Community Health Needs ASSESSMENT REPORT2016-2018

Parkview Medical Center (PMC) is a unique community hospital that serves uninsured, underinsured, and insured residents, while also providing countless community outreach services for a wide range of demographics.

PMC first conducted a community health needs assessment in June of 2013 following the requirements of Health Care Reform Legislation (Patient Protection and Affordable Care Act - ACA). PMC will again meet this ACA requirement with completion of the 2016 needs assessment and action plan and will continue to assess and identify new challenges every three years.

PMC prepared a health needs assessment in 2016-2018

using the published document as a strategic guide with identified objectives to meet the needs of Pueblo County residents. PMC has very strong and active partnerships with numerous community health, governmental and social service organizations, enabling the best community resources and prevention education possible.

In preparation for the 2016 needs assessment, PMC has again aligned with the Pueblo City-County Health Department, Pueblo Triple Aim Corporation, the Pueblo Community Health Center, as well as individual residents in the Pueblo community. Coming together in support of Parkview’s needs assessment effort, the group outlined and identified some of the communities’ most significant needs.

Table of ContentsExecutive Summary .....................................................................................................................2

Introduction ...................................................................................................................................2

2013 Overview ..............................................................................................................................3

2013 Evaluation .......................................................................................................................3-4

2013 Broad Interests of the Community ..........................................................................5-6

Community Partners ...................................................................................................................7

Pueblo County Demographics ................................................................................................7

Populations Served ....................................................................................................................8

The State of Pueblo County’s Health .....................................................................................9

PMC Service Lines ..............................................................................................................10-11

Community Involvement .................................................................................................11-12

PMC Strategies for Addressing Needs 2016-2018 ...................................................12-13

Action Plans & Evaluations

Appendixes & Sources ............................................................................................................. 14

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Executive SummaryParkview Medical Center (PMC) has developed a new assessment plan with an overarching goal designed to improve the health of Pueblo County residents. This 2016 PMC community health needs assessment required support and feedback from randomly selected residents of Pueblo County, key members of the hospital staff, leaders in the community representing regional public health and clinicians providing healthcare to under-served populations. The assessment is designed to identify needs and create objectives and action plans to be utilized by PMC to better the health of the community.

While the process for the PMC community health needs assessment was required and initialized by the Patient Protection and Affordable Care Act (ACA), the goal is to define worthwhile initiatives that will positively impact our community. The implementation of the needs assessment involved collecting data, evaluating the data to determine the needs of the community, and then establishing objectives to meet the greatest identified need of the community.

After this extensive exercise, Parkview’s committee has opted to focus in 2016 on working to positively impact lifestyles in an effort to reduce obesity.

The following document provides information specifically related to Pueblo County, the populations that PMC serves, and the potential impact of the priority chosen. The document also provides a detailed look at PMC’s strategic plan for meeting objectives and sustaining the objectives as outlined over the next three years. PMC’s plan involves planning, implementing and evaluating actions and activities related to the identified objectives. PMC will follow best practice guidelines by selecting objectives that include specific, measurable, achievable and time-defined goals.

PMC understands that it will take efforts from multiple partners in the community to effectively impact lifestyle changes needed to lower obesity rates in Pueblo County. PMC will continue to partner with these needed agencies as well as residents of Pueblo to successfully reach the outlined objectives.

IntroductionPMC was founded in 1923 and offers acute healthcare and behavioral health specialty services. The hospital was incorporated as a Colorado nonprofit corporation in 1983 for the purpose of conducting the day-to-day operations of the hospital facilities. PMC receives tax-exempt status pursuant to section 501 (c) (3) of the Internal Revenue Code and public charity status pursuant to section 509 (a) (1). A nonprofit organization is exempt from income tax and property tax for the activities who relate to the reason they have been given that status. PMC provides healthcare to everyone that presents at the facility regardless of ability to pay. For any activity outside the scope of PMC’s exemption, income tax and property tax is paid. PMC is one of the largest property tax payers in the city, as property tax is paid

on all of the medical office buildings.

PMC’s community-focused mission is a reflection of the past and a guide to the future of the organization. One of the key roles of the health system and Medical Center Trustees is to oversee the sensitive balancing of PMC’s charitable purpose, with the ongoing growth and viability of the facility. PMC’s track record over the years has been one of diligent responsibility to the community. PMC successfully expanded facilities offering the latest in technology advancements, while providing uncomplicated access to care in the community. Each year a significant amount of free care and discounts are provided by the hospital to those with limited or no ability to pay. PMC has supports the development of a talented medical staff and successfully recruited and retained excellent healthcare professionals and support staff. PMC continues to operate a safe, cost-effective entity with the highest ethical practices.

The hospital is licensed for 350 acute-care beds and provides a full range of healthcare services, including the only Level II Trauma Center in Southern Colorado and the region’s first certified Stroke Center, STEMI chest accreditation, and an accredited hip and knee center.

