Harrison Memorial Hospital Community Health Needs ... · PDF fileAbout Harrison Memorial Hospital 5 ... including sources and dates of data, analytical ... HMH now has cardiologist

Harrison Memorial Hospital

Community Health Needs Assessment

2015

Table of Contents

Introduction 1CHNA Implementation Strategic Plan 2

Prelude: Update from 2012 CHNA Initiatives 3

About Harrison Memorial Hospital 5

Community Served by Harrison Memorial 7

Harrison Memorial’s Community Involvement 9

Harrison Memorial’s Community Details 10

Characteristics of the Community 11Harrison County 12

Pendleton County 14

Robertson County 16

Nicholas County 17

Health Status of the Community 19

Health Outcomes and Factors 29

Health Resources 32

Physician Resources 34

Community Health Surveys 36Results Overview 38

Survey Results 39

Community Health Expert Interviews 44Results/Key Findings 45

Prioritization of Identified Health Needs 47

Community Health Needs Assessment 2015

1INTRODUCTION

Community Health Needs Assessment

The Patient Protection and Affordable Care Act, signed into law on March 23, 2010, and subsequent guidance impose additional requirements on hospitals seeking to obtain or maintain charitable tax-exempt status as defined under Section 501 of the Internal Revenue Code of 1986. One of the new requirements is the completion of a Community Health Needs Assessment (CHNA). Impacted hospitals must complete and document this assessment in a written report, including several key elements:

• A description of the community served by the facility and how the “community” was determined.

• Detail of the process and methods used to conduct the CHNA, including sources and dates of data, analytical methods used, information gaps, collaborating organizations, and the identity and qualifications of third parties contracted with to assist in conducting the CHNA.

• How the hospital considered input from persons representing the broad interests of the community served by the facility, including information on individuals and organizations that provided input.

• A prioritized account of all the community health needs identified and a description of the process and criteria used in prioritizing the needs.

• A description of the existing healthcare resources in the community available to meet the Community Health Needs (CHN) identified in the CHNA.

• Public access to the CHNA report.

• Adoption of the CHNA report by an authorized body of the Hospital.

• Written comments received on the most recently completed CHNA report have been taken into account.

The needs assessment is a critical tool used by the Hospital to understand the needs of the community and highlight the areas where Harrison Memorial Hospital can continue to serve as a community healthcare leader for years to come.

The community health needs assessment is not only this final published document, but the process of uncovering the needs, gaps, and concerns of the community served by the Hospital. The process involves collection and analysis of data, interviews with key stakeholders with expertise in public health and surveying members of the community. Most of the research, analysis, and development of this report took place during the months March thru July 2015.

To assist in the completion of this assessment, Harrison Memorial Hospital engaged Dean Dorton Allen Ford, PLLC (Dean Dorton). Dean Dorton is an accounting and advisory firm with offices in Lexington and Louisville, KY. The Healthcare team at Dean Dorton is comprised of audit, tax, and consulting professionals who provide services to clients across the state of Kentucky and beyond.

Introduction


Harrison Memorial Hospital (HMH) completed a community health needs assessment (CHNA) in 2012 as required by the Patient Protection and Affordable Care Act (ACA). A new CHNA is required every three years and HMH again conducted a CHNA in 2015 and will thereafter as required. Under current practice, HMH assesses the community health needs through several board level committees and meetings. The CHNA (including its Implementation plan) is integrated into these board initiatives throughout the year and progress towards achievement of the implementation plan is monitored in these meetings. This coordinated usage of the CHNA and the resulting actions create the HMH strategic plan for making the CHNA and its associated implementation plan impactful. We welcome comments on any of our CHNA reports and implementation plans. Comments may be submitted using the e-mail address [email protected].

HMH has two board-level committees who provide recommendations to the HMH board of directors. The first, Planning Market Share Enhancement (PMSE) committee is comprised of HMH board members and HMH physician staff members. The PMSE committee is presented with market share data of the inpatient activity of the hospital and of major service lines like cardiology, orthopedics and others. The data informs the PMSE committee where patients in the HMH service area choose to receive healthcare. The data is extracted from Kentucky Infosuite each quarter. The reports aid the PMSE committee in making decisions in regards to the needs of the community. Each year the PMSE committee hosts a strategic retreat inviting HMH board members, physician staff members and senior management to discuss community needs and plans for the future. The CHNA is used by the PMSE committee.

The second board-level committee is called Medical Staff Development (MSD). The MSD committee is comprised of HMH board members, HMH physician staff members and community volunteers. Each year the Medical Staff Development committee completes a physician needs assessment. The assessment demonstrates the physician demand in the area based on population. The assessment is used to form a physician recruiting plan for the future and is recommended to the board for approval. The CHNA will be used by the MSD committee.

HMH also receives input on the community health needs assessment from the HMH Active Medical Staff. The medical staff meets monthly to determine physician appointments, policies, and other issues. At every meeting, the HMH Medical Staff is involved in discussions pertaining to the community health needs for the patients seen in each practice. The information is utilized for future plans.

HMH board meetings are held quarterly. CHNA related initiatives not contained in the implementation plan that originate in the PMSE and MSD committees will receive final approval at the board level similar to how the implementation plan is approved. Our implementation plan can be requested via Mollie Smith (Marketing Department) at [email protected].

CHNA ImplementationStrategic Plan

2INTRODUCTION

3INTRODUCTION


The 2012 CHNA, implementation plan, and resulting actions taken by the HMH board of directors all contributed to great progress towards addressing HMH’s community health needs. The Community Collaborative Initiative helped improve communications with the varying providers along the continuum of care and expanded provider education about hospice care. HMH has also expanded post-discharge procedures, including the usage of several tools and documentation measures in addition to increased calls to nursing homes. The planned health fairs continued in the years since the last CHNA in an effort to promote education, provide services, and increase health awareness.

A Pediatrician was brought into the community to promote even better care for infants and children and to change any possible misconception that pediatric care was not a priority or that it was being under-served in any way. The on-campus Pediatric office now features a child-specific waiting room and patient rooms that are more suitable for children. The Pediatric addition also supplemented the addition of three other primary care health providers and various Nurse Practitioners and Physician Assistant resources that focus on primary care while only two primary care doctors transitioned out of care in the community. HMH achieved its goals related to primary care from the 2012 CHNA initiative. These primary care providers may enable better progress on improving obesity, lifestyle choices, and overall health from infants to adults in the community and additionally may further relieve Emergency Department (ED) misuse.

To stem improper ED usage, the health clinic continues in operation at a very “visible” location in the community and a newly HMH employed Physician resource is utilized via an on-campus practice and HMH believes both have been effective. The HMH ED now features more focus on allocating the appropriate level of care based on the screened medical need. Also, the free healthcare clinic in Harrison County is now open twice a month.

In addition to campaigns for the new primary care practitioners previously mentioned, HMH successfully launched initial public awareness initiatives regarding new pulmonary, cardiac, pain management, and mental health professional services using newspaper advertisement, newsletter distribution, radio segments, and disease or health specific initiatives such as a Go Red Campaign and Men’s Health. HMH now has cardiologist coverage 5 days a week and Pulmonologist services up to two days a week to address the need related to heart care. In additional to executing the noted action plan related to drugs and narcotics, HMH believes that its role in bringing the new pain management doctor to the area will help stem drug abuse. The provider has availability weekly. The increased effort to coordinate with local mental health service providers has led to the weekly availability of “Comprehend”, a Buffalo Trace District provider.

