevention, promotion, and protection effortsthroughout communities. However, it is widely-known that theseefforts cannot be done independently by public health. Public health,healthcare, non-profit organizations, private sector and othercommunity-based sectors need to partner together to: (1) identifycommunity health issues; (2) prioritize issues; and (3) work towardsimproving community health.

The Olmsted County community has partnered together to developone local assessment and planning process to develop two guidingdocuments: the Community Health Needs Assessment and theCommunity Health Improvement Plan. The assessment and planningprocess has been initially created to encompass two main stages:Phase I and Phase II. Throughout both Phase I and II, significantcommunity involvement remains as the highest priority.

Phase I of the assessment and planning process is grounded in theefforts that launched the Community Health Needs Assessment andimmediate steps that followed. These efforts and activities tookplace from mid-2012 through mid to late-2014, and included: Identifying and assessing health indicators Prioritizing the health indicators and identifying top community

priorities Determining priority workgroups, specifically workgroup leads Developing broad, community-based strategies that define the

Community Health Improvement Plan

Any plan is only practical – and useful, or even helpful – if it makesit to the implementation stage. Phase II of the assessment andplanning process will revolve around future efforts, beginning in2015, to: identify and implement community initiatives andactivities; and monitor and evaluate the impact on improving thecommunity’s health. During this phase, all identified communityinitiatives and activities will be monitored and assessed forprogress. Additionally, adjustments will be made as appropriate toensure the community strategies and overall Community HealthImprovement Plan remains relevant.

This Community Health Improvement Plan serves as a reflection ofthe community’s readiness, excitement, and eagerness forcollective action to improve Olmsted County’s health.

Introduction

Olmsted County is located in the southeastern part of Minnesota, approximately 80 milessoutheast of the Minneapolis/St. Paul metropolitan area. Olmsted County has a totalarea of 655 square miles, of which just over 650 acres are water areas. Olmsted Countyconsists of 18 townships and all are part of 8 cities, including the cities of Byron, Eyota,Dover, Oronoco, Rochester, Stewartville, and parts of Chatfield and Pine Island.

Olmsted County is projected to remain one of Minnesota’s fastest-growing counties overthe next 30 years, while Rochester will be the central city of the fastest-growingmetropolitan area in the State. Olmsted County remains the eighth largest county in theState. According to the 2010 Census, the population of Olmsted County was 144,248.Seventy-four percent of the County population lives in the city of Rochester, with a 2010population of 106,769. Rochester, the County seat, is the largest city in Minnesotaoutside of the Minneapolis/St. Paul metropolitan area; Rochester grew by nearly 25%over the last decade (20,963 people). The surrounding cities range in size from a low of741 in Dover to a high of 5,916 in Stewartville.

Olmsted County represents 29% of the population of the 11-county southeast Minnesota region. Olmsted County’s population has grown by 35.5% since the 1990Census. Olmsted County has 2.25 times the population of the next largest county in the region and continues to grow at a significantly higher rate than other countiesin southeastern Minnesota – while Olmsted County grew by 16% per decade for the last twenty years; the balance of the region grew by only 4%.

According to census figures, the median age of Olmsted County residents was 36.3 years in 2010. Residents under age 18 made up 25.2% of the population, whilethose aged 65 years and older made up 12.6% of the population. Olmsted County’s population is 51.1% female – total female population is 73,763; total malepopulation is 70,485.

Olmsted County has seen a significant increase in populations of ethnic and racial minorities in recent years. Minorities (all persons other than non-Hispanic Whites)now make up almost 17% of Olmsted County’s total population. The minority population grew 75% from 2000 to 2010, compared to an 8.8% increase in the non-Hispanic White population. Over the last 20 years, the minority population has increased from 5,290 (1990) to 23,900 (2010) – an increase of 4 ½ times.

The 2011 American Community Survey (2011 ACS) reports that 13,292 foreign-born persons reside in Olmsted County. According to the 2011 ACS, 12.4% of peopleover the age of 5 speak a language other than English in the home. According to Olmsted County school district data, Somali, Spanish, Cambodian (Khmer), Arabic,Vietnamese, Chinese, Lao, and Bosnian are the most prevalent languages spoken in the home.

Household and per capita incomes in Olmsted County exceed both the State and national averages. According to the 2007-2011 ACS estimates, Olmsted County had amedian household income of $66,202, compared to $58,476 for Minnesota and $52,762 for US. However, outside the Minneapolis/St. Paul metropolitan area,Olmsted County has the 3rd highest free and reduced lunch enrollment in schools, which is an indicator of low socioeconomic status.

Rochester is most notably known as the home of the Mayo Clinic, and thus a medical community. Major employers in Olmsted County include: Mayo Clinic, IBM,Rochester Public Schools, Olmsted County, Olmsted Medical Center, City of Rochester, Charter Communications, Crenlo, Rochester Community and Technical College,Federal Medical Center, Seneca Food, and Hiawatha Homes.

6

Olmsted County Community

Demographics

Collaborative Nature

Olmsted County Public Health Services, Olmsted Medical Center, and the Mayo Clinic have a strong, symbiotic relationship and have collaborated with each other, andother community partners for many years to serve the health needs of the residents in Olmsted County, Minnesota.

A unique first example of community collaboration in Olmsted County dates back to the late 1800’s. In 1883, the ‘Great Tornado’ swept through Rochester, killing 26people and destroying much of the north side of town. In the wake of that terrifying experience, Sister Mary Alfred, a Franciscan Sister teaching in Rochester,approached the ‘country doctor’ to discuss the need for a hospital. The Sisters of St Francis offered to build and maintain a hospital if the good doctor would provide themedical staff. The humanitarian spirit of a Franciscan Sister combined with the professional dedication of a small town physician named William Worrall Mayo, and hismore famous sons Will and Charlie, formed the foundation that continues today. The humble dedication and practice of sharing information and knowledge of past andpresent leaders had created a culture where prevention, resiliency, and foresight are the fabric of our community’s existence.