PMC has two Emergency Service locations; Parkview Emergency Department at the Main campus and Parkview Pueblo West Emergency Services. The Main Emergency Department has 30 beds and sees approximately 63,000 visits per year. Pueblo West Emergency Department has 12 beds and sees about 20,000 patients per year.

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2013 Evaluation

2013 OBJECTIVE #1: Enabling Pueblo County Residents to find Primary Care PhysiciansBy the end of calendar year one (2013) PMC will partner with local area organizations to provide quarterly updated physician resources, as well as provide an online tool for PCP availability.

BACKGROUND ON STRATEGY Evidence Base: To educate residents who are in need of a PCP, regardless of income/insurance to avoid costly and/or unneeded ED or Urgent Care visitsPolicy Change (Y/N): N

ACTION PLAN Activity Lead Person/ Anticipated Final Product or Result

Organization Product or Result

a) Identify and contact all area Urgent Care and Emergi-care facilities in Pueblo County to provide quarterly printed, updated copies of Pueblo PCPs

b) Provide quarterly printed, updated copies to Pueblo PCPs to all ER/ED patients who present with no known PCP

Community Outreach Coordinator/ Physician Liaison

Community Outreach Coordinator/ Physician Liaison

Commitment of two of the four facilities to routinely provide information to patients who present with no known PCP

All PMC ER/ED staff will provide information to patients who present with no known PCP

The objective was met. All area Urgent Care and Emergi-care facilities, as well as the PMC Emergency Departments, have appointed a person who acts as a point of contact for this objective. Oversight and organization of this objective is the responsibility of the Parkview Physician Relations Coordinator.

The objective was met. This document is updated on a regular basis and supplied to all primary care provider (PCP) offices in Pueblo County and is also given to the PMC Emergency Departments. Oversight and organization of this objective is the responsibility of the Parkview Physician Relations Coordinator.

2013 Overview:PMC began implementing the 2013 needs assessment in July, 2013. The needs assessment, which was completed in June of 2013, had a specific focus on access to healthcare. Access to healthcare is a broad topic, to which PMC narrowed the scope of work by focusing on increasing physician contact and marketing within the community, while also working internally to improve diabetes care.During 2013, 2014, and 2015, PMC was able to meet all listed objectives laid out in the 2013 needs assessment. This accomplishment is outlined in the 2013 evaluation of this report. Completion of these objectives helped to serve the community of Pueblo residents and improve their access to healthcare as well as overall quality of life.

c) Provide quarterly printed, updated copies to additional organizations/service lines (School Based Wellness Centers, Parkview Mobile Nurses, and PCCHD)

d)Provide an on-line physician database and search engine on the PMC website

Community Outreach Coordinator/ Physician Liaison

Public Relations Specialist and Community Outreach Coordinator/ Physician Liaison

Commitment that 2 of the 3 organizations will continually promote and provide the resources needed to clients/patients who present with no known PCP

An easily accessible site for the public to use to locate a PCP

The objective was met. The Parkview Mobile Nurses provide updated copies of the PCP document to all community health and education events they attend. The Pueblo City-County Health Department (PCCHD) also receives updated digital and hard copies of this document. Oversight and organization of this objective is the responsibility of the Parkview Physician Relations Coordinator.

The objective was met. The website is commonly advertised in both Parkview Medical Center and Parkview Medical Group marketing tactics to draw public attention to the information available. Oversight and organization of this objective is the responsibility of the Parkview Physician Relations Coordinator and the Parkview Digital Marketing Specialist.

2013 OBJECTIVE #2: Type 1 & 2 Diabetes EducationBy the end of calendar year one (2013) PMC will provide diabetes specific education to all newly diagnosed inpatients with Type 1 or 2 Diabetes

BACKGROUND ON STRATEGY Evidence Base: Based on recommendations of ADA to provide education to diagnosed cases of diabetes within the first year of diagnosis.Source: www.diabetes.org/news-research/research/access-diabetes-research/diabetes-education-can-aid-newly-diagnosed-patientsPolicy Change (Y/N): Y

ACTION PLAN Activity Lead Person/ Anticipated Final Product or Result

Organization Product or Result

a-i) Newly diagnosed patients will receive diabetes education within 24 hours of identification of new onset diabetes diagnosis(Based on weekday stay)

b) The DCC will provide written education material to all newly diagnosed inpatients

c) The DCC will provide skill teaching to all newly diagnosed inpatients

d) Outpatient education will be offered to every newly diagnosed inpatient

e) The DCC will follow up with a phone call to new onset inpatients two days post discharge

Diabetes Care Center (DCC)

Diabetes Care Center (DCC)

Diabetes Care Center (DCC)

Diabetes Care Center (DCC)

Diabetes Care Center (DCC)

The DCC will provide education to 90 percent of all newly diagnosed inpatients in year two and three (2014, 2015)

The DCC will provide written education to 90 percent of all newly diagnosed inpatients in year two and three (2014, 2015)

The DCC will provide skills teaching to 90 percent of all newly diagnosed inpatients in year two and three (2014, 2015)