Several closely related mental health interim needs also arose since 2012 including addressing suicide prevention in the local school system and additionally, the mental health aspect of “Champions for a Drug Free Harrison County,” which HMH became involved with. The suicide prevention included screening of a broad portion of students. All-encompassing mental health solutions are closer to reality due to actions taken by HMH in the last few years. These are a part of a continuing effort to build the HMH brand, to educate the local community about available resources, and most importantly to create better health with specialized services.

Prelude: Update from 2012CHNA Initiatives


Prelude: Update from 2012 CHNA Initiatives (continued)

The Medicaid Managed Care situation in KY continues to be an issue for HMH. While the implementation plan has been followed, the situation is far from resolved. Many of the issues seem to be out of a provider’s control. Diabetes initiatives continue in areas where at least minimal attendance of the general population is present. The two certified educators are still present. The health fair related testing and assessments continue. To combat childhood obesity, HMH has supported the Community Health Partnership but further action may be needed as notable progress does not seem to have occurred. In addition to implementing the noted plan to address COPD and heart disease, HMH had increased awareness of COPD initiatives.

There is more measureable progress to be made in addition to the great progress that has already occurred. Economic barriers to care and insurance plan confusion have improved due to the HMH employment of a “KY KYNECT certified” professional and having counseling services available five days a week, but further progress can be made. High smoking rates have been addressed directly with smoking cessation products being offered upon discharge and various educational programs, but this has proven a tough area to make drastic progress. Similarly the implementation plans targeting obesity and drug use were followed but these lifestyle related health concerns will simply take longer periods of time to overcome. The 2012 CHNA and implementation plan certainly improved the health needs of the local community and the 2015 CHNA continues with these efforts. The 2015 CHNA also adds some new issues and associated plans to further pursue solutions to the communities’ health needs.

4INTRODUCTION


Harrison Memorial Hospital is a regional medical center located in Cynthiana, Kentucky. For more than 100 years, Harrison Memorial Hospital has been a healthcare leader for our community. Our mission is to provide high-quality health and medical services to the people of Harrison and surrounding counties. Evidence of this mission is proven through our recent completion of a new facility, investments in advanced technology and strong and lasting partnerships with area specialists. These efforts make higher quality and more convenient care a wonderful end result for our patients and community.

Harrison Memorial Hospital is governed by a Board of Directors and licensed by the state of Kentucky to operate 61 beds, and certified by both Medicare and Medicaid. Additionally, Harrison Memorial Hospital is a member in good standing with the agencies below, and we meet or exceed their standards for quality:

• The Joint Commission

• American Hospital Association

• College of American Pathologist

• Kentucky Hospital Association

• Kentucky Rural Health Association

Our Services

Allergy Oncology

Allied Health Ophthalmology

Anesthesia Oral and Maxillofacial Surgery

Audiology Orthopedic Surgery

Cardiac Care Otolaryngology (Ears, Nose and Throat)

Cardiology Outpatient Surgery

Cardiothoracic Surgery Pain Management

Dermatology Pathology

Emergency Medicine Pediatrics

Endocrinology Podiatry

Family Medicine Pulmonology

Gastroenterology Radiology

General Surgery Reconstructive Surgery

Internal Medicine Rehabilitation Center

Lab Respiratory Therapy

Nephrology Rheumatology

Neurology Sleep Disorders

Neurosurgery Urology

Obstetrics and Gynecology

About Harrison Memorial Hospital

5INTRODUCTION


6INTRODUCTION

Our Mission

Harrison Memorial Hospital exists for the purpose of providing high-quality health and medical care services to the people of Harrison and surrounding counties of our region. In fulfilling this mission, we strive for excellence:

• In the care we deliver

• In the facilities we provide

• In the recruitment, retention and development of dedicated physicians and personnel

• In facilitating, coordinating and providing access to general and specialized health services through our own resources and in collaboration with the resources of others

Our Vision

To become the Health Care Delivery System of choice for the people we serve.

Our Customer Service Commitment

We promise every day in every encounter to…

• Treat you with dignity and kindness

• Respect your right to confidentiality

• Educate you about your care

• Acknowledge you and your concerns

• Timely response to your need

Our Core Values

• Integrity, honesty, fairness and ethical behavior in all we do

• The continual pursuit of excellence and innovation

• The contribution of each employee in achieving our mission

• The right of each patient to choose the type and extent of care

• Caring and sensitivity in all patient interactions

• Responsible resource management

• Teamwork, cooperation and flexibility

• Encouragement of differences among people


7COMMUNITY SERVED BY HARRISON MEMORIAL

Our community is defined by the geographical proximity to Cynthiana, Kentucky, as well as the number of annual inpatient discharges and outpatient encounters by zip code.

Identification of Geographical Community

Cynthiana, Kentucky, the county seat of Harrison County, is located approximately 25 miles northeast of Lexington, Kentucky. Harrison County shares a border with Nicholas, Bourbon, Scott, Grant, Pendleton, Bracken, and Robertson counties.

Community Served by Harrison Memorial


8COMMUNITY SERVED BY HARRISON MEMORIAL

Inpatient

Zip Code Community/County CY 2014 Discharges % of Total Days of Care41031 Cynthiana - Harrison 827 52.61% 2,662

40311 Carlisle - Nicholas 225 14.31% 699

41040 Falmouth - Pendleton 107 6.81% 353

41064 Mount Olivet - Robertson 97 6.17% 321

41003 Berry - Harrison 94 5.98% 272

40361 Paris - Bourbon 67 4.26% 209

40370 Sadieville - Scott 20 1.27% 87

41004 Georgetown - Scott 18 1.15% 48

Other N/A 117 7.44% 359

TOTAL 1,572 100.0% 5,010

Source: Hospital Data

Outpatient

Zip Code Community/County Encounters % of Total

41031 Cynthiana - Harrison 30,445 61.05%

40311 Carlisle - Nicholas 5,007 10.04%

41003 Berry - Harrison 3,257 6.53%

41040 Falmouth - Pendleton 2,495 5.00%

41064 Mount Olivet - Robertson 1,992 3.99%

40361 Paris - Bourbon 1,939 3.89%

40370 Sadieville - Scott 677 1.36%

Other N/A 4,057 8.14%

TOTAL 49,689 100.00%

Source: Hospital Data

Based on the geographical and discharge information, Harrison Memorial Hospital has defined its primary community area as Harrison, Pendleton, Robertson, and Nicholas counties. This methodology is also consistent with previous regulations set forth by CMS which defines a hospital’s service area as an “area from which a hospital draws at least 75 percent of its inpatients during the most recent 12-month cost reporting period.”

Discharges by Zip Code

During calendar year 2014, Harrison Memorial Hospital discharged 1,572 inpatients. The following chart outlines the residential zip codes related to those discharged patients. During 2014 49,869 outpatient encounters occurred. The second chart below outlines residential zip codes related to those encounters.

9HARRISON MEMORIAL’S COMMUNITY INVOLVEMENT


Harrison Memorial’s Community Involvement

Harrison Memorial Hospital takes great pride in serving as a healthcare leader in the community. We believe that it is our obligation to provide services that extend beyond providing medical care to our patients. Our community involvement is visible through our commitments to education, providing healthcare resources, and even financial contributions and support. Below is a sampling of our recent community benefit activities.