Since these early beginnings, the community has taken positive and proactive actions to lay a foundation for a culture of health with its residents through thedevelopment of public health policies and practices dating back to 1866 when the first health ordinance was enacted, and is embedded in many aspects of ourcommunity today.

Olmsted County is small enough where people know each other, yet large enough to bring resources together to respond to problems. The spirit of communitycollaboration and ‘group practice’ stems back to the Mayo brothers and have shaped and formed the way community leaders approach the challenges related to health,safety, and social conditions in our neighborhoods, cities, and county as a whole. While the ‘Great Tornado’ could be cited as the original catalyst for collaboration in ourcommunity, a series of more recent initiatives, events, decisions and partnerships serve as additional motivation and influence. These consist of:

Healthcare Collaborations, including: Coalition for Community Health Integration; CommunityHealthcare Access Collaborative; Health Workers; Good Samaritan Health Clinics;Rochester Epidemiology Project; School-located Vaccination Clinics;Southeast Minnesota Beacon Project; and Zumbro Valley Mental Health

Housing Initiatives, including: Affordable Home Ownership; the Housing Summit andAssessment; Permanent, Supportive Housing; and Transitional Housing

Improved Nutrition and Physical Activity, including: Active Living Policies and Plansfacilitated by Statewide Health Improvement Plan; CardioVision 2020; ImprovedNutrition Access; Increasing Physical Activity Opportunities; and School Gardens

Tobacco-Free Living, including: Community Cessation Efforts; Smoke-Free Campuses;Smoke-Free Policies; and Smoke Free Rental Housing

These well-established relationships and past initiatives and projects provided a natural ‘steppingstone’ to conduct one joint community assessment and planning process. One joint process hasgalvanized leadership from key sectors to be part of the solution to address the conditions and factorsthat impede optimal health.

The above synopsis of the community’s collaborative nature was summarized from Olmsted County’sRobert Wood Johnson Foundation’s Culture of Health Prize Phase I application.

7

Olmsted County Community

Purpose

In early 2012, discussions began between Olmsted County Public HealthServices, Olmsted Medical Center, and Mayo Clinic on the opportunityto work together on a collective assessment and planning process toproduce a joint Community Health Needs Assessment and CommunityHealth Improvement Plan. Olmsted County Public Health Services hasconducted community health assessments and developedimprovement plans since the enactment of the Local Public Health Actin 1976 (Minnesota State Statue 145A). However, new requirementsfor local public health agencies in Minnesota and non-profit hospitalsprovided a unique opportunity to conduct one community assessmentand planning process for Olmsted County.

For the first time, local public health agencies in Minnesota are nowrequired to develop a plan with, and for the community, instead of aninternal department plan. This is apparent within the Minnesota LocalPublic Health Assessment and Planning Process. This state-wideprocess now integrates and aligns local public health deliverables withthe national accreditation (Public Health Accreditation Board - PHAB)standards and measures. PHAB requires local public health agencies to(1) participate in or lead a collaborative process resulting in acomprehensive community health assessment and (2) conduct acomprehensive planning process resulting in a community healthimprovement plan.

In addition to the current requirements for local public health agencies,a new requirement in the Patient Protection and Affordable Care Act(PPACA) requires non-profit hospitals to conduct a community healthneeds assessment every three years in order to maintain their taxexempt status. Within Olmsted County, two organizations fit thisPPACA requirement: Olmsted Medical Center and Mayo Clinic.

For a complete description of the organizational requirements, pleaserefer to Appendix B.

8

Community Health Improvement Plan Context

Yes, there are new requirements specifying an assessment and planningprocess must be conducted at the community level; however, OlmstedCounty has and is looking above and beyond these requirements andfocusing efforts more on the value and benefits of communitycollaboration. Because of the numerous past collaborations andpartnerships within Olmsted County – and specifically between OlmstedCounty Public Health Services, Olmsted Medical Center, and the MayoClinic – one joint community assessment and planning process wasidentified as the best strategy for all three organizations and ultimately,the entire community. This is the right thing to do!

The purpose and true intent of the current Community HealthImprovement Plan is to provide guidance to Olmsted County on improvingthe community’s health priorities. Specifically, the Community HealthImprovement Plan:

Describes the assessment and planning process, includingpartners involved

Outlines the top five community health priorities, along with theprioritization process used

Identifies community-level strategies with key/lead organizationinvolvement

Provides measureable and time-framed objectives Describes future implementation, monitoring and evaluation

activities

9

Framework

Several best practice frameworks and models influenced and guidedthe overall assessment and planning process for the Olmsted Countycommunity. One specific framework was not followed in it’s entirety;however, the combination of all steered the collaborative nature ofthe overall community process.

Steps and/or phases of the following frameworks were usedthroughout Olmsted County’s assessment and planning process:

Collective Impact Core Public Health Functions and Essential Services County Health Rankings and Roadmaps Health Impact Pyramid Minnesota Local Public Health Assessment and Planning

Process (Community Health Improvement Plan) Mobilizing for Action through Planning and Partnerships

(MAAP) Precede-Proceed Model Social Determinants of Health Framework

For a complete description and listing of the guiding frameworks used in theassessment and planning process, please refer to Appendix C.

Process

The assessment and planning process began in early 2012 with the formation of theCommunity Health Needs Assessment/Community Health Improvement Plan Core GroupPlanning Team (Core Group). The Core Group immediately and continues to be theleadership group guiding the full assessment and planning process. Early on, it wasdetermined that since this community process was new and different from previous planningefforts (i.e. community driven versus organization, independently driven), that the processwould have to be completed and implemented in stages (refer to Community HealthImprovement Plan Introduction, page 5). The first stage – referred to as Phase I – includedcommunity efforts that launched the Community Health Needs Assessment and immediatesteps that followed. For a broad timeline of assessment and planning efforts, please seeCommunity Health Improvement Plan Assessment and Planning Timeline, page 11.

Assess Health Indicators: With guidance and leadership from the Data Subgroup and CoreGroup, a comprehensive Community Health Needs Assessment was completed in late 2013.The assessment process integrated a variety of steps, including: identifying potential healthindicators; collecting and analyzing relevant information including data from the CommunitySurvey and Community Listening Sessions; and the assembly and dissemination of the finaldocument.