The DCC will offer additional education opportunities to 90 percent of all newly diagnosed inpatients in year two and three (2014, 2015)

The DCC will follow-up with a phone call to 90 percent of all newly diagnosed inpatients in year two and three (2014, 2015)

The objective was met.PMC Diabetes Care Center (DCC) provided education within 24 hours to all inpatients based on weekday stay. All information is documented within each patient’s record and on file with the DCC

The objective was met.PMC DCC provided written education within 24 hours to all inpatients (including those who decline verbal instruction) based on weekday stay.All information is documented within each patient record

The objective was met.PMC DCC offered skill training to all newly diagnosed inpatients.All information is documented within each patient record (ie: utilizing teach back technique to assess patient’s ability to perform survival skills)All information is documented within each patient record.

The objective was met.PMC DCC offered skill training to all newly diagnosed inpatients.All information is documented within each patient record and on file with DCC.

This objective was met.This process was transitioned within PMC to the Transition Nurse Care Coordinators.All patients receive an attempted follow-up phone call.All information is documented within each patient record.

a-ii) Patients who have an inpatient status on a weekend will have education upon DCC return to normal business hours or offered a free one-hour consult following

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2013 Objective EvaluationObjective #1Evaluating the implementation of each of the listed objectives is crucial to the improvement of Pueblo County. PMC will have continual follow-up and quarterly drop-off dates/times for all printed PCP publications and will be able to track how many resources are given out. PMC will also be able to identify by page and/or physician how many inquiries have been made via the internet.

• The evaluation of this objective was met and followed as outlined.• Contacts are routinely supplied with digital and hard copy updated lists of primary care providers who are

accepting new patients, regardless of their income/insurance status and/or type. The list of providers acceptingnew patients allows ED staff to help direct patients to seek appropriate care for future non-urgent medical needs.The list allows PCP offices to offer alternative providers in the event that their office is unable to accommodate thenew patient request.

• The PMC website has a “Find a Doctor” page and links users to PCP and specialist physician profiles. These profilesare continually being improved by assessing Web analytics and adjusting information to better meet the needs ofthose searching for health information on our site. The “Contact Us” page allows users the opportunity to send amessage or request and their contact information to us and then we can connect them with the appropriate care.

Objective #2 To evaluate diabetes education, PMC will use internal medical record documentation and ICD9 and ICD10 codes to report the amount of inpatients educated. The DCC will use the data gathered from the compilation of electronic documentation and coding to cross-reference patients who received inpatient education as well as post/out patients that continued education in the Diabetes Care Center.

• This evaluation method was partially used.• There were many barriers to effectively using ICD9 and ICD10 codes in documenting newly diagnosed diabetes

patients. Because of the obstacles encountered, the DCC continued to document within nursing notes and/ordiabetes teaching plans, as well as documentation within the DCC department.

2013 Broad Interests of the Community:PMC strives to work in the Pueblo community with local organizations that have closely aligned objectives in the area of improving lifestyles for residents. PMC has always worked with and will continue to partner with the Pueblo City-County Health Department, Pueblo Community Health Center, and Pueblo Triple Aim Corporation and other entities that serve the community. Each of these organizations were not only key partners during the collection, implementation and evaluation of the 2013 needs assessment, they also will continue to be key partners as PMC continues to improve the health of the community.

In addition to representing the broad interests of the community, each major partner provided valuable resources and data for the 2013 PMC assessment.

Pueblo City-County Health Department (PCCHD)Pueblo City-County Health Department is a vital asset, committed to promoting and protecting the health and environment of the community through prevention, partnerships, leadership and enforcement.PCCHD is currently in the implementation phase for the identified community needs of obesity and teen and unintended pregnancy for 2013-2017.

Based on the 2013 PMC needs assessment, areas that are working well include: “It is great to have specific activities that are detailed within the plan and have areas of focus that are significant burdens on the community.”

Based on the 2013 PMC needs assessment, the area(s) which need improvement include:“Unsure of the completion for various activities, the activities are focused rather internally, not much of an external community focus.”

Changes or improvements witnessed, based on the objectives of the 2013 needs assessment:“Accessing care is difficult with the Medicare/Medicaid expansion and increased demand for providers. Although progress was made on this, there is still great need to address both issues.”

In the community served, what is the biggest health disparity that needs to be addressed and what resources would most benefit those needs?“Based on data, the biggest disparity can be seen among those with lower income and education levels related to all health issues. However, Pueblo has a particular disparity related to chronic diseases in comparison to the state. Applying a health equity approach when addressing the priority issues should be an approach every organization takes. Make sure programs, education and services are provided at an appropriate education level at times that accommodate work schedules and at a cost that is affordable.”

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Pueblo Community Health Center (PCHC)PCHC is a non-profit, full-service family practice health center. PCHC has services for medical care, dental care, prenatal care, as well as laboratory, radiology and pharmaceutical services. PCHC provides homeless outreach and care in the community.