Health Fairs and ScreeningsHarrison County Community Health FairPendleton County Connections and Health FairRobertson County Health FairNicholas County Health Fair3M Health and Safety FairLadies Day OnlyFree Sports Physical ClinicFree Eye Screenings for Diabetics

SeminarsGo Red for Women Campaign Women’s Health Issues SeminarHarrison County Diabetes SeminarDinner with the Doc SeriesSafe Sitter Classes

Community Outreach Blood DrivesChristmas AngelsHMH Food DriveChristmas Child Shoebox ProjectJunior Achievement

EventsHarrison Memorial Hospital ToursHarrison County Relay for Life Buffalo Trace March of DimesHarrison County FairBorn to Run/Walk 5KLittle Feet, Big FeetRock the BlockWestside Health Education FairRotary Career DayRotary Volunteer FairDocument Shred Day

Events (continued)Nicholas County Back to School BashSpecial Night on Church/Hospice EventCynthiana Lion’s Club AuctionCynthiana Rotary Fabulous Fourth NAACP GalaFree Friday Night Flicks Cynthiana Arts Walk Dress in Blue Day Go Pink! Day Agriculture Safety Day Rotary Volunteer

Education and SupportSilver SneakersTobaccoWCYN’s Coffee BreakWPTJ’s Live on MainLocal Newspapers – Provide press releases on health – related topicsHarrison Area Technology CenterLicking Valley Community CollegeHCHS AthleticsPendleton County FootballParis High School FootballRobertson County BasketballWellness CenterSmoking Cessation Classes Cynthiana – Harrison Chamber of CommerceHarrison County Community FoundationCynthiana Lion’s ClubCynthiana Rotary ClubLicking Valley Professional WomenHarrison County/Cynthiana Economic DevelopmentJourney Medical Mission

Harrison Memorial’sCommunity Involvement


Based on 2010 U.S. Census data and 2013/2014 U.S. Census estimates, the combined population of Harrison Memorial Hospital’s primary community area is around 43,000 people. Children and youth under 18 years of age comprise roughly 23% of the total population, while persons aged 65 or more varies by county, but are higher than the Kentucky average which shows that just over 14% of Kentuckians are older than 65 years of age.

Demographic Harrison County

Pendleton County

Robertson County

Nicholas County

Kentucky

Population (2014) 18,592 14,493 2,197 7,041 4,413,457

Population (2010) 18,846 14,877 2,282 7,135 4,339,367

Population change (2010 to 2014) -1.4% -2.6% -3.7% -1.2% 1.7%

Persons under 18 years - % (2013) 22.9% 22.9% 20.4% 23.0% 23.1%

Persons 65 years and over - % (2013) 16.2% 13.7% 21.1% 16.9% 14.4%

Median household income (2009 - 2013) $36,048 $45,480 $31,786 $43,081 $43,036

Persons below poverty level (2009 - 2013) 23.1% 15.6% 22.8% 16.0% 18.8%

High school graduates % of persons age 25+ (2009 - 2013)

80.0% 83.8% 72.7% 79.5% 83.0%

Bachelor’s Degree or higher % of persons age 25+ (2009 - 2013)

14.2% 12.4% 12.5% 13.7% 21.5%

Land area in square miles (2010) 306.36 277.16 99.91 195.17 39,486.34

Persons per square mile (2010) 61.5 53.7 22.8 36.6 109.90

Source: http://quickfacts.census.gov/qfd/index.html

10HARRISON MEMORIAL’S COMMUNITY DETAILS

Harrison Memorial’s Community Details

11CHARACTERISTICS OF THE COMMUNITY


The Community

Social, economic, and demographic characteristics of a community are significant factors in the perceptions and realities of the health and wellness of its people. The following tables highlight some of the population, labor market, and unemployment data that impact the healthcare of the community and its citizens. The information highlights the statistics for Harrison, Pendleton, Robertson, and Nicholas counties.

As previously addressed, Harrison Memorial Hospital has identified its community as Harrison, Pendleton, Robertson, and Nicholas counties.

The Labor Market Area is a key component of the demographic and economic aspects of the community.

Labor Market Area

Most of the demographic and workforce data that follows includes totals for the community’s labor market area. Maps of each county’s labor market areas are provided for reference. Labor market counties are composed of counties which significantly exist within the sixty (60) minute drive range of the originating county’s county seat. A county is included within the radius of the centroid point (a point representing the center of the geographic area of a county) if it falls within the drive zone. Additionally, all contiguous counties will be classified as part of the labor market with the exception of non-Kentucky contiguous counties which have been excluded by the above mentioned 60-minute drive range and have a border with the Mississippi and/or Ohio Rivers.

Harrison County Pendleton County Robertson County Nicholas County

Population (2013) 18,518 14,570 2,235 7,039

Labor Market Area Population (2013)

699,958 392,570 152,509 512,777

Total Available Labor (2012) 706 676 99 423

Labor Market Area Total Available Labor (2012)

25,536 15,367 6,613 19,308

Unemployment Rate (2013) 7.4% 8.3% 9.3% 10.4%

Labor Market Area Unemployment Rate (2013)

7.0% 7.3% 8.0% 7.1%

U.S. Unemployment Rate (2013)

7.4% 7.4% 7.4% 7.4%

Source: www.thinkky.com

Characteristics of the Community



Harrison County

With nearly 45% of the four-county area population, Harrison County is a major economic hub for Harrison Memorial Hospital’s community.

Harrison County Labor Market Area

Employment Percent Employment Percent

All Industries 4,738 100.0 325,336 100.0

Agriculture, Forestry, Fishing and Hunting

0 0 N/A N/A

Mining 0 0 N/A N/A

Construction 0 0 10,098 3.1

Manufacturing 1,130 23.8 N/A N/A

Trade, Transportation, and Utilities

633 13.4 56,349 17.3

Information 55 1.2 6,597 2

Financial Activities 114 2.4 12,331 3.8

Services 758 16.0 119,450 36.7

Public Administration 278 5.9 21,805 6.7

Other 1 0.0 N/A N/A




Firm Product(s)/Service(s) Employees Year Established

Cynthiana

3M Office supplies and stationery products: repositionable note pads, easel pads, labels and packaging tapes

520 1969

Bay Horse Innovations Horse trailers and metal designs such as fencing, cabinets, storage solutions, utility bodies mounted to pickup trucks, general aluminum fabrication and machining

10 2013

Chromascape, Inc. Carbon black dispersions 35 1991

Continental Mixer Solutions Mixers for cement trucks 20 N/A

Cynthiana Publishing Co., LLC Newspaper and shopper’s guide publishing, computer typesetting and web offset printing, real estate magazine publishing

30 1945

E.D. Bullard Company Safety hard hats, fire helmets, face masks, hoods & respirators, thermal imaging cameras

235 1972

E-Z Pack Refuse Hauling Solutions, LLC

Machine shop: truck body fabrication—refuse bodies manufacturing

190 2006

Farmer’s Tobacco Co of Cynthiana Cigarettes 50 2000

Fikeco, Inc. Sheet metal fabrication, HVAC, welding 21 1985

Glen Gery Landmar Stone 25 2007

Harrison Machine Shop Machine shop: welding, drilling, boring, cutting, honing, lathe work, general machining, hand grinding and sandblasting, mechanics, construction

15 1974

Lucas Equine Equipment, Inc. Wood & metal farm gates; steel and wood horse barn window grills, doors and stall fronts

30 1981

Slade, Inc. Powder coating equine products, stall doors, gates, handrail. Powder coating metal containers

11 2000

STI Manufacturing, Co. Wiring harnesses, automotive lights recycling, assembly and packaging

19 1990

Source: www.thinkky.com; Kentucky Cabinet for Economic Development (July 30, 2015).