For a further defined assessment process, please refer to Olmsted County’s 2013 Community Health Needs Assessment: Olmsted County Community Health Needs Assessment.

Prioritize Indicators: During the assembly of the Community Health Needs Assessmentdocument, a process was developed and implemented to prioritize the health issues ofOlmsted County (Spring 2013). Local data on each issue (i.e. objective factors) was presentedand shared with community groups which in turn contributed subjective scores/factors to thefull prioritization process (refer to Community Health Improvement Plan Prioritization Process,page 13).

Identify Workgroups: After dissemination of the Community Health Needs Assessment andcommunity priorities, an Assessment and Planning Community Meeting was held to launchthe next steps of the assessment and planning process (i.e. Community Health ImprovementPlan Planning Kick-off – November, 2013). During this meeting, community partners weregiven a brief synopsis of the five community health priorities and were tasked to identify oneto two organizations that could lead workgroups into the future. For a complete listing ofworkgroup leads, please refer to Appendix D.

(cont.)

Community Health Improvement Plan Context

Initial effort should be placed on recognizing the tremendous workalready happening in the community – while also remembering to lookproactively for future collaborative work

The realization that the Community Health Improvement Plan needs tobe a dynamic, evolving plan – being the first community plan; knowingthis is just the start and improvement will come with time

The overall Community Health Improvement Plan and morespecifically, the strategies need to be practical and realistic – strive forno more than 2-3 strategies per priority area

The understanding that each issue is at a different level of complexity,maturity in addressing, data availability to address progress, etc. –therefore, strategies will be at different levels (i.e. process versusoperational)

The need to monitor and evaluate strategies and initiatives is critical,but the maturity of measurement will continue to evolve

This Community Health Improvement Plan serves as the final stages of PhaseI as the community of Olmsted County is now ready to move towards andinto Phase II that revolves around implementation, monitoring andevaluation. Work into the future will strive to continually improve theoverall assessment and planning process.

10

Process (cont.)

Develop Community Strategies: Once workgroup leads were identified,these organizations and partners moved into developing broad communityplans of action designed to achieve progress towards each communitypriority (i.e. Community Strategies). Workgroup leads, along with otherpertinent individuals, partners and community organizations, metperiodically between January and September 2014, to develop these broadcommunity strategies.

Olmsted County Community Involvement: Throughout all assessment andplanning efforts, community involvement was the core, foundation andguiding principle that drove the process. The overall community wasinvolved in a number of ways, but most notably serving, participating, andattending Assessment and Planning Community meetings and Public HealthServices Advisory Board meetings.

Defining Health and Wellness: Coinciding with the assessment andplanning process is another new initiative introduced by Mayo Clinic calledDestination Medical Center (DMC). DMC strives to secure Mayo Clinic’sstatus as a global medical destination now and into the future. One earlycollaborative event revolved around ‘Community Conversations’ to helpdefine what health and wellness means to the community. It was apparentthat the phrase ‘health and wellness’ encompasses a variety of attributes,from: access to healthcare, to holistic health, to prevention, to mentalhealth. It was also clear that accessibility and inclusivity are keycomponents to ensuring health equity for all. As the assessment andplanning process progresses, this definition will be important in consideringfuture Community Health Needs Assessment indicators and CommunityHealth Improvement Plan strategies.

Challenges, Assumptions and Themes Identified Throughout the PlanningProcess: Awareness that this is the first true community plan – we need to cast

a wide net and be inclusive, but understand what it takes to managethe logistics with limited resources

Community Health Improvement Plan Context

11

Assessment and Planning Process Timeline

12

Health Assessment and Planning Partnership

Partnership Representation

The assessment and planning process strived to have membership,involvement and participation from all walks of life. The ‘LargeGroup’ – Health Assessment and Planning Partnership – welldefined multi-sector representation, and included a variety ofindividuals and organizations throughout the Olmsted Countycommunity.

Team Vision and Goals

Throughout the assessment and planning process, and explicitly seenwithin the Health Assessment and Planning Partnership Team, wasalignment with national initiatives, specifically with Healthy People2020. With this alignment, the team agreed upon adhering andsupporting the following all-encompassing goals:

Community Health Improvement Plan Overarching Goals

Attain high-quality, longer lives free of preventable disease,disability, injury, and premature death

Promote quality of life, healthy development, and healthybehaviors across all life stages

Create social and physical environments that promote goodhealth for all

Achieve health equity, eliminate disparities, and improve healthof all groups

For a full listing of contributing organizations to the assessment andplanning process, see Appendix E.

Prioritization Process

Once sufficient data was collected on each health indictor throughthe progression of the Community Health Needs Assessment, aprocess to prioritize the indicators was determined through theCommunity Health Needs Assessment Data Subgroup, andadministered during Spring 2013.

Each health indicator was scored on objective (at risk, affected,trend, and premature death) and subjective factors (quality of life,economic impact, community perception, ability to impact, andadditional resources needed).

Objective scores were predetermined and approved through theCommunity Health Needs Assessment Data Subgroup. Subjectivescores were gathered through five separate groups:

Community Healthcare Access Collaborative, Work Group Mayo Clinic, Employee and Community Health Executive

Leadership* OCPHS, Public Health Services Advisory Board OCPHS, Strategic Management Committee Olmsted Medical Center, Leadership Council

*completed a modified version of the above described process

For a complete description and listing of the subjective and objectivefactors used in the prioritization process, please refer to Appendix F.Additionally, please refer to Appendix E for a listing of contributingorganizations, including those that participated in the prioritizationprocess.

The results from each of the five subjective prioritizations were thencompiled with the objective scores to determine an overallnumerical ranking of the health indicators.

13

This process allowed us to identify the top ten indicators with thehighest community rankings:

1. Obesity2. Mental Health3. Vaccine Preventable Diseases4. Homelessness5. Diabetes6. Financial Stress7. Multiple Chronic Conditions8. Educational Level9. Poverty10. Asthma

In order to identify a manageable number of issues that could beaddressed in the Community Health Improvement Plan, the Core Groupand Data Subgroup further refined the priority list to the Top FiveCommunity Health Priorities.