Based on the 2013 PMC needs assessment, areas that are working well include: “School based wellness centers, which are expanded to County HS and contributed to lower teen pregnancy rate”“PMC has provided a sustainable operating model.”

Based on the 2013 PMC needs assessment, the area(s) which need improvement include:“Physician supply, the ratio of doctors has been improved due to the IM residency and recruitment efforts. PCHC encourages PMC to align with Pueblo Triple Aim Corp’s objectives, i.e., cost, population health and patient engagement.”

Changes or improvements witnessed, based on the objectives of the 2013 needs assessment:“I am not personally aware of the changes and improvements that have been made with the two objectives in the CNA. I do think there is more physician choice in the community, in general, and PMC has been contributing to that improvement. I also know that PMC has been aggressive at addressing inappropriate ER use.”In the community served, what is the biggest health disparity that needs to be addressed and what resources would most benefit those needs?

“Substance abuse and mental health. There needs to be increased access to these services.”

Pueblo Triple Aim Corporation (PTAC)PTAC was established in 2010 to improve population health, reduce the cost of care, and improve experiences of care in Pueblo County. PTAC is the backbone support organization to coordinate all Pueblo County efforts which work toward making Pueblo County the healthiest county in Colorado.

Based on the 2013 PMC needs assessment, areas that are working well include: “The outpatient education to newly diagnosed inpatients diabetics (and the follow up phone calls) is positive for Pueblo; the on-line physician database is a great resource.”

Based on the 2013 PMC needs assessment, the area(s) which need improvement include:“A more direct physician and provider availability online (a list of who is taking new patients, what insurances they accepts, etc), and keeping current lists of both family practice and specialty physicians and providers.”

Changes or improvements witnessed based on the objectives of the 2013 needs assessment:“Improvements can be seen through health care community conversations (SE Colorado Transitions of Care group, Get Pueblo Covered).”

In the community served, what is the biggest health disparity that needs to be addressed and what resources would most benefit those needs?“Obesity, the availability and affordability of recreational activities; neighborhood level data on how these types of services might be made available at the grassroots population level.”

The 2013 PMC needs assessment was published and made available in paper copy and posted on the PMC website, www.parkviewmc.org.

PMC received the following feedback based on the 2013 assessment:“The assessment needed to include focus on discharge explanations to patients.”

“PMC has successfully, through the designated physician recruiting department, replaced several primary care physicians in the Adult Medicine Clinic.”

“There is a need for non-elderly, uninsured Pueblo adults to have a regular source of healthcare.”

“The 2013 needs assessment is helping Pueblo residents find doctors and provide diabetes education.”

“Locating a PCP through the Internal Medicine Residency Program has been successful. It is a stress reliever for patients.”

“The Diabetes Care team and education has been huge, this team is committed.”

“I have seen Diabetes education provide inpatient consults, glycemic control with 70 percent goal, education for clinical staff, classes available for residents of Southern Colorado, while accepting Medicaid and Medicare.”

“The Diabetes Care center has expanded information and helped foster positive outcomes.”

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Pueblo County Demographics:Pueblo County is located along the Interstate 25 corridor in Southeastern Colorado at the confluence of the Arkansas River and the Fountain Creek. Pueblo County is one of the larger counties in Colorado by geography with a total land area of 2,386 square miles and a total population of 161,875 residents.1 Pueblo County has diverse agricultural, manufacturing and human service industries. There are several distinct geographical areas within Pueblo County, including high desert/prairie and mountains. Other distinct land features include Lake Pueblo State Park which includes 10,000 acres of land and the Pueblo Reservoir with 60 miles of shoreline.2 The majority of the population lives in the City of Pueblo (108,423) or Pueblo West (29,637). However, there are several outlying rural areas including St. Charles Mesa, Avondale, Boone, Colorado City, Rye, and Beulah.1 According to U.S. Census data, 14 percent of the total population of Pueblo County lives in a rural area.3

Of the total population of Pueblo County, 19 percent live below poverty level, compared to 12 percent for Colorado.1

The population demographics in Pueblo County includes 52.9 percent White non-Hispanic, 42.5 percent Hispanic or Latino, 2.5 percent Black, 3.0 percent American Indian/Alaskan Native and 1.81 percent are Asian.1 Pueblo County School Districts report a high school completion rate of 87.1 percent, which is lower than the Colorado average (90.2 percent), while slightly above the Healthy People 2020 goal of 87 percent.4, 5 The unemployment rate is approximately 3 percent higher than the Colorado average. Pueblo County unemployment was 7.1 percent in 2015.6

Community PartnersThere are many other organizations that PMC closely aligns with, in the Pueblo community and surrounding areas. Those include:

A Caring Pregnancy CenterACOVAAmerican Red CrossCatholic CharitiesGreater Pueblo Chamber of CommerceCity Parks and RecreationCity-County of Pueblo

Colorado BlueskyCooperative Care CenterCrossroads Turning PointsCSU ExtensionDepartment of Social ServicesEl Centro de los PobresJunior AchievementLa Leche LeaguePosadaPueblo Alliance for Health TeensPueblo City School Districts 60Pueblo City-County Health Department