Harrison County (continued)

Below you will find more information regarding Harrison County’s major employers.



Pendleton County Labor Market Area


All Industries 2,320 100.0 134,019 100.0


N/A N/A N/A N/A

Mining 0 0 N/A N/A

Construction 0 0 3,025 2.3

Manufacturing 320 13.8 N/A N/A


320 13.8 19,212 14.3

Information 0 0 959 0.7

Financial Activities 0 0 6,785 5.1

Services 93 4 49,200 36.7


Other N/A N/A N/A N/A


Pendleton County

Pendleton County, located directly north of Harrison County is also the second most populous of the four counties in Harrison Memorial Hospital’s community, with nearly 34% of the total. Falmouth is the county seat of Pendleton County.



Pendleton County (continued)

Below you will find more information regarding Pendleton County’s major employers.


Butler

Carmeuse Lime & Stone, Inc. Chemical and metallurgical quicklime, hydrate, and limestone products

200 1967

Griffin Industries, Inc. Meat meal; tallow and grease rendering; cookie meal, bio-diesel fuel

85 1942

Hilltop Stone, LLC Crushed limestone 29 1954

Jay Gee Manufacturing Machine shop: drilling and boring, arc, gas, MIG and TIG welding; sheet, plate and structural metal fabricating

79 1971

Mago Construction Co., Inc. Bituminous concrete and asphalt 1 1958

Medialog, Inc. Library catalog card and catalog data printing

20 2000

Pittsfield of Kentucky, Inc. Industrial filters 43 1981

Sunrise Corporation Rendering equipment manufacturer and heavy equipment installation and movers

10 1994

Williams Manufacturing Co., Inc. Plastic laminated products and cabinets; counter tops - laminate and solid surface

8 1980

Falmouth

Hammer Strength Corporation Fitness equipment and plate loading exercise equipment

90 1988

Pendleton DataFarm, LLC Mortgage document retrieval nationwide; title search and mortgage closings in eight states

95 2002




Robertson County Labor Market Area


All Industries 275 100.0 50,987 100.0


N/A N/A N/A N/A

Mining N/A N/A N/A N/A

Construction 8 2.9 1,106 2.2

Manufacturing N/A N/A N/A N/A


4 1.5 8,174 16

Information N/A N/A 260 0.5

Financial Activities 10 3.6 1,224 2.4

Services 87 31.6 10,550 20.7


Other 0 0.0 N/A N/A


Robertson County

Robertson County is located east-northeast of Harrison County and is the smallest county (population) in the state of Kentucky. In terms of land area, Robertson County is the second smallest in the state, with approximately 100 square miles of land.



Nicholas County

Located east-southeast of Harrison County, Nicholas County is anchored by the town of Carlisle and has approximately 16% of the four-county area community.

Nicholas County Labor Market Area


All Industries 904 100.0 254,266 100.0


11 1.2 N/A N/A

Mining N/A N/A N/A N/A

Construction 12 1.3 9,054 3.6

Manufacturing 46 5.1 N/A N/A


133 14.7 46,101 18.1

Information 0 0 5,802 2.3

Financial Activities 0 0 9,952 3.9

Services 292 32.3 96,359 37.9

Public Administration 72 8 9,027 3.6

Other 0 0.0 N/A N/A





Carlisle

Carlisle Mercury Newspaper publishing 4 1993

Lee-Lynn Machining, Inc. CNC machining of parts for the mining industry, safety industry, construction industry, archery industry, and entertainment industry, (speakers) and many more

19 1992


Nicholas County

Most of the demographic and workforce data that follow include totals for the community’s labor market.


19HEALTH STATUS OF THE COMMUNITY

Leading Causes of DeathThe table below reflects the leading causes of death for Harrison, Pendleton, Robertson, and Nicholas county residents. The numbers compare the rates, per thousand, to the state of Kentucky average rates, per thousand. The Kentucky division of Epidemiology and Health Planning has not updated this information since 2005; therefore, the information detailed below is from the Community Commons report, compiled on April 9, 2015.

Full Health Indicators Report, 2015

Health Statusof the Community

Key data indicators used in the report compare Health Outcomes of the four communities in relation to Kentucky. The key Data Indicators are:

• Diabetes (Adult)• Heart Disease (Medicare Population)• Overweight• Obesity• Poor General Health

• Cancer Incidence - Colon and Rectum• Low Birth Weight• Mortality - Premature Death• Infant Mortality

As detailed on the following pages, these health indicators play the largest role in the leading causes of deaths related to the health field (does not take into account motor vehicle accidents).

Harrison County

Pendleton County

Robertson County

Nicholas County

Kentucky

Number Rate Number Rate Number Rate Number Rate Number Rate

Total Deaths, All Causes 199 1080.6 137 902.6 31 1373.5 87 1241.6 39,471 946.0

Diseases of Heart 56 304.1 33 217.4 5 221.5 27 385.3 10,572 253.4

Malignant Neoplasms 47 255.2 32 210.8 9 398.8 15 214.1 9,343 223.9

Chronic Lower Respiratory Diseases

13 70.6 13 85.6 - - 6 85.6 2,545 61.0

Unintentional Injuries 6 2.6 11 72.5 - - 4 57.1 2,264 54.3

Cerebrovascular Diseases 16 86.9 9 59.3 - - 7 99.9 2,117 50.7

Diabetes Mellitus 5 7.2 - - - - 6 85.6 1.168 28.0

Influenza and Pneumonia 10 54.3 7 46.1 - - - - 996 23.9

Nephritis, Nephrotic Syndrome and Nephrosis

6 32.6 4 26.4 - - - - 887 21.3

Septicemia - - - - 4 177.2 - - 575 13.8

Lung Cancer 12 65.2 11 72.5 - - 5 71.4 3,343 80.1

Motor Vehicle Crashes - - 6 39.5 - - - - 918 22.0

Source: KY Division of Epidemiology and Health Planning

Leading and Selected Causes of Resident Deaths, 2005



Diabetes (Adult)This indicator reports the percentage of adults aged 20 and older who have ever been told by a doctor that they have diabetes. This indicator is relevant because diabetes is a prevalent problem in the U.S.; it may indicate an unhealthy lifestyle and puts individuals at risk for further health issues.



Heart Disease (Medicare Population)This indicator reports the percentage of the Medicare fee-for-service population with ischaemic heart disease.



Overweight43% of adults aged 18 and older self-report that they have a Body Mass Index (BMI) between 25.0 and 30.0 (overweight) in the report area. Excess weight may indicate an unhealthy lifestyle and puts individuals at risk for further health issues.



Obesity29.93% of adults aged 20 and older self-report that they have a Body Mass Index (BMI) greater than 30.0 (obese) in the report area. Excess weight may indicate an unhealthy lifestyle and puts individuals at risk for further health issues.



Poor General HealthWithin the report area 28.38% of adults age 18 and older self-report having poor or fair health in response to the question “Would you say that in general your health is excellent, very good, good, fair, or poor?” This indicator is relevant because it is a measure of general poor health status.



Cancer Incidence - Colon and RectumThis indicator reports the age-adjusted incidence rate (cases per 100,000 population per year) of colon and rectum cancer adjusted to 2000 U.S. standard population age groups (Under age 1, 1-4, 5-9, ..., 80-84, 85 and older). This indicator is relevant because cancer is a leading cause of death and it is important to identify cancers separately to better target interventions.



Low Birth WeightThis indicator reports the percentage of total births that are low birth weight (Under 2500g). This indicator is relevant because low birth weight infants are at high risk for health problems. This indicator can also highlight the existence of health disparities.