While there are opportunities to improve the prioritization process usedfor this assessment and planning cycle, the hope is that this firstintegrated process serves as the foundation to better address the healthconcerns facing Olmsted County now, and into the future.

Community Health Priorities and Strategies

Community Priorities

The next several pages are devoted to the community’s priorities. This section will focus on a summary of why the health issue is a community priorityand then describe community level strategies to ultimately improve the status of the issue in Olmsted County.

Within the health issue summary, the following will be described: Community Health Importance and Impact

A description of why the issue is important to the health of the general community* and what else is associated and/or impacts theindicator

*community health in general, not necessarily exclusive to Olmsted County ‘The Priority’ in Olmsted County (i.e. Obesity in Olmsted County)

Local, current data* from the recent Community Health Needs Assessment (2013)is presented for each priority

*includes multiple quantitative and qualitative data sources Community Strengths

A broad portrayal* of current community assets and resources, including currentcommunity programming, partnerships and/or resources

*a non-exhaustive list

After the portrayal of the health issue, community level strategies will be broadly describedand include:

GoalDesired long-term result for community priority

Outcome Objective*Overall long-term intended effect from strategies

*when applicable, written SMART to measure improvement in priority healthstatus

StrategyBroad community plan of action designed to achieve progress towards health priority

Strategic Objective *Shorter-term intended effect from strategy initiatives and activities

*when applicable, written SMART to measure improvement in status upstreamfrom priority health area

After describing the Five Community Health Priorities and Strategies, there will be a small section devoted to describing the need and illustrating fourOverarching Community Health Improvement Plan Strategies.

14

Community Health Priorities and Strategies

TOP 5 COMMUNITY HEALTH PRIORITIES

Olmsted County, MinnesotaCommunity Health Needs Assessment

October 2013

VACCINE PREVENTABLE

DISEASES

FINANCIAL STRESS/HOMELESSNESSOBESITY MENTAL

HEALTHDIABETES

10% of youth feel

sad all or most days

Adults average 3days of mental health issues

monthly

64% of adults are

overweight (BMI>25.0)

With 28% being

obese (BMI >30.0)

8% of population

currently living with diabetes

20% of adults 65

years and older have diabetes

76% of children are up

to date with the recommend

immunization series

60% of residents

receive annual flu shot

26% of adults have

had a time in the last year when they have

been worried or stressed about having enough money to pay

monthly bills

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17

Obesity

Diab

ete

s

Glu

cose

Me

ntal H

ealth

BMI

Heart Disease

Hyp

erte

nsio

nP

roce

ssed

Foo

ds

Access to healthy foods

Lifestyle

Ph

ysical Activity

Body Fat

Chronic DiseaseSafe places to exercise

Weight

Fast Food

Sedentary

Po

rtion

Co

ntro

lAdults

Children

Tee

ns

Co

st of M

ed

ical Care

Safe Routes to School

Active Transportation

Healthy LivingSm

art Snacks

Active Classrooms

Active

Re

cess

Physical Education

Parks and Trails

Scho

ol G

arde

ns

Farm to Table

Scho

ol B

reakfast P

rogram

s

Community Health Importance and Impact

The overall health and well-being of a community rely heavily onproper nutrition and adequate physical activity. Healthful diets andbody weights are directly related to health status. Good nutrition isimportant to overall physical and developmental growth.Additionally, physical activity can improve the health and quality oflife of all ages, regardless of the presence of a chronic disease ordisability.

Proper nutrition and physical activity have great community benefits.Healthy diets rich in fruits and vegetables have been shown to reducemany health conditions, including: overweight and obesity, heartdisease, high blood pressure, dyslipidemia, type II diabetes, oraldisease, and some cancers. Furthermore, physical activity can lowerthe risk of: early death, coronary heart disease, stroke, high bloodpressure, type 2 diabetes, breast and colon cancer, falls, anddepression.

Unfortunately, many people do not meet the guidelines for physicalactivity or fruit and vegetable consumption; and these people are atan increased risk for obesity. Furthermore, obesity is associated withmany additional health-related problems. These problems rangefrom diabetes, heart disease, hypertension, premature mortality tomental health issues. Obesity increases the overall cost of healthcare placed on society.

Many factors are associated with overeating and inadequate exercisethat results in obesity. Factors may include lack of knowledge ofcaloric intake, lack of access to healthy foods, eating for psycho-socialreasons, overfeeding by parents, or lack of safe places to exercise.There are many future health and life risks, implications, andconsequences associated with consuming an unhealthy diet, whichincludes those without adequate fruits and vegetables.

18

Community Health Priority:Obesity

Obesity in Olmsted County

Local obesity data is primarily from the community telephone surveyto help inform the Community Health Needs Assessment. Informationgathered from that survey indicates that 45% of survey respondentsbelieve they are currently overweight. This figure rises considerablywhen looking at self-reported height and weight measurements (BMIcalculations) – 64% of Olmsted County adults are overweight, with28% being obese.

Obesity is a problem throughout all communities. However, amongadults, the prevalence is highest for middle-aged people and for non-Hispanic black and Mexican American women. The association ofincome with obesity varies by age, gender, and race/ethnicity. Limitedsub-population breakdown is available for Olmsted County; however,the 2013 Community Health Needs Assessment Survey shows thehighest obesity disparity between Hispanic (47.1%) and non-Hispanic(26.8%) individuals, which is consistent with national trends.