Pueblo Community Health CenterPueblo Division of Social ServicesPueblo Latino Chamber of CommercePueblo School District 70Pueblo StepUpPueblo Triple Aim CorporationSaint Mary-Corwin – Centura HealthSpanish Peaks Mental Health CenterThe Greater Pueblo ChamberWayside CrossYMCA of PuebloYWCA

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Populations Served:PMC serves not only the Pueblo community but also the outlying Southern Colorado areas and rural areas in surrounding states and has the potential to have a significant impact on the health of Pueblo County residents and citizens throughout Southern Colorado.PMC has a primary payer mix of government funded insurance. The county map below outlines smaller communities of residents living in the primary area that PMC serves. The zip codes of Pueblo County that comprise the primary users PMC services are 81001, 81002, 81003, 81004, 81005, 81006, 81007 and 81008.

Outlying areas and medical providers of Southern Colorado that have populations using services of PMC are: Lamar, Prowers Medical Center, La Junta, Arkansas Valley Regional Medical Center, Springfield, Southeast Colorado Hospital, Eads, Weisbrod Memorial Hospital, Trinidad, Mt. San Rafael Hospital, Walsenburg, Spanish Peaks Regional Medical Center, Salida, Heart of the Rockies Regional Medical Center, Del Norte, Rio Grande Hospital, La Jara, Conejos County Hospital, Alamosa, San Luis Valley Regional Medical Center, Westcliffe, Custer County Medical Clinic; Canon City, St. Thomas More Hospital, Raton and New Mexico Miners Colfax Hospital.

PMC sees on average 1,303 inpatients each month, with approximately 66 percent being Pueblo County residents and the remaining 34 percent from outlying Southern Colorado counties and beyond.

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The State of Pueblo County’s Health:The Colorado Department of Public Health and Environment (CDPHE) have identified 10 health related topics that are considered “winnable battles” in the state.8 Each of these areas has a substantial impact on the health of Pueblo County residents, as well as Colorado. The top ten winnable battles are:

1. Healthier air2. Clean water3. Infectious disease prevention4. Injury prevention5. Mental health and substance abuse6. Obesity7. Oral health8. Safe food9. Tobacco10. Unintended pregnancy

According to the Pueblo County Community Health Report published in 2011, while the Pueblo community is moving forward with innovative policy and built environment options, residents continue to fall below state and national benchmarks for health and prevention.9 The Pueblo City-County Health Department published the Community Health Improvement Plan in 2013, stating results of collective data which identified priorities in Pueblo in order of importance.10

1. Obesity2. Mental Health3. Teen Pregnancy4. Lack of Access to Healthcare5. Poverty

In addition, eight key health issues also were identified and include: cardiovascular disease, communicable and infectious disease prevention, diabetes, lack of providers/access to care, mental health, obesity (adult and childhood), poverty, and teen pregnancy/unintended pregnancy.

The focus of lifestyles leading to obesity, selected by PMC, is considered a winnable battle in Colorado and a top priority for Pueblo County. In addition, the CDC also lists obesity as a winnable battle for the nation.11

Obesity:Obesity has a negative effect on health and is measured by body fat percentage and body mass index (BMI). Obesity increases a person’s risk for chronic disease. Colorado now has the lowest rates of adult obesity in the nation.12 The current rate of adult obesity in Colorado is 21.3 percent.12 However, Pueblo County has a population of 29 percent of adults who are obese.4

Mental Health:Behavioral health or mental health is how a person thinks, feels, acts and copes in life. Mental health can determine stress levels and choices. Mental health is often overlooked as a significant public health issue. Pueblo County has seen 4,213.4 per 100,000 hospitalizations due to mental health and 96.4 per 100,000 hospitalizations for suicide.4

Teen Pregnancy:Teen pregnancy is specific to women between the ages of 15-19 years, weather intended or unintended. Teen pregnancy is a multi-level health burden, putting a financial strain on the teen and the child. Teen births are linked to lower high school graduation rates, higher public assistance needs, higher poverty rates, and the children born to teen mothers are more likely to have lower education.13

Teen pregnancy rates in Pueblo remain higher than the Colorado average. In 2014, teens represented 21.2 percent of all births in Pueblo County.4

Lack of Access to Healthcare:Access to healthcare is multi-facetted. Access is relevant to finding healthcare, utilizing healthcare, affordability of healthcare, and compliance of ongoing care.Pueblo County scores an overall index of 7.8 out of 10 based on three key areas: potential access, barriers to care, and realized access.14

Poverty:According to the 2010 Census, 19 percent of Pueblo County residents fall below the poverty line, compared to 13 percent for Colorado. Poverty is measured by family income and threshold.1

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Parkview Medical Center Service Lines:PMC has departments and service lines that work to serve the needs of the community. Those include Emergency Services, Physician Recruitment, Pueblo Health Care, Adult Medicine Clinic, the Diabetes Care Center, the Parkview Mobile Nurses, and many department specific services.

