Middlesboro ARH ?· Middlesboro ARH Services Middlesboro ARH Hospital CHNA 8. A Portrait of the Community…

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C o m m u n i t y H e a l t H n e e d s a s s e s s m e n t 2 0 1 6

Middlesboro ARH Hospital


This Community Health Needs Assessment (CHNA) Implementation Strategy was

prepared for Appalachian Regional Healthcare by the Community and Economic

Development Initiative of Kentucky (CEDIK) at the University of Kentucky.

CEDIK works with stakeholders to build engaged communities and vibrant economies.

If you have questions about the assessment process, contact CEDIK:

Dr. Alison Davis, CEDIK Executive Director


(859) 257-7260

Marisa Aull, CEDIK CHNA Coordinator


(859) 218-4385

Middlesboro ARH Hospital CHNA


Dear ARH Service Area Resident,


Joseph L. Grossman

ARH President and CEO

Thank you for your interest in the 2015-2016 ARH Community Health Needs

Assessment (CHNA). The data reflected in this report was collected from surveys

and focus groups conducted in your local ARH community. These results are being

reported along with an update about how we utilized the results from our previous

needs assessment from three years ago.

The unique design of this CHNA permits an examination of the diverse aspects of

each of our 11 ARH communities. The assessment results from each ARH facility

demonstrate the desire for individual and community health improvement. These

results provide valuable information that will be used for planning purposes, service

improvements and community outreach.

Special thanks to the CHNA Community Steering Committees in each of our 11

communities for giving of their valuable time and guiding this community health needs

assessment process. It is our hope that this assessment will help ARH, in partnership

with our communities, to identify respective health concerns, measure the impact of

current public health efforts and guide the appropriate use of local resources. We

also hope that together, we can improve the health and well-being of the residents of

Eastern Kentucky and Southern West Virginia.

Middlesboro ARH Hospital CHNA


ARH - Our HistoryIn 1956, the United Mine Workers of America (UMWA) and thousands of citizens

in the coal communities dedicated the Miners Memorial Hospital Associations

(MMHA) facilities. The systems hospitals were located in Harlan, Hazard, McDowell,

Middlesboro, Whitesburg, Pikeville and South Williamson, Kentucky; Man and Beckley

West Virginia; and Wise, Virginia. By the early 1960s, MMHA announced its intention

to close some of the hospitals and soon after the Board of National Missions formed

a new and independent not-for-profit health system Appalachian Regional Hospitals

(ARH)--that purchased the Miners Memorial Hospitals. The health system changed its

name in 1986 to Appalachian Regional Healthcare to more accurately describe its far-

ranging activities.

Today we operate hospitals in Barbourville, Harlan, Hazard, Hyden, McDowell,

Middlesboro, Morgan County, South Williamson and Whitesburg, Kentucky, and

Beckley and Summers County, West Virginia. ARH has always responded to the

changing demands of rural healthcare. Over the years, we have built and acquired

new facilities as well as invested in new technology and medical capabilities.

MissionTo improve health and promote well-being of all the people in Central Appalachia in

partnership with our communities.

VisionTo earn the confidence and trust of the diverse communities we serve by offering

healthcare excellence, delivered with compassion in a timely manner.

ValuesExcellence, Compassion, Safety, Teamwork, Inclusion, Professionalism

Middlesboro ARH Hospital CHNA


Appalachian Regional Healthcare contracted with the Community and Economic

Development Initiative of Kentucky (CEDIK) in the fall of 2015 to conduct a Community

Health Needs Assessment (CHNA) in accordance with the Affordable Care Act (ACA).

The Affordable Care Act (ACA), enacted March 23, 2010, added new requirements

that hospital organizations must satisfy in order to be described in section 501(c)(3),

as well as new reporting and excise taxes.

The IRS requires hospital organizations to complete a CHNA and adopt an

implementation strategy at least once every three years. This CHNA was the second

prepared by CEDIK for this organization; the first was completed in 2013.