Strategy 1: Promote a culture of

healthy eating

By 2018, increase the percentage of Olmsted County adults who meet the recommended guidelines for fruit and vegetable consumption from 50.0% to 55.0%

By 2018, increase the percentage of Olmsted County adolescents who meet the recommended guidelines for fruit and vegetable consumption from 21.1% to 25.0%

Strategy 2: Promote a culture of

physical activity

By 2018, increase the percentage of Olmsted County adults who meet the recommended guidelines for moderate physical activity from 48.0% to 55.0%

By 2018, increase the percentage of Olmsted County adolescents who meet the recommended guidelines for moderate physical activity from 48.2% to 55.0%

Goal Promote health and reduce chronic disease risk through the consumption of healthful

diets and achievement and maintenance of healthy body weights Improve health, fitness, and quality of life through daily physical activity

Outcome Objective By 2020, reduce the percentage of Olmsted County adults who are obese from 28.0%

to 26.0% By 2020, reduce the percentage of Olmsted County adolescents who are obese from

7.4% to 7.0% By 2020, reduce the percentage of Olmsted County adults who are overweight from

64.0% to 60.0%

Community Strengths

Bicycle Master PlanBicycle Pedestrian Advisory Council

Community EducationComplete Streets Policy

Farmers MarketFarm to Table

Healthy ConcessionsHealthy Food Alliance of SE MN

Healthy Living Rochester Coalition – Mayo ClinicOCPHS Statewide Health Improvement Plan

Rochester Area Family YWe Bike RochesterWorksite Wellness

19

Community Health Priority: Obesity

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20

Diabetes Insu

lin

Glu

cose

Type

I

Type

II

Blood Sugars

Obesity

Mu

scle

Complications

Quality of Life

Screening

Education

GestationalAdult Onset

Treatab

leNutritionPrevention

21

Diet

Exercise

We

ight Lo

ss

LifestyleCo

ntro

l

Metabolism

Pan

creas

CarbohydrateMedications

22

Community Health Importance and Impact

Diabetes mellitus (DM) is a disease that affects how your body usesblood glucose, or blood sugar. Individuals who are diagnosed withDM have too much glucose in their blood. There are severaldifferent types of DM, including Type I, Type II and gestationaldiabetes. Diabetes affects an estimated 23.6 million people in theUnited States and is a top leading cause of death.

Currently, Type I DM is not preventable but treatable. Type II DM isclosely associated with obesity and has been increasing in frequencyfor the past few decades. Type II DM key risk factors are acombination of genetic predisposition and obesity. The relativeimportance of the two is unknown; but preventing obesity can delayor prevent the onset of Type II DM.

DM impacts all aspects of a patient’s life from requiring changes ineating habits and daily monitoring of glucose levels to increasing riskfor many other chronic conditions. The rapid, often termedepidemic, increase in DM puts high demand on health care servicesincluding patient education and forces the profession, includingpublic health, to address the wide spread issues of low to modesthealth literacy. Because DM requires patients to manage theircondition on a day to day basis, it is imperative that they understandtheir condition and self management goals and mechanisms.

Data presented are overall DM disease prevalence; however,community strategies are focusing solely on Type II DM.

Diabetes in Olmsted County

Approximately 8% of Olmsted County residents are currently living withdiabetes. Differences in DM prevalence are apparent in local data –specifically across gender and age cohorts. Men in Olmsted County havehigher rates of diabetes as compared to women (8.9% vs. 6.6%,respectively). Additionally, the highest diabetes prevalence is seen in theoldest aged cohort – adults 65 years of age and older – at 20.2%.

At a local, state-level, and nation overall, DM risk is higher among AfricanAmericans. Locally in Olmsted County, this disparity has been shown to betrue for the recently arrived Somali immigrants with several cases of newonset Type II DM following arrival in the US and changes in diet andexercise.

2 in 10 adults age 65 and older have diabetes

Community Health Priority:Diabetes

Strategy 1:

Promote and increase diabetes screening

throughout the community

By 2015, establish the baseline level for community diabetes screening rate By 2018, increase diabetes screening rate for high risk population (baseline and target

rate to be established)

Strategy 2:

Improve collaboration to expand health education and awareness

By 2018, improve the rates of formal diabetes education received by newly diagnosed diabetics (baseline and target rate to be established)

Goal Reduce the disease and economic burden of diabetes mellitus (DM) and improve the

quality of life for all persons who have, or are at risk for DM

Outcome Objective By 2020, reduce the prevalence of adult DM from 7.6% to 7.0% Increase availability of diabetes screening and education in the community (baseline and

target rate to be established)

Community StrengthsAmerican Diabetic Association

Community Health Services Inc.Good Samaritan Clinic

Mayo ClinicOlmsted County Public Health Services

Olmsted Medical CenterPrivate Providers

Rochester Area Family YSenior Center

Worksite Wellness

23

Community Health Priority:Diabetes

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24

25

Borderline Personality Disorder

Mental Health Stress Emotional

Stigma Pan

ic

Be

havio

ral

AD

HD

De

pre

ssion

Qu

ality of Life

Developmental

Anxiety

Resources

Dental Health

Suicide

Fear

OC

D

PTSD

Traum

a

Sadn

ess

Eating Disorder

AddictionsIsolation

Self-D

estru

ction

Schizo

ph

ren

ia

AD

D

Co

pin

g

Autism

Worry

Stable

Ho

usin

g

Ch

ron

ic Illne

ss

Physical Pain

Pro

pe

r Diet

We

llne

ss Activitie

sR

esilie

ncy

Bip

olar

Self-care

Sup

po

rt System

Acce

ss to C

are

Therapy

Ad

vocacy

26

Mental Health in Olmsted County

Recent data reports over 10% of all Olmsted County adolescents feel sadon all or most days. Regardless of grade in school, the magnitude andtrend of self-reported depression continues to increase throughout thepast several years.

Adult mental health status and the frequency of visiting mental healthproviders were assessed during the 2013 Community Health NeedsAssessment Survey. Key findings illustrated that: 57% of adults have feltworried, tense or anxious at least one day during the last 30 days; 31% ofadults have felt their mental health has not been good for at least one dayduring the last 30 days, and; 13% of adults report seeing a mental healthprovider about their own personal health during the last year – of thosethat did not see a mental health provider (87%), 5% believe they shouldhave seen a health professional.

Over 1 in 10 adolescents report feeling sad on all or most days

Almost 6 in 10 adults felt worried, tense, or anxious at least 1 day in last 30 days

Community Health Importance and Impact

Mental health is a state of successful performance of mentalfunction, resulting in productive activities, fulfilling relationships withother people, and the ability to adapt to change and to cope withchallenges. Mental health is essential to personal well-being, familyand interpersonal relationships, and the ability to contribute tocommunity or society.