Pueblo Health Care:Pueblo Health Care (PHC) is an Independent Practice Association (IPA) and has been in the Pueblo Community since 2000. PHC is a subsidiary of PMC. The entity is set-up as a PPO network to contract with health plans on behalf of physician members via the Messenger Model.15 PHC offers monthly educational in-services to physician members and their staff on a variety of topics, including health plan updates, coding/billing, compliance training, human resources updates, customer service and management training, Medicare programs, etc. PHC also serves as a valuable resource for access to information and contacts for physicians and office staff as the need arises. Members also receive a publication of a quarterly newsletter with information on the ever-changing health care industry, current issues and health plan changes/updates. A brief “PHC Update” email is sent out to members on a weekly basis as an additional informational resource to PHC Members.

PHC currently has 255 multi-specialty physician members (181 specialists, 65 primary care providers and nine hospitalists) who enjoy the benefits of PHC.

Physicians also receive delegated credentialing with health plan partners, based on the Credentialing Verification Organization (CVO) Agreement that is in place between PMC and PHC. New physicians are able to start building their business and seeing insured patients immediately upon becoming a PHC member for those contracts held through PHC. Physicians do not have to wait up to 180 days for completion of direct credentialing with health plans.

Adult Medicine Clinic:In June 2012, PMC welcomed a new service line to improve patient care in Southern Colorado, the Adult Medicine Clinic (AMC). The AMC is made up of nine physicians, two nurse practitioners and 10 resident physicians. The AMC serves as a teaching facility as well as a solution to the ever-growing dilemma for Southern Colorado residents who do not have a primary health care provider. The AMC accepts private insurance, Medicare, Medicaid and CHP+ members. The clinic is able to offer a 24-hour turnaround for patients seen in the Emergency Department with no primary care physician. In fiscal year 2015, this clinic saw more than 15,000 patients. Since opening the AMC has seen 5,000 newly established patients.

Diabetes Care Center:The Diabetes Care Center (DCC) at Parkview is recognized by the American Diabetes Association. The DCC can be accessed by provider referral as well as self-referrals from persons with diabetes. The DCC serves Pueblo County as well as surrounding counties. Diabetes classes and individual appointments are offered during daytime and evening hours. All-day seminar classes also are available. The day time classes and appointments are accessible by public transportation for individuals who do not drive. For persons living outside Pueblo County, full-day courses are available to deliver the same content in a single day to reduce travel. Evening courses are offered to provide education to people who work or attend school during the day hours. Individual appointments also are available to address individual needs and concerns.

The DDC accepts all insurances including Medicare and Medicaid. Grant funding is sought annually to provide diabetes education to persons who do not have insurance. Diabetes education materials are provided at no charge upon request for people who prefer not to attend a class or an individual appointment. A translation service is available by appointment for those people needing diabetes education in a language other than English.

Outcomes data is gathered on all people attending the diabetes self-management education classes. Behavior changes goals are selected by the person attending education. Follow-up on those patient goals are done at three months after the educational intervention. Hemoglobin A1C data is collected pre-class and three months after the education intervention. The goal of the program is that 50 percent of all participants meet their self-selected behavior change goal as well as reduce their A1C blood test.

The DCC also offers a free diabetes education support group for persons with diabetes who desire ongoing support.

In addition to the outpatient diabetes education classes at Parkview, inpatient diabetes education is available while persons with diabetes are hospitalized. Inpatient diabetes education is available at no extra charge to the inpatient. From January 1, 2013 to December 21, 2015, two hundred and twenty five persons with new onset diabetes were seen for diabetes education while they were hospitalized.

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Mobile Nurses:Parkview Medical Center, through the Parkview Mobile Nurses (PMN) team, commits thousands of hours annually directly to the residents in the Pueblo community and surrounding regions. Parkview Mobile Nurses are a tremendous community asset and the services offered by this team have truly been lifesaving. This team works in the community and provides preventative services such as flu shots, wellness education, and health screenings to local area businesses, civic groups and numerous other organizations.

The PMN team provides some specific services related to this assessment plan. The nurses work with individuals to identify health risks, provide health education by setting up and conducting on-site screenings complying to specific requests including: body composition, waist circumference measurements, blood pressure, heart rate, pulse oxygen saturation, diabetes (blood glucose and Hemoglobin A1C), fitness testing including three minute step tests, and flexibility, nutrition education, prostate specific antigen testing, bone density, grip and strength, cardiac assessments, full lipid panel cholesterol testing, influenza vaccinations. Parkview Mobile Nurses work with a variety of national/community agencies including American Heart Association, American College of Cardiology, Society of Cardiovascular Patient Care, and the American Red Cross. Each nurse on the mobile team is trained in motivational interviewing and several of the team members are certified in plant-based nutrition to provide guidance on healthy lifestyles and behavior modification.