Here is an overview of the CHNA process that CEDIK uses based on the IRS


CHNA Background

Middlesboro ARH Hospital CHNA


Since the 2013 Community Health Needs Assessment, we have taken these opportunities

to fulfill our promise to the community:

Specialist physicians have been added in dermatology and full-time invasive cardiology. We have also added a certified nurse midwife to our womens health service line so that women have the option of a female provider.

To recruit more physical therapists & enhance orthopedics & sports medicine services



Y #2



Y #1



Y #3



Y #4

To increase the knowledge of the community about financial assistance options

Provide adequate specialist coverage

Increase educational programs; increase access to prevention & early diagnosis information on Diabetes and Hypertension

Successfully implemented community-outreach, educational program called Lunch & Learn. Topics have included heart health, weight loss and exercise, womens health and the importance of annual screenings, urology health, fall prevention, when to call 911, stroke, bone health, organ donation, and skin rejuvenation.

Partnered with Middlesboro Mall to launch a community-outreach, educational program called Paint the Mall PINK! Program educated women of all ages on how to do self breast exams. Paint the Mall PINK! has reached several hundred women and their families and raised $2,400 for breast cancer research over the last two years.

Our financial counselors received training via the state to become Kynectors and were very successful in helping patients enroll in the expanded Medicaid program. We also offered a public education program on understanding the Affordable Care Act and buying insurance on the health insurance exchange.

We offer all rehabilitation specialties including physical, occupational, and speech therapy. We hired 2 full-time physical therapists and a new full-time physical therapy assistant due to increasing volumes. Treatments include vestibular rehabilitation, kinesio taping, and lymphedema therapy.

As part of our sports medicine outreach we provided athletic training services to Middlesboro Independent Schools for boys football and boys and girls soccer. We were also the exclusive game sponsor for the 2013 and 2014 boys football season and 2015 girls volleyball season.

Educating the community about the importance of mammogram screenings over the last several years through health fairs, Lunch & Learn, and Susan G. Komen fundraisers has resulted in an increase of mammograms scheduled at our hospital and our first grant from Susan G. Komen Lexington. The $13,480 grant will provide funds for our local breast cancer patient assistance program.

- Michael Slusher, Middlesboro ARH Community CEO


Table of Contents

1. Portrait of Community Served by the Hospital 9

2. The Assessment Process 10

3. Secondary Data Exploration:

Community, Economic & Health Profiles

4. Hospital Utilization Data 13

5. The Community Steering Committee 16

6. Community Feedback

7. Survey Results 18

8. Prioritization of Identified Health Needs 20

9. Implementation Strategy 21

10. Next Steps 24

11. Appendix 25

*Secondary Data Sources

*Survey Template

12. Approval 34

Middlesboro ARH Hospital CHNA




IntroductionAppalachian Regional Healthcare (ARH) is a not-for-profit health system serving

350,000 residents across Eastern Kentucky and Southern West Virginia. Operating

eleven hospitals, multi-specialty physician practices, home health agencies,

HomeCare Stores and retail pharmacies, ARH is the largest provider of care and

single largest employer in southeastern Kentucky and the third largest private

employer in southern West Virginia.

The ARH system employs nearly 5,000 employees and has a network of more than

600 active and courtesy medical staff members representing various specialties.

Consistently recognized for its medical excellence, the ARH system is one of two

Kentucky health systems to be named to the 2012 IMS Top 100 Integrated Healthcare

Networks list of the most highly integrated healthcare networks in the nation, and

was selected as the 2010 Outstanding Rural Health Organization in the nation by the

National Rural Health Association (NRHA).

Middlesboro ARH Hospital Middlesboro ARH Hospital is located on the

Kentucky, Tennessee and Virginia border

in Middlesboro, Kentucky. It was the first

Kentucky hospital to open in the Appalachian

Regional Healthcare system more than