Mental illness affects every aspect of a person’s and their family’slife, as it impacts the former’s ability to fulfill family, home,community and work roles. For many, mental illness continues to beassociated with stigma that prevent discussion of the symptoms andmay prevent seeking or receiving appropriate and needed healthcare services. For those who are chronically mentally ill, this can alsodisrupt having a home and a sense of any community.

People with both acute and chronic mental health conditions areoften under recognized and under treated, leaving them with asignificant burden. People with chronic mental illnesses have ashortened life span, a lower rate of full-time and steady employment,and higher rates of homelessness. Mental health problems inchildren and adolescents have both short term and potentially longterm consequences. Long term, children and adolescents withemotional, developmental or behavioral problems are less likely toattend college or trade school, less likely to hold full-time jobs, andmore likely to spend time incarcerated. The costs of care for theseproblems are significant and insurance coverage is often limited.

Community Health Priority:Mental Health

Strategy 2: Engage collaboratives to

enhance and connect current and future strategies within the framework developed

Strategy 1: Develop a framework to improve mental health

for all populations

By 2016, assure the completed framework encompasses current gaps and challenges fromprevention to treatment, including: Improving data collection, dissemination, coordination and reporting Promoting positive mental health and resiliency Enhancing strategies for the prevention and early identification of mental illness Facilitating access to mental health resources Addressing premature mortality of people with serious and persistent mental illness Recognizing unique needs of certain populations such as military veterans, cultural groups,

refugees, and jail inmates

By 2016, identify strategies that align with the framework for the 2018-2020 Community HealthImprovement Plan

GoalPromote a culture of mental health wellness and resilience

Outcome ObjectiveBy 2016, complete the foundational work necessary to develop a set of mental health

strategies for Olmsted County

Community StrengthsChildren’s Mental Health Collaborative

Faith CommunitiesFamily Services Rochester

Law EnforcementLegal Services

Mayo ClinicNAMI SE Minnesota

Olmsted County Community ServicesOlmsted County Public Health Services

Olmsted Medical CenterPrivate and Public School Districts

Private Providers in Prevention and TreatmentZumbro Valley Mental Health

27

Community Health Priority:Mental Health

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28

29

DTaP

Vaccine Preventable Diseases

Varice

lla

Meningococcal

Polio

Influ

enza

Vaccine Hesitancy

PVC

Disab

ility

Ou

tbre

aksMMR

Infectious Disease

He

patitis B

Hib

HPVTd

Emerging Threats

Anti-Vaccine

Vaccine Preventable Diseases in Olmsted County

Childhood Immunization SeriesIt is recommended that all children receive the childhood immunizationseries* to protect against a variety of vaccine-preventable diseases. The2013 Olmsted County Community Health Needs Assessment reports that76.7% of Olmsted County children ages 24-35 months are fully vaccinatedwith the recommended childhoodimmunization series.

*includes DTap, Td, Hib,Polio, MMR, Hepatitis B, andvaricella vaccines

Olmsted County is still below theHP 2020 goal, which ultimatelyleads to a greater number of vulnerablechildren during outbreak settings.

Influenza VaccineDuring the 2011-2012 influenzaseason, approximately 60% of allOlmsted County residents (six monthsand older) received the influenzavaccine. Olmsted County’s overallcoverage is drastically higher than theUS and State coverage rates (41.8%and 47.2%, respectively). However,when looking at children (6 months –17 years of age), this increase fadesaway – Olmsted County, along withMinnesota and the US, hovers around53% of children receiving their flushots.

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Community Health Importance and Impact

The increase in life expectancy during the 20th century is largely due toimprovements in child survival; this increase is associated with reductionsin infectious disease mortality, largely due to immunizations. However,infectious diseases remain a major cause of illness, disability, and death.Immunization recommendations in the United States currently target 17vaccine-preventable diseases across the lifespan.

Vaccines are among the most cost-effective clinical preventive servicesand are a core component of any preventive services package. Forexample, childhood immunization programs provide a very high return oninvestment. For each birth cohort vaccinated with the routineimmunization schedule: society saves 33,000 lives; prevents 14 millioncases of disease; reduces direct health care costs by $9.9 billion, and;saves $33.4 billion in indirect costs.

Despite progress, approximately 42,000 adults and 300 children in theUnited States die each year from vaccine-preventable diseases.Communities with pockets of unvaccinated and under vaccinatedpopulations are at increased risk for outbreaks of vaccine-preventablediseases. The emergence of new or replacement strains of vaccine-preventable disease can result in a significant increase in serious illnessesand death.

Community Health Priority: Vaccine Preventable Diseases

GoalReduce the incidence of vaccine preventable diseases

Community Strengths

Mayo ClinicMinnesota Vaccines for Children

Olmsted County Public Health ServicesOlmsted Medical Center

Private Provider Immunization ClinicsSchool-Located Immunization Clinics

Southeast Minnesota Immunization Connection (SEMIC)

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Strategy 2: Develop innovative means to

address vaccine hesitancy

By 2018, decrease or maintain the percentage of conscientious objectors reported at kindergarten and seventh grade by 20%

For a list of current baseline percentages of conscientious objectors see appendix G

Strategy 1: Increase immunization rates

By 2018, increase immunization rates of HPV, Influenza, Childhood Recommended Series (Dtap, Polio, MMR, Hep B, Varicella, Tdap), Adolescent Tdap, and Meningococcal to 80%

For a list of current baseline immunization rates, see Appendix G

Outcome ObjectiveBy 2020, reduce or maintain the number of reported vaccine preventable diseases in

Olmsted County:

Community Health Priority:Vaccine Preventable Diseases

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Financial Stress/Homelessness

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FoodViolence

InsecurityPhysical Health

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Social Support SystemVulnerability

Worry

Unhealthy Coping Behaviors

Utility Bills

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Medications

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Community Health Importance and Impact

Social determinants of health are directly correlated with healthstatus. Poverty, unemployment, and lack of educationalachievement affect access to care and a community’s ability toengage in healthy behaviors. Without a network of support and asafe community, families cannot thrive. Ensuring access to socialand economic resources provides a foundation for a healthycommunity.