Mortality - Premature DeathThis indicator reports Years of Potential Life Lost (YPLL) before age 75 per 100,000 population for all causes of death, age-adjusted to the 2000 standard. YPLL measures premature death and is calculated by subtracting the age of death from the 75 year benchmark. This indicator is relevant because a measure of premature death can provide a unique and comprehensive look at overall health status.



Infant MortalityThis indicator reports the rate of deaths to infants less than one year of age per 1,000 births. This indicator is relevant because high rates of infant mortality indicate the existence of broader issues pertaining to access to care and maternal and child health.


29HEALTH OUTCOMES AND FACTORS

This portion of the assessment highlights key health status statistics for the citizens of Harrison, Pendleton, Robertson, and Nicholas counties. The data used in this analysis was compiled from County Health Rankings (www.countyhealthrankings.org) and is based on each county’s mortality and morbidity health outcomes. Mortality (length of life) and morbidity (quality of life) metrics are compiled for each county and the results are utilized to rank the healthiest counties in each state. The rankings are reflective of a variety of health measures and each county is ranked relative to other counties in the same state.

For each of the four counties, Harrison Memorial Hospital has included the following data elements:• Health Outcomes rankings (Mortality and Morbidity)• Health Factors rankings

– Health Behaviors – Clinical care – Social and Economic Factors – Physical Environment

Each county is ranked (out of 120 Kentucky counties) on each of the factors and then compared to Kentucky and national benchmarks.

Definitions relative to the following charts:

Premature death: Represented by the years of potential life lost before age 75 (YPLL-75). Every death occurring before the age of 75 contributes to the total number of years of potential life lost. For example, a person dying at age 25 contributes 50 years of life lost, whereas a person who dies at age 65 contributes 10 years of life lost to a county’s YPLL. The YPLL measure is presented as a rate per 100,000 population and is age-adjusted to the 2000 U.S. population.

Violent crime: Represented as an annual rate per 100,000 population. Violent crimes are defined as offenses that involve face-to-face confrontation between the victim and the perpetrator, including homicide, forcible rape, robbery, and aggravated assault.

Health Outcomes and Factors



Harrison County

Nicholas County

Pendleton County

RobertsonCounty

Kentucky

Health Outcomes (Rank of 120) 87 90 80 108

Length of Life (Rank of 120) 97 89 43 120

Premature death 12,287 11,289 8,919 16,641 8,900

Quality of Life (Rank of 120) 68 88 99 64

Poor or fair health 17% 32% 23% 21%

Poor physical health days 4.1 4.0 5.6 6.8 4.8

Poor mental health days 6.0 4.4 4.3

Low birthweight 10.7% 11.7% 10.1% 8.4% 9.1%

Health Factors (Rank of 120) 47 65 50 77

Health Behaviors (Rank of 120) 42 41 47 108

Adult smoking 31% 30% 28% 33% 26%

Adult obesity 28% 31% 32% 33% 32%

Food environment index 7.3 8.0 8.0 3.6 7.2

Physical inactivity 31% 35% 33% 33% 29%

Access to exercise opportunities 43% 12% 43% 52% 72%

Excessive drinking 15% 12%

Alcohol-impaired driving deaths 30% 0% 35% 100% 29%

Sexually transmitted infections 193 243 253 394 394

Teen birth rate 59 52 48 34 48

Clinical Care (Rank of 120) 57 85 53 91

Uninsured 17% 19% 17% 20% 16%

Primary care physicians 2069:1 7000:1 7302:1 1551:1

Dentists 2645:1 2346:1 7285:1 2235:0 1683:1

Mental health providers 2315:1 3520:1 2081:1 621:1

Preventable hospital stays 106 132 86 94

Diabetic screening 86% 85% 87% 85% 85%

Mammography screening 49.4% 60.8% 57.7% 51.9% 60.1%

Social & Economic Factors (Rank of 120) 55 70 49 31

High school graduation 90% 92% 91% 96% 86

Some college 52.4% 55.8% 43.3% 58.0% 58.1%

Unemployment 7.4% 10.4% 8.3% 9.3% 8.3%

Children in poverty 25% 32% 24% 36% 26%

Inadequate social support 5.6 4.8 4.1 5 5.1

Children in single-parent households 34% 31% 30% 23% 34%

Violent crime rate 161 91 63 235

Physical Environment (Rank of 120) 78 88 86 15

Injury deaths 98 107 110 115 81

Air pollution-particulate matter days 13.1 13.0 13.2 13.1 13.5

Drinking water violations 16% 42% 12% 0% 9%

Severe housing problems 14% 13% 13% 15% 14%

Driving alone to work 83% 80% 82% 75% 83%

Long commute - driving alone 39% 50% 61% 58% 28%

Source: countyhealthrankings.org



Health outcomes ratings improved slightly for Pendleton County from 2012 and improved significantly for Nicholas County. Robertson experienced a sizeable decline in this area and while Harrison’s rating also decreased, it is still second in the four county area. Health Factors improved slightly for Nicholas county, improved significantly for Pendleton County, decreased slightly for Robertson County and declined significantly for Harrison County, although Harrison still scores the best of the four counties. Overall the Health Factors average for the area was nearly unchanged and the Health Outcomes overall average declined about 15 ranking spots.

Harrison County scores 87th out of 120 counties in the Health Outcomes portion and 47th out of 120 counties in the Health Factors elements. Harrison County had the best scores of the four county community in health factors.

Pendleton County scores 80th out of 120 counties in the Health Outcomes scorecard and 50th out of 120 counties in the Health Factors portion.

Robertson County scored the worst of any of the four counties, obtaining the ranking of 108th out of 120 in Health Outcomes. In the Health Factors component, Robertson County ranked 77th out of 120.

Nicholas County fared second worse than any of the counties in Health Outcomes, ranking 90th out of 120 total Kentucky counties. In Health Factors, they ranked much better, securing the 65th spot.


32HEALTHCARE RESOURCES

Access to healthcare resources is critical to providing a continuum of care that supports the health and well-being of a community. If there is an imbalance between supply and demand, then the quality and timeliness of care can be significantly impacted. Below is a listing of the other hospital facilities available to the residents of Harrison, Nicholas, Robertson, and Pendleton counties:

Hospitals

Facility Name Facility Type Bed Size Location Miles from Cynthiana, KY

Harrison Memorial Hospital Acute Care 61 Cynthiana, KY 0

Bourbon Community Hospital Acute Care 58 Paris, KY 15

Georgetown Community Hospital Acute Care 75 Georgetown, KY 21

Saint Elizabeth Medical Center (Grant County)

Critical Access 16 Williamstown, KY 28

Meadowview Regional Medical Center

Acute Care 100 Maysville, KY 46

Harrison Memorial Hospital - Located in Cynthiana, Kentucky, Harrison Memorial Hospital is an acute care facility located in the heart of Cynthiana.

Bourbon Community Hospital – Located in Paris, Kentucky, Bourbon Community Hospital is an acute care facility approximately 15 miles south of Cynthiana.

Georgetown Community Hospital – Located in Georgetown, Kentucky, Georgetown Community Hospital is an acute care facility approximately 21 miles southwest of Cynthiana.

Saint Elizabeth Medical Center Grant County (SEMCGC) – Located in Williamstown, Kentucky, SEMCGC is a critical access facility approximately 28 miles northwest of Cynthiana.

Meadowview Regional Medical Center (MRMC) – MRMC is an acute care facility located in Maysville, Kentucky approximately 46 miles northeast of Cynthiana.