Department Specific Services:Along with PMN nurses, Parkview has many service lines within the hospital that work in the community to provide free education and services to reduce the burden of health disparities. Those departments include:

• Emergency Department Services• Respiratory Therapy• Trauma and Injury Prevention• Rehabilitation Services• Hip and Joint• Stroke Education• Diabetes Care Center• Employee Assistance Program• Behavioral Health• Parkview Medical Group

Community Involvement:As a true community hospital and working in compliance with the mandates of the Charitable Hospital Community Health Needs Excise Tax and the Affordable Care Act, Parkview has hosted numerous meetings seeking input for the 2016 needs assessment. Upon completion of the 2013 needs assessment, PMC put a process in place to solicit and collect input regarding healthcare needs priority areas for Pueblo County. This was done through post visit surveys with PMC, and also through the use of brief questionnaires distributed over the past two years, beginning in January of 2014, at various community events hosted by the PMN and other members of the Parkview team. These surveys requested participants to rank what they believe were disparities in healthcare in the community and over 100 individuals completed the questionnaire. The goal was to collect qualitative information to identify critical public health issues in Pueblo County. The data was compiled based on greatest response using a rating scale of highest priority to lowest priority. The twelve areas that could be assessed were: heart disease, contagious disease, diabetes, lack of providers or lack of access to care, mental health, obesity, teen/unintended pregnancy, injuries, alcohol/ tobacco/other drugs, cancer, lack of immunizations, and nutrition/food safety.The theme from the collection of data was there is a perceived greatest need in the community for improvement of:

1. Alcohol, tobacco, and other drugs2. Obesity3. Diabetes and Heart Disease4. Diabetes and Heart disease ranked the same for greatest need below alcohol, tobacco, and other drugs and

obesity.

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The second step in the assessment involved a meeting of PMC leaders and key members held on November 30, 2015. This group met to discuss data collection, summary of the 2013 assessment, and designate roles for the 2016 assessment. A complete list of attendees can be found in Appendix A.

The final step in working toward the completion of the 2016 needs assessment was to formally meet with a combined community group, known as the Parkview Family Advocacy Committee (PFAC), on February 11, 2016. This group was established to help the hospital capture direct patient care feedback from community members who have experienced care at Parkview. PFAC is also designed to help the hospital better work to understand and meet the needs of our community. The group was asked very specific questions to gather feedback on the 2013 needs assessment, as well as input for the needs of the community in 2016.

The efforts of the group meetings provided tremendous feedback and have helped Parkview leadership establish focused service priorities for PMC in striving to improve community health. PMC will choose a primary focus for 2016-2018 of reducing obesity by placing a specific emphasis on lifestyle.

PMC Strategies for Addressing Needs in 2016-2018OBJECTIVE #1: PMC will utilize the Diabetes Prevention Program (DPP), created by the CDC, to impact weight loss for community residents.

BACKGROUND ON STRATEGY Evidence Base: Using the 16-week DPP program to educate residents on various health topics while promoting weight loss and behavior modificationSource: http://www.cdc.gov/diabetes/prevention/index.htmlPolicy Change (Y/N): N

ACTION PLAN Activity Target Date Resources Required Lead Person/ Anticipated Product

Organization or Result

a) The DCC will provide continual 16 week classes throughout the calendar year and will track participation within the program to ensure best results.

b) The DCC will provide continual 16-week classes throughout the calendar year and will track participation within the program to ensure best results.

c) The DCC will provide continual 16-week classes throughout the calendar year and will track participation within the program to ensure best results.

d) The DCC will provide continual 16-week classes throughout the calendar year and will track the percent of weight lost by participant.

Partial Calendar Year, July 2016-December 2016

Calendar year of Janu-ary 2017- December 2017

Calendar year of Janu-ary 2018 - December 2018This measure will be dependent upon insur-ance reimbursement for sustainability.

December 2018

Diabetes Care Center

Diabetes Care Center

Diabetes Care Center

The DCC will have a completion rate of 40 percent of participants engaging in a full 16-week program.

The DCC will have a completion rate of 50 percent of participants engaging in a full 16-week program.

The DCC will have a completion rate of 60 percent of participants engaging in a full 16-week program.

During the course of programing, 50 percent of participants will lose seven percent or more of their starting body weight

Classroom supplies

Classroom supplies

Classroom supplies

Classroom SuppliesScale

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PMC Strategies for Addressing Needs 2016-2018:OBJECTIVE #2: The Parkview Mobile Nurses (PMN) will provide sustainable health education within the community to lower obesity and improve connected health risks.