Financial stress is one of the leading causes of stress in America. Itis linked to health problems such as anxiety, depression, andunhealthy coping behaviors. Financial instability affects everyonein a family and can lead to poor school attendance, crime, poverty,and an inability to meet basic needs. With less money in thebudget, people tend to cut corners in areas of health care to payfor basic necessities (i.e. money for groceries over prescriptionmedicine), which ultimately can lead to more serious health issues.

People without homes cannot build productive lives – physical andmental health deteriorate and it is difficult, if not impossible, tofind and keep a job. Without income and a place to sleep at night,people are more likely to turn to crime; children cannot moveforward with their education and they cannot develop healthy,sustainable relationships with their peers. For many city officials,community leaders, and even direct service providers, it oftenseems that placing homeless people in shelters is the mostinexpensive way to meet the basic needs of people experiencinghomelessness. However, the cost of homelessness can be quitehigh: hospitalization, medical treatment, incarceration, policeintervention, and emergency shelter expenses can add up quickly,making homelessness surprisingly expensive for communities.

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Financial Stress/Homelessness in Olmsted County

According to the 2013 Community Health Needs Assessment Survey,26% of Olmsted County adults stated there has been a time in the past12 months when they were worried or stressed about having enoughmoney to pay their bills. One third of those individuals living infinancial stress reported the stress was there every month, with themost concern over: utilities, rent/mortgage, credit cards, medical bills,groceries, and insurance.

US Census data illustrates the share of Olmsted County householdspaying too much for housing has jumped from 7,900 households in2000 to 14,900 households in 2010. More than one in five ownerhouseholds and more than two in five renter households pay over 30%of their income for housing.

Exactly how many people are homeless or at risk for homelessness inOlmsted County is difficult to say, but the data and opinions shared inthe Families and Youth without Stable Housing in Rochester: A NeedsAssessment suggests that an estimated 200 to 300 families arehomeless or at imminent risk of homelessness each year in Rochesterand Olmsted County. Two percent of Olmsted County adults havereported they have stayed in a shelter, somewhere not intended as aplace to live, or at someone else’s home because they had no otherplace to stay (over 2,000 adults have potentially been without housingin the past year).

Community Health Priority: Financial Stress/Homelessness

By 2017, increase the Food Support Access Index from 60% to 65% By 2016, increase the participation rate in the federal Earned Income Tax Credit and the state

Working Families Credit By 2016, decrease the number of uninsured people from 6% to 1% By 2016, improve community outreach, education, and access to all safety net programs, including

food, cash, housing, and medical assistance

Strategy 2: Ensure people have access to

safety net programs

Goal Create social (and physical) environments that promote good health for all

Outcome Objective By 2020, decrease the percentage of Olmsted County adults reporting

living in financial stress from 26.0% to 20.0%

Community StrengthsCommunity Action Program (CAP)

Community Food ResponseDorothy Day House

Interfaith Hospitality NetworkLiving Independently with Knowledge (LINK)

Olmsted County Community ServicesRochester School District

Salvation Army United Way of Olmsted County

Women’s Shelter

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By 2020, increased the percentage of jobs in Olmsted County that pay a living wage from an estimated 62% to 70%

Strategy 3: Increase the proportion

of living wage jobs

By 2020, decrease the percentage of households paying more than 30% of their income for housing

By 2015, evaluate and begin implementation of strategies identified in the Olmsted County Housing Plan that increase affordable housing for lower income levels

Strategy 1: Increase the availability of

affordable housing

Community Health Priority: Financial Stress/Homelessness

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Each of the five Olmsted County priority area workgroupswere able to identify issue-specific, broad, communitystrategies. In addition to the issue-specific strategies, eachworkgroup independently identified several overarchingCommunity Health Improvement Plan strategies. Eachworkgroup was able to recognize the importance of broadercommunity engagement, data and data sources,communication, and policy change. These overarchingstrategies reach across all five priority areas and thereforewill be assessed and addressed at a community level –implementation will not be placed on a specific priorityworkgroup.

Strategy 1Evaluate local community capacity and improve community-wide partnership and engagement

Strategy 2Collect and evaluate local data sources

Strategy 3Develop community-wide communication and marketing

Strategy 4Explore policy changes needed to affect change

Community Health Improvement Plan Overarching Strategies

Overarching Strategies

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Olmsted CountyPriority

Healthy Minnesota2020

Healthy People2020

Obesity

Diabetes

Mental Health

Vaccine Preventable Diseases

Financial Stress /Homelessness

Throughout the assessment and planning process, Olmsted County has consistently aligned with Stateand National processes and priorities.

Based on the statewide health assessment, Healthy MN 2020 is a framework for creating andimproving health throughout the state of Minnesota. Healthy MN 2020 emphasizes creatingconditions that allow people to be healthy, conditions that assure a healthy start and that set the stagefor healthy choices throughout life. Currently, Healthy MN 2020 has 12 Topic Areas encompassingChronic Disease and Injury – locally, Obesity and Diabetes are aligned with statewide targets.Additionally, throughout Healthy MN 2020 health equity and social determinants of health areapparent across all topic areas.

The US Department of Health and Human Service’s Healthy People 2020 sets 10-year goals andobjectives for health promotion and disease prevention. Currently, Healthy People 2020 has 42 topicareas that encompass a wide array of health issues. Locally, all five priority areas are aligned with thenational topics and objectives that include: nutrition and weight status, diabetes, mental health andmental disorders, immunization and infectious diseases, and social determinants of health.

For a more detailed matrix aligning Olmsted County’s Community Health Improvement Plan Prioritieswith State and National Priorities, please refer to Appendix H.

Alignment with State and National Priorities

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Olmsted County will enter and begin Phase II of the community assessmentand planning process immediately after dissemination of the CommunityHealth Improvement Plan Community Strategies; Phase II will last throughoutthe three-year cyclic process.