Although the hospital is typically the hub of any healthcare community, other resources play a key role in maintaining the well being and health of its residents. Excluding the physician providers that serve this area, other important healthcare resources include the following:

Other Healthcare Facilities and Providers

Buffalo Trace District Health Department – Serving the people of Mason and Robertson counties, The Buffalo Trace District Health Department, is focused on providing information and resources related to health education classes, personal, and preventive health services, environmental health services, public health emergency planning and response as well as information on late-breaking health news.

Healthcare Resources


33HEALTHCARE RESOURCES

Other Healthcare Facilities and Providers (continued)

Wedco District Health Department – Serving Harrison, Nicholas, and Scott counties, the Wedco District Health Department service array includes preventive health care such as Well Child and Prenatal Clinics; early intervention and treatment clinics such as STD and TB; environmental services such as restaurant, swimming pool and hotel inspections; health education services such as drug prevention and postponing sexual involvement education; as well as many other vital services such as home visitation to first time high risk parents (our H.A.N.D.S. Program) and school nursing.

Journey Medical Mission - The services offered by the Journey Medical Mission are intended to provide ongoing medical management of acute and chronic medical conditions (including diabetes, hypertension and cardiovascular disease) to Harrison County resident patients without other medical resources and to improve the overall health of the community.

Hospice of the Bluegrass - Hospice of the Bluegrass is a private non-profit organization governed by a Board of Directors. The program is a member of the National Hospice and Palliative Care Organization, is certified by Medicare and Medicaid, is licensed by the State of Kentucky and accredited by the Joint Commission on Accreditation of Healthcare Organizations. Hospice of the Bluegrass serves more than 1,000 patients daily in 32 central, southeastern and northern Kentucky counties.

Saint Elizabeth Healthcare Falmouth – Located in Pendleton, KY, offers chemical dependency rehabilitation assistance

Cedar Ridge Health Campus – Located in Cynthiana, KY, Cedar Ridge Health Campus offers senior-centered care, including rehabilitative services, skilled nursing care, and assisted living.

Edgemont Nursing Home – A 68-bed nursing home located in Cynthiana, Edgemont provides nursing home services in the community.

Grand Haven Nursing Home – Located in Cynthiana, Grand Haven is a 54-bed nursing home facility providing services in the community.

Johnson-Mathers Nursing Home – A nursing home facility located in Carlisle, Kentucky.

Robertson County Nursing Home – A nursing care facility located in Mount Olivet, Kentucky.

Three Rivers District Health Department – Provides health and wellness services for Gallatin, Carroll, Owen, and Pendleton counties.

Parkside Manor – A private facility offering assisted living services. Parkside Manor is located in Cynthiana.

Shady Lawn Facility – A private facility offering assisted living services. Shady Lawn is located in Cynthiana.

Bracken County Nursing & Rehabilitation Center - A 32-bed skilled nursing and 30-bed personal care facility located in the rural community of Chatham, Kentucky.

River Valley Nursing Home - A 60-bed nursing care facility location in Butler, Kentucky.

Harrison County and Nicholas County Comprehensive Care Centers - Provide outpatient mental health services, intellectual and developmental disabilities and substance abuse services, case management services for adults with severe and persistent mental illness, children’s services including intensive outpatient for children and their families, consultation and education, courts and jails, domestic violence services, and emergency services. Located in Cynthiana, Kentucky (Harrison) and in Paris, Kentucky (Nicholas).

UTC Georgetown (Urgent Treatment Center) - Provides health and wellness services including 24/7 emergency first, occupational medicine, and worker comp care to central Kentucky.

The Clinic at Walmart (Cynthiana Walmart) - Offers health and wellness services including physicals and basic care. Located in the Cynthiana Walmart.

Baptist Express Urgent Care - Provides basic healthcare services. Located in the Paris, Kentucky Walmart.


34PHYSICIAN RESOURCES

In order to identify existing medical services within each county and develop future plans that may affect Harrison Memorial Hospital, the study includes the analysis of the existing health resources in each county, compared to the national median.

Definitions relative to the following chart:

Short-term general hospitalsThese hospitals are coded as the follows by the American Hospital Association: Length of Stay = “1,” Short-term; Type of Service = “10,” General medical and surgical. These hospitals provide non-specialized care, and the majority of their patients stay for fewer than 30 days.

Ambulatory Surgical CenterFor Medicare purposes this is a distinct entity that operates exclusively for the purpose of furnishing outpatient surgical services to patients. The ASC must enter into a “participating provider” agreement with CMS.

Community Mental Health CenterThese centers must provide four core services:

1. Outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically mentally ill, and residents of the CMHC’s mental health services area who have been discharged from inpatient treatment at a mental health facility.

2. 24-hour-a-day emergency care services.3. Day treatment, or other partial hospitalization services, or psychosocial rehabilitation services.4. Screening for patients being considered for admission to State mental health facilities to determine the

appropriateness of such admission.

Federal Qualified Health Center:Servicers include all of the Rural Health Clinics (defined as a facility located in a rural area designated as a shortage area and is neither a rehabilitation agency nor a facility for the care and treatment of mental diseases; a clinic located on an island may be eligible to be certified as an RHC even though it does not have a physician assistant, nurse practitioner, or a certified nurse-midwife) as well as preventative primary services. Preventive primary services must be furnished by or under the direct supervision of a physician, a nurse practitioner, a physician assistant, nurse midwife, clinical psychologist, or a social worker. The services must be furnished by a member of the center’s health care staff who is an employee of the center or by a physician under arrangements with the center.

HPSAs:These are Health Professional Shortage Areas and are defined by HRSA according to certain criteria.

Physician Resources


35PHYSICIAN RESOURCES

Harrison County

Pendleton County

Robertson County

Nicholas County

National Median

Primary Care Physicians

Number

Physicians/Population (number of physicians per 100,000 population)

General Practice/Family Practice Physicians

Number

Physicians/Population

Internal Medicine Physicians

Number


Pediatricians

Number


10*

48.3

6.5*

37.6

2

10.7

2*

0.0

2

13.7

2

13.7

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

1

14.3

0

0.0

1

14.3

0

0.0

8

40.3

5

27.3

1

5.3

0

0.0

Obstetricians/Gynecologists

Number


3*

21.1

0

0.0

0

0.0

0

0.0

0

0.0

General Surgeons

Number


3*

5.4

0

0.0

0*

45.7

0

0.0

0

0.0

Psychiatrists

Number


1

5.4

0

0.0

0

0.0

0

0.0

0

0.0

Dentists

Number


7

37.1

2

13.4

0

0.0

2*

0.0

4

22.2

Hospitals

Number of hospitals, total

Number of beds, total

Number of short-term general hospitals

Number of short-term general hospital beds

1

49

1

49

0

0

0

0

0

0

0

0

0*

0*

0*

0*

1

25

1

25

Health Centers

Community Mental Health Centers

Federally-Qualified Health Centers

0

0

0

0

0

0*

0

0

1

1

Source: http://www.arf.hrsa.gov/arfwebtool/Counties_list.asp

*Updated with more recent information (as of September 9, 2015).


36COMMUNITY HEALTH SURVEYS

Harrison Memorial Hospital surveyed members of the community. Surveys were distributed to health fair participants, volunteers, civic groups, hospital patients, and other members of the community. Surveys were distributed, collected, and analyzed over a period of four months (March through June 2015) and the results provided insights into the opinions and beliefs of the community at large. Harrison Memorial Hospital collected in excess of 1,000 surveys from the community. A sample of the survey is included on the following page.