BACKGROUND ON STRATEGY Evidence Base: Primary health education focused on lifestyle will reduce obesity. Primary education will include printed and written education based on best practice guidelines.Source: www.heart.org/STEMI Receiving Center AccreditationPolicy Change (Y/N): N

ACTION PLAN Activity Target Date Resources Required Lead Person/ Anticipated Product

Organization or Result

a) The PMN will comply with the STEMI Accreditation and collect pledged signatures in Early Heart Attack Care (EHAC)

b) The PMN will comply with the STEMI Accreditation and collect pledged signatures in Early Heart Attack Care (EHAC)

c) The PMN will comply with the STEMI Accreditation and collect pledged signatures in Early Heart Attack Care (EHAC)

d) The PMN will produce health education to be used in Health Information Centers (HIC - large graphic education boards with handout materials, updated quarterly) located throughout Pueblo County and will increase the number of HIC in Pueblo County

December 2016

December 2017

December 2018

December 2018

Parkview Mobile Nurses

Parkview Mobile Nurses

Parkview Mobile Nurses

Parkview Mobile Nurses

The PMN will collect 500 pledges based on written and verbal EHAC education

The PMN will collect an additional 600 pledges based on written and verbal EHAC education

The PMN will collect an additional 700 pledges based on written and verbal EHAC education

During the course of programing the PMN will produce 36 health education materials and will have 37 HIC stations set up throughout Southern Colorado

EvaluationsObjective #1Evaluating the implementation and results of each of the listed goals in the objective is crucial to improving lifestyles that reduce obesity in Pueblo County. The DCC will utilize a confidential tracking system to follow each participant in the DPP program for participation and weight loss.

Objective #2To evaluate written and verbal health education, the PMN will continue to partner with the STEMI accreditation and will keep record of HIC locations and materials produced. EHAC education is an important component of lifestyle choices related to obesity as cardiovascular disease risks increase.

Paper printing

Paper printing

Paper printing

HIC boards Printed materials

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Appendix APMC would like to thank the following individuals and organizations for their commitment to the Community Health Needs Assessment process and their dedication to improving the health of Pueblo County and its residents.

Planning GroupsAnn M. Bellah, Pueblo Health Care Executive Director, PMCBobbie Blood, RN, BSN, Director of Data Governance, PMCNicole Brown, BA, Physician Relations Coordinator, PMCScott Cleveland, CPA, Controller, PMCTerry Frazier, Director of Medical Staff Services, PMCAlicia Garcia, Community MemberJacklyn Gazette, RN, BSN, CMSRN, Nurse Manager Med Surg, PMCRhonda Lewis, RN, BSN, Director of Diabetes Care Center, PMCPete Martinez, AVP Physician Services, PMCJan Philson, RN, Parkview Mobile Nurses, PMCBryan Serena, Community MemberRyan Smith, Business Office Director, PMCStephanie Swithers, BS, Employee Wellness Coordinator, PMC Terri Tibbs, RN, CRRN, Clinical Coordinator Parkview Mobile Nurses, PMC

Community Groups and Input:Christine Cortese, Employee Member of PFACShylo Dennison, MPH, CHES, Public Health Planner, PCCHD Jennifer Dingman, Community Member of PFACDarla Dunmire, Community Member of PFACJennifer Gallagher, Employee Member of PFACMatt Guy, Executive Director, Pueblo Triple Aim CorporationJill Mandarich, Community Member of PFAC Kelsey Markenson, Employee Member of PFACDonald Moore, Chief Executive Officer, PCHCKathleen A. Smith, Community Member of PFACAmeila Vigil, Employee member of PFACJune Wells, Employee member of PFACSean Westbrook, Community Member of PFACJoann Wright, Community Member of PFAC

Writing/Design/Editing:Stephanie Swithers, BS, Employee Wellness Coordinator, PMC Tammy Moore, Graphic Design Specialist, PMCJeff Tucker, Public Relations Specialist, PMC

Sources:1. 2010 U.S. Census Bureau (Age groups and sex; Race;

American Community Survey; Small Area Income and Poverty Estimates; Insured rates). Available from www.factfinder2.census.gov; www.census.gov

2. Pueblo County Government. Available from http://county.pueblo.org/

3. City Data. Available from http://www.city-data.com/city/Pueblo-Colorado.html

4. Colorado Health Indicators (n.d.). Colorado Health and Environmental Data (CHED).

5. Healthy People 2020 Objectives. Available from www.healthypeople.gove/2020

6. Pueblo County Department of Social Services. Correspondence May 2011

7. Census Scope. Available at http://www.censusscope.org

8. Colorado Department of Public Health and Environment. Available from https://www.colorado.gov/pacific/cdphe/colorados10winnablebattles

9. Pueblo County Community Health Report. Available from http://county.pueblo.org PDF version

10. Pueblo County Community Health Improvement Plan (2013-2017). Available from http://county.pueblo.org/sites/default/files/documents/CHIP%20FINAL%20w.o.%20signatures.pdf

11. CDC Winnable Battles. Available from http://www.cdc.gov/winnablebattles/

12. State of Obesity. Available from http://stateofobesity.org/states/co/

13. Department of Health and Human Services. Available from http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive-health/teen-pregnancy/

14. Colorado Health Institute. Available from http://www.coloradohealthinstitute.org/key-issues/detail/new-models-of-health-care/colorado-access-to-care-index

15. Federal Trade Commission and Department of Justice Health Care Hearings. Available http://www.ftc.gov/ogc/healthcarehearings/docs/030925douglasross.pdf