Throughout Phase II of the process (implementation, monitoring andevaluation), local concepts will align and integrate with the logic modelframework. By using this framework, the community will be able to answerthe following questions: What current (and new) initiatives are occurring in the community

regarding the five priority areas? Who are the partner organizations involved in these initiatives? What are the anticipated (and eventual) results of the community

initiatives?

In addition, the full Health Assessment and Planning Partnership will take thecurrent plan and focus on action and sustainability efforts, including: Continue to increase community engagement in the overall

assessment and planning process Identify current initiatives that connect to the broad community-based

Community Health Improvement Plan strategies Monitor status and progress of community activities via quarterly

Assessment and Planning community meetings Measure and evaluate how well the Community Health Improvement

Plan was implemented and whether the initiatives improved thehealth of the community

Work towards community sustainability efforts for the completeassessment and planning process

Our Future Health: From Planning to Action

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Implementation

The initial step in the implementation phase will be the identification of thoseorganizations that play a role in reaching the community strategies (developmentof a community collection of assets) and formation of the full communityworkgroups.

Once each workgroup is established, the next step in the implementation phasewill include organizations involved in the workgroups completing all thecorresponding information included in the implementation matrix, which isbased on the logic model concept. Items within the table will include thefollowing, and will serve as a preliminary plan of action:1. Health Priority

Acts as the table heading; describes the Community Health ImprovementPlan community health priority along with the identified community goal andoutcome objective .

2. StrategyDepicts the identified broad community-based strategy along with thestrategy-specific objective.

3. InitiativesDescribes the comprehensive series of related activities directed towards arelated outcome.

4. Key ActivitiesPortrays those specific activities that will take place to meet an initiative.Key activities will be briefly described with an implementation timeframe,identified if the activity has a policy component to it, and recognized if theactivity is based on best practices and/or evidence-based.

5. ContactLists those organizations involved in the planning and implementation of theactivity and lead contact person.

6. Anticipated ResultsShort-term and long-term results will describe and illustrate how theseresults are upstream from the long-term outcome objective (performancemeasures, targets, etc. are not included in the implementation table – for thisinformation, please refer to the Monitoring and Evaluation section).

Our Future Health: From Planning to Action

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Monitoring and Evaluation

In a similar fashion to the Community Health Improvement Plan implementation,evaluation will be based on the logic model concept. Within the evaluationstage, priority area workgroups will complete the corresponding informationincluded in the evaluation matrix. Items within the table will include thefollowing, and will serve as a preliminary plan of reporting and communicatingCommunity Health Improvement Plan efforts and achievements:1. Health Priority

Acts as the table heading; describes the Community Health ImprovementPlan community health priority along with the identified community goal andoutcome objective .

2. StrategyDepicts the identified broad community-based strategy along with thestrategy-specific objective.

3. InitiativesDescribes the comprehensive series of related activities directed towards arelated outcome.

4. Key ActivitiesPortrays those specific activities that will take place to meet an initiativeKey activities will be briefly described with an implementation timeframe andlead contact person (organization). Identification of activity inputs(resources, investments, etc.) and outputs (events, reach, etc.) will also beshared.

5. Anticipated ResultsShort-term and long-term results will be described and illustrate how theseresults are upstream from the long-term outcome objective. Specific detail toperformance measures and outcomes will be described.

For a template of the implementation and evaluation matrices, and an initialVaccine Preventable Disease implementation example, please refer to AppendixesI , J and K.

Our Future Health: From Planning to Action

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Sustainability

The current Community Health Improvement Plan reflects a coordinated health improvement effort that will last multiple cycles, and ultimatelymany years. In alignment with other initiatives, the Olmsted County community will follow a three-year cyclic assessment and planning process.Such aligned community initiatives include: Olmsted County Public Health Services’ commitment and compliance to the Minnesota Local Public Health Assessment and Planning Process Olmsted County Public Health Services’ pursuit of national public health accreditation through the Public Health Accreditation Board Mayo Clinic and Olmsted Medical Center’s observing the Affordable Care Act requirements Commitment and charge of the Core Group to continually improve the process, and continued outreach and inclusion of all in the community

In addition to the above mentioned aligned efforts, the following will serve to further support sustained action: Integration of the Centers for Disease Control and Prevention’s Sustainability Planning Guide for Healthy Communities into the assessment and

planning process Joint community funded Project Manager position with the goal of helping to sustain the community assessment and planning efforts Dedication and engagement from community organizations and individuals to consistently serve on the Data Subgroup Quarterly Assessment and Planning community meetings – conveyed, coordinated and facilitated by Olmsted County Public Health Services Commitment and charge of the Coalition for Community Health Integration

Our Future Health: From Planning to Action

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Record of Changes and Updates

Date Changes/Updates Summary Responsible Person(s)

December 5, 2014 Initial creation of CHIP Vicky Kramer

September 8, 2015 Vaccine Preventable Disease strategy 2 changed to: Expand health education and awareness

Vicky Kramer

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See CHIP supplemental document for appendices, which include:

A. Assessment and Planning Process

B. Assessment and Planning Requirements

C. Guiding Frameworks

D. Community Priority Area Workgroup Leads

E. Contributing Organizations

F. Prioritization Process Factors

G. Baseline and Target Vaccine Preventable Disease Metrics

H. Community Health Priorities: Alignment with State and National Priorities

I. CHIP Implementation Matrix

J. CHIP Evaluation Matrix

K. VPD Implementation Example

L. Acronyms

M. Data Sources & References

List of Appendices

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Questions regarding the Community Health Improvement Plan document or process can be directed to:Olmsted County Public Health Services

Health Assessment and Planning Division507-328-7500

The development of the process and final documents would not have been feasible without

LEADERSHIP, GUIDANCE and DIRECTION from the:

Health Assessment and Planning Partnership CHNA/CHIP Core Group Planning Team

Coalition for Community Health IntegrationCommunity Healthcare Access Collaborative

Public Health Services Advisory Board Workgroup Lead Organizations

Thank You

A special thank-you to all the individuals, organizations and partners that have been involved throughout the assessment and planning process.