Community Health Surveys

1. What is your age?18 or under19 - 2930 - 3940 - 4950 - 5960 - 6970 or over

2. What is your sex?FemaleMale

3. What is your zip code?4103141040410644100641003List Other ______________

4. Employment Status?Full-timePart-timeRetiredUnemployedSelf-employed

5. Where do you go for routine healthcare? a. Doctor’soffice b. Health Department c. Emergency Department d. Local clinic e. I do not receive routine healthcare

6. How long ago was your last medical exam? a. Less than 1 year ago b. 1-2 years ago c. 2-5 years ago d. Greater than 5 years ago e. I’ve never had an exam

7. Are you able to visit with a doctor when needed? a. Yes b. No

8. If your answer to #7 was “No,” why? a. No insurance b. Health services too far away c. Don’t have time d. No transportation e. Notimeslotsavailableatdoctor’soffice f. Other:

9. Do you have any of the following conditions? a. Asthma b. Obesity c. Heart Diseases d. Diabetes e. Cancer f. High Blood Pressure g. Mental Health Condition h. Addiction (any type) i. Depression j. I do not have any health challenges k. Other:

10. How would you rate your health? a. Excellent b. Very good c. Fair d. Poor e. Don’t know

11. Do you currently use: a. Tobacco (once a week or more) b. Alcohol (once a week or more)

12. Do you regularly travel to larger cities for healthcare services?

a. Yes b. No c. If yes, where:

13. If you answered “Yes” to #12, why? a. The specialty I need doesn’t exist here b. IfeelthatIgetbettercarethere c. My long time doctor is there

14. Medical care in Harrison County is a. Great b. Good c. Average d. Poor

15. What do you feel is the biggest health issue in your community?

a. Obesity b. Drug abuse c. Tobacco use d. Alcohol abuse e. Teen pregnancy f. Other:

Community Health Needs SurveyHarrison Memorial Hospital is seeking community input as it completes a community health needs assessment.

The hospital appreciates your honest responses to the following questions.

Please return survey to:HMHc/o Mollie Smith1210 KY Highway 36 EastCynthiana, KY 41031

ordrop-offatHMHfrontlobby


38COMMUNITY HEALTH SURVEY RESULTS

Developed in collaboration between Harrison Memorial Hospital and Dean Dorton Allen Ford, the survey questions selected were intended to provide feedback on geographical, demographic, socioeconomic, and health and wellness concerns of the community. A sample of some of the responses are highlighted below:

Complete survey results can be found on the following pages (39-43).

90% of the people surveyed indicated that they visit their physician’s office for routine healthcare.

69% of the participants had their last medical exam within the past year.

19% of the respondents stated that they do not currently face any health problems. However, the most common responses for those who did claim having health issues were as follows

• High Blood Pressure

• Obesity

• Diabetes

• Asthma

26% of the people responded that they regularly travel to larger cities for their healthcare. The majority of those people cited that the specialty care they need doesn’t exist in the area.

Female73%

Male27%

Sex

0%

7%

12%

19%

21%23%

17%

0%

5%

10%

15%

20%

25%

18 or under 19 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 or over

Current Age



1. What is your age?18 or under19 - 2930 - 3940 - 4950 - 5960 - 6970 or over

2. What is your sex?MaleFemale

3. What is your zip code?

Community Health Needs Survey Results

0%

7%

12%

19%

21%23%

17%

0%

5%

10%

15%

20%

25%

18 or under 19 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 or over

Current Age

Female73%

Male27%

Sex

65%

5% 4% 2% 5%

19%

0%

10%

20%

30%

40%

50%

60%

70%

41031 41040 41064 41006 41003 Other

Zip Code


5. Where do you go for routine healthcare? a. Doctor’soffice b. Health department c. Emergency Department d. Local clinic e. I do not receive routine healthcare

6. How long ago was your last medical exam? a. Less than 1 year ago b. 1-2 years ago c. 2-5 years ago d. Greater than 5 years ago e. I’ve never had an exam

4. Employment Status?Full-timePart-timeRetiredUnemployedSelf-employed


52%

7%

29%

6%6%

Employment StatusFull-time Part-time Retired Unemployed Self-employed

90%

1% 0%

4% 5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Doctor's office Health Department EmergencyDepartment

Local clinic I do not receiveroutine healthcare

Where do you go for routine healthcare?

69%

19%

6%5%

1%

How long ago was your last medical exam?

Less than 1 year ago

1-2 years ago

2-5 years ago

Greater than 5 years ago

I've never had an exam



9. Do you have any of the following conditions?

a. Asthma b. Obesity c. Heart Diseases d. Diabetes e. Cancer f. High Blood Pressure g. Mental Health Condition h. Addiction (any type) i. Depression j. I do not have any health challenges k. Other:

7. Are you able to visit with a doctor when needed? a. Yes b. No

8. If your answer to #7 was “No,” why? a. No insurance b. Health services too far away c. Don’t have time d. No transportation e. No time slots available atdoctor’soffice f. Other:

98%

2%

Are you able to visit with a doctor when needed?

Yes

No

17%13% 13%

7%

17%

33%

0%

5%

10%

15%

20%

25%

30%

35%

No insurance Health services too faraway

Don't have time No transportation No time slots available atdoctor's office

Other (please specify)

If you answered "No," why?

6%

15%

6%8%

2%

27%

1% 1%

5%

19%

10%

0%

5%

10%

15%

20%

25%

30%

Do you have any of the following conditions?


10. How would you rate your health? a. Excellent b. Very good c. Fair d. Poor e. Don’t know

11. Do you currently use: a. Tobacco (once a week or more) b. Alcohol (once a week or more)

12. Do you regularly travel to larger cities for healthcare services?

a. Yes b. No

12.7%

11.2%

10.0%

10.5%

11.0%

11.5%

12.0%

12.5%

13.0%

Tobacco (once a week or more) Alcohol (once a week or more)

Do you currently use tobacco or alcohol?


12%

57%

28%

2% 1%

How would you rate your health?

Excellent

Very good

Fair

Poor

Don't know

26%

74%

Do you regularly travel to larger cities for healthcare services?

Yes

No



13. If you answered “Yes” to #12, why? a. The specialty care I need doesn’t exist here b. IfeelthatIgetbettercarethere c. My long time doctor is there

14. Medical care in Harrison County is: a. Great b. Good c. Average d. Poor

15. What do you feel is the biggest health issue in your community?

a. Obesity b. Drug abuse c. Tobacco use d. Alcohol abuse e. Teen pregnancy f. Other

41%

19%

40%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

The specialty I need doesn'texist here

I feel that I get better carethere

My long time doctor is there

If you answered "Yes," why?

23%

59%

17%

1%

Medical Care in Harrison County is:

Great

Good

Average

Poor

17%

51%

8%

18%

4%2%

0%

10%

20%

30%

40%

50%

60%

Obesity Drug abuse Tobacco use Alcohol abuse Teen pregnancy Other

What do you feel is the biggest health issue in your community?


44COMMUNITY HEALTH EXPERT INTERVIEWS

As part of conducting a compliant Community Health Needs Assessment, the Patient Protection and Affordable Care Act stipulates that the Hospital must seek input from individuals who represent the broad interests of the community, including those with special knowledge of or expertise in public health. Dean Dorton assisted Harrison Memorial Hospital with interviewing community health experts familiar with the health and wellness of the people in Harrison, Nicholas, Robertson, and Pendleton counties. Harrison Memorial Hospital selected the community experts they wanted to interview. As part of the interview process, the experts were asked to openly discuss their roles within the healthcare community and their perspectives on health, wellness, diseases, and needs of the community. The health experts who participated in the assessment are listed below:

Dr. Brian MulberryFamily Medicine Physician HMH Board ChairmanCynthiana and Falmouth Offices

Dr. Stephen Besson Internal Medicine and Pediatrics PhysicianHMH Board MemberCynthiana and Carlisle Offices

Chief Ray JohnsonCynthiana Police Department

Alex BarnettHarrison County Judge-Executive

Amy CoxHospice of the Bluegrass

Matt Harney, PharmDClinic Pharmacy

Allison AlexanderRobertson County Health Department

Dr. Gerald HarpelHMH OB/GYN

April ThomasWedco District Health Department

James SmithMayor of Cynthiana

Brad Allison, Athletic DirectorHarrison County School System

Angie ForsytheGrand Haven Nursing Home

Dr. James PetteyOrthopedics and Sports MedicineHMH Chief of Staff

Jane TatumWedco District Health

Dr. Lauren BlackwellPediatricsCynthiana Offices

Dr. Stephen MosesFamily Medicine PhysicianCynthiana Office

Dr. Greg CooperFamily Medicine Physician Cynthiana and Falmouth Offices

Somer HurstonCedar Ridge Nursing Home

Dr. Richard ArnoldGeneral Practice

Mollie SmithHarrison Memorial Marketing

Sheila Currans CEO Harrison Memorial

Community Health Expert Interviews



As part of the interview process, Dean Dorton specifically asked each individual to provide insight and perspective on each of the following topics:

• What are the significant health needs or concerns of the local population (4 counties)? (What conditions and diseases are prevalent)

• What gaps exist in the local healthcare delivery system?

• What prevents access to care in the community? What are the barriers?

The following summarizes the key discussion points from the expert interviews:

Gaps in the healthcare delivery system:

• Facilities (buildings and technology)

• Patient understanding preventative care covered by insurance

• Expansion of Primary Care services desired for post-natal care (weight/nutrition, lactation consultant, etc.)

• Pediatric Dental Care

• Impending shortage of Primary Care Providers (PCP)

• Lack of workforce level emphasis on health in community businesses

• Consults to specialists’ need to increase across care continuum, need to coordinate care

• Top Talent (Medical Personnel) from local population identified, approached, and retained

• More Geriatric and other Psychiatric services via integration on care continuum

• Pulmonary and Gastroenterology services should be expanded and be more extensive

• Physicians need more training on counseling for end-of-life situations and patient options

• Dermatology and child allergy services are lacking

• Drug and Addiction treatment options are not sufficient

• Needle exchange or disposal programs are needed

Barriers to access to healthcare:

• Changes in methods of education, messaging techniques

• Lack of simple actionable plans (health coach, a plan, reminders, schedule, action, and follow-up)

• Expansion of hours across care continuum

• Population lacks motivation and financial ability to prioritize health

• Poor environment, lifestyle choices, habits, and self-medical follow-up

• Pharmacy and prescribing needs during off hours - sometimes not available

• Transportation is unavailable to some citizens

Health diseases and/or concerns in the community:

• Diabetes is common and poorly managed on a whole as a community

• High Blood Pressure, Heart Disease, and COPD

• Overweight and Obesity is common - lack of fitness (high in children)

• Mental Illness is present and largely untreated

• Child rearing deficiencies in local parental skill sets

• Tobacco related illness prevalent; address cultural issues



Health diseases and/or concerns in the community (continued):

• Drugs and Narcotics - an increasing and changing problem

• Dental conditions are poor

• Poor nutrition is prevalent and access to proper dietary food lacking


Because Harrison Memorial Hospital takes quite seriously its position as a healthcare leader in its community, survey and interview results were scored and prioritized based on four key factors:

1. The scope of the need, e.g., number of people impacted, geographical reach, etc.

2. The level of necessary resources to address the need.

3. The impact of not addressing the identified need.

4. The ability of Harrison Memorial Hospital to positively impact the need.

The following page details the prioritization of community health needs based on the responses from the interviewees. Sheila Currans, CEO and Dave Mellet, CFO prioritized the needs based on those identified through the interview and survey process.

Note: Each category was rounded from 1 (low) to 5 (high). The level of resources category was inverted because initiatives with low resource needs should be prioritized higher. The total weighted core used a scale of 125%, making the highest average possible a 6.

47PRIORITIZATION OF IDENTIFIED HEALTH NEEDS

Prioritization of Identified Health Needs

Scope of the need

Level of resources needed to

address the need

Impact of not

addressing the need

HMH ability to positively impact the

need

Total Weighted

Score

Gaps in healthcare delivery system 30% 25% 35% 35%Facilities (buildings and technology) 5 1 5 5 5

Patient understanding preventative care covered by insurance

5 4 3 4 5

Expansion of Primary Care services desired for post natal care (weight/nutrition, lactation consultant, etc.)

3 5 3 5 5

Pediatric Dental Care 2 5 4 3 4

Impending shortage of Primary Care Providers (PCP)

5 1 5 2 4

Lack of workforce level emphasis on health in community businesses

2 4 3 4 4

Consults to specialists need to increase across care continuum, need to coordinate care

3 4 2 4 4

Top Talent (Medical Personnel) from local population identified, approached and retained

4 1 5 2 4

More Geriatric and other Psychiatric services via integration on care continuum

4 1 4 2 2

Pulmonary and Gastroenterology services should be expanded and be more extensive

4 2 3 2 3

Physicians need more training on counseling for end of life situations and patient options

3 4 2 2 3

Dermatology and child allergy services are lacking 2 3 2 3 3

Drug and Addiction treatment options are not sufficient

3 1 3 2 3

Needle exchange or disposal programs are needed

2 5 0 0 2




Scope of the need

Level of resources needed to

address the need

Impact of not

addressing the need

HMH ability to positively impact the

need

Total Weighted

Score

Barriers to access to careChanges in methods of education, messaging techniques

5 3 5 5 6

Lack of simple actionable plans (health coach, a plan, reminders, schedule, action, and follow-up)

4 4 4 2 4

Expansion of hours across care continuum 4 2 4 3 4

Population lacks motivation and financial ability to prioritize health

5 1 5 1 4

Poor environment, lifestyle, choices, habits, and self-medical follow up

5 1 5 1 4

Pharmacy and prescribing needs during off hours sometimes not available

2 5 1 0 2

Transportation is unavailable to some citizens 2 5 0 0 2

Health diseases and concernsDiabetes is common and poorly managed on a whole as a community

5 4 5 2 5

High Blood Pressure, Heart Disease, and COPD 5 4 5 2 5

Overweight & Obesity common- lack of fitness (high in children)

4 4 4 3 5

Mental Illness is present and largely untreated 5 1 5 3 5

Child rearing deficiencies in local parental skill sets 4 3 4 3 4

Tobacco related illness prevalent; address cultural issues

4 4 4 2 4

Drugs and Narcotics- an increasing and changing problem

5 1 5 2 4

Dental conditions poor 3 3 5 2 4

Poor nutrition is prevalent and access to proper dietary food lacking

3 1 3 1 3




Note: Our detailed implementation plan is filed with our Form 990.

Documents

Harrison Memorial Hospital Community Health Needs ... · PDF fileAbout Harrison Memorial Hospital 5 ... including sources and dates of data, analytical ... HMH now has cardiologist