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HMS Associates urges all networks and alliances to have completed a community health needs assessment. The needs assessment is the basis for joint action and sets priorities for collaborative action. It fulfills multiple purposes and comprises part of the foundation of the public benefit purpose of the network which is one of the "tests" of antitrust concerns.
HMS favors multifaceted assessments which incorporate the views and values of the local community as well as service providers, epidemiological data, and health service statistics.
The accompanying Executive Summary illustrates how these different forms of information can be merged and used as the basis for future multi-organizational network initiatives. The Executive Summary is an excellent "advertisement" for local providers in that it conveys the community spirit of participating members and the importance of local providers who listen and respond to their community's needs.
An assessment of the health care needs of the Lake Ontario region was
conducted by HMS Associates under the auspices of the Lake Ontario Rural
Health Network (LORHN), a coalition of local health and mental hygiene organizations.
LORHN members include the Orleans County Departments of Health, Social Services,
and Mental Health; the Lakeside Health System; the Medina Memorial Hospital;
and the Oak Orchard Community Health Center. The purpose of the assessment
was to ascertain the health care needs of Orleans and western Monroe County
The community needs assessment combined three types of information:
Inpatient hospital use
These different types of data and analyses resulted in a comprehensive
assessment of the Lake Ontario region. The community perception assessment
gave insight on needs and priorities for change supported in the community,
while the health status and hospital statistical information assessed the
magnitude of the need for change through comparisons of local data to state
or regional norms. This report summarizes and integrates this information.
More detailed information on each analysis can be found in the individual
In May of 1996, the Lake Ontario Rural Health Network selected three major priorities which emerged from the community health needs assessment. The three major objectives identified by LORHN reflect the coalition's commitment to assuring that health care resources in the community are addressing the community's most critical health care problems and to developing a system of health care services which is both responsive to the need to control health care costs and yet maintain local access to high quality health care services:
LORHN believes that these three projects present some of the greatest potential for success for the development and stabilization of a locally controlled and operated health care system. By targeting health promotion programs, LORHN emphasizes its fundamental commitment to a healthy community. Its cost and specialists network objectives reflect the network's interest in crossing organizational boundaries and developing local programs which are only viable if multiple health care organizations participate.
Orleans County, the core of the LORHN community, has an exceptionally
high death rate for Acute Myocardial Infarction (AMI) or heart attacks.
In the period 1992-93, on average 70 people died each year from heart attacks.
This equaled a rate that was the highest in the state.
Likewise, teen pregnancy, especially females 15 to 17 years of age, although declining in some areas of the County recently, is a major problem. For the 1992-93 period on average each year, 47 teenagers in this age group became pregnant. Teenage parents are disadvantaged to parenthood due to a host of reasons. The high teen pregnancy rate in the area means that more needs to be done about this problem and its effects upon communities and families.
Several organizations in the LORHN area operate programs designed to reduce the risk for heart attacks and or treat heart disease and many agencies offer some type of service related to teen pregnancy. Teen Pregnancy and Healthy Heart Coordinating Committees will be formed with these agencies and local health care practitioners to:
Local hospitals are the least costly in the region. Yet, health care insurance premiums paid by local employers, government and families are based upon Rochester or Buffalo, NY health care costs which are much higher. LORHN will be examining insurance costs and use patterns in the areas and ways through which the efficiencies of local providers can be passed on to local health care consumers. The potential for the creation of service networks to negotiate with insurance plans or the development of products for sale directly to local businesses will be explored.
Services from medical specialists such as oncologists, orthopedic surgeons,
and psychiatrists are often unavailable in rural communities due to limited
demand. When several rural health care providers work together they can
often establish a referral network which will generate enough patients to
attract specialists to practice in the area. A variety of specialty areas
will be explored relative to the need for referral networks as the basis
for creating "concentrated" demand for the service in the area.
A major component of the community health needs assessment was a survey
of individual perceptions regarding unmet local needs. Through a series
of focus groups, telephone interviews, and a mail-in survey, participants
expressed their views regarding service needs, interagency collaboration,
service access, and desirable changes.
The community perception analysis reflects the experiences of the individuals chosen to participate in the assessment. Since sampling techniques were not used to select participants, information in the assessment should not be generalized to the Lake Ontario population. However, the individuals chosen to participate were identified by LORHN as key informants who represent major aspects of the region, and, as such, their opinions are valid reflections of community sentiment and the potential for change in the local health care system.
Participants included 42 individuals who were interviewed over the telephone. These individuals represented emergency medical services, long term care, community, schools, child care, regional/state, insurers, and growers. Organizations represented by the telephone interviewees are listed in the Acknowledgment page of this report.
In addition to telephone interviews, focus groups were held with each of the six LORHN member organizations: Medina Memorial Hospital (two focus groups), Lakeside Health System, Orleans County Departments of Health, Social Services, and Mental Health, and Oak Orchard Community Health Center; and with the Orleans County Legislature, the Parenting Resource Center Advisory Group, the Medina Chamber of Commerce, and the Brockport Rotary Club. A total of 94 individuals participated in the 11 focus groups, which averaged about 9 individuals per group.
Health care assessment surveys were forwarded to twenty-two dentists residing in the LORHN area. Five of these surveys were returned, bringing the total number of individuals participating in the community needs assessment to 141.
Participants made a total of 422 major references to health care issues (Table 1). Primary care needs were identified most often by the participants, accounting for about one quarter of all citations (26%). Primary care needs were followed by needs in community education, access, mental hygiene, dental services, long term care, and emergency medical services. Telephone interviewees were more concerned about long term care needs than the other groups, while the focus groups were more concerned about mental hygiene, and the dentists who returned the survey cared most about dental health.
Table 2 lists the 36 different health care needs that were identified
by the telephone interviewees, focus groups and survey respondents. Although
a wide range of health care issues were identified by the participants,
specific issues mentioned most often were in the areas of community education,
primary care, and access.
Many individuals saw a need for more community education on a variety
of topics, particularly on wellness, prevention, immunization, and nutrition.
Expanded wellness and prevention programs were identified most often by
insurers, schools, and child care representatives, while information on
available services and programs was stressed most by emergency medical service
and community workers. The need for more effective parenting classes for
pregnant and young teens was voiced in almost all focus groups and by school
and child care workers.
More than half of the telephone interviewees and most of the focus groups support the need for more primary care physicians. Several individuals stated that more physicians were needed to provide for greater patient choice, to meet the demand in underserved areas, and to serve the Medicaid population. Some identified a need for more "urgent" care (walk-in capacity), particularly late at night in Albion. Improved customer service in primary care through more convenient hours and locations was also suggested.
The difficulty that Medicaid patients have in accessing appropriate care was raised by several participants, along with concerns regarding the adequate care of the uninsured and underinsured. Other primary care issues were the need for specialty, special services, and allied professionals. Some individuals were concerned about health insurance options, particularly the effect of managed care on patient choice.
A very large number of individuals felt that the high cost of health care insurance and services acted as barriers to access for many residents. This complaint was raised by representatives in all areas, except the insurers. Community and school representatives, growers and business leaders were the most concerned. Transportation was also identified as a barrier to accessing health care services. A need for central access, assistance in applying for services, and a convenient method of identifying services through a phone line or a directory were discussed.
Many people expressed concerns over waiting lists for mental health services. A need for prompt evaluations and more frequent mental health appointments was suggested, particularly by the focus groups, schools and community representatives. Other mental health issues were the need for more residential services, greater choice of provider for Medicaid patients, improved communication among organizations, and improved recruitment and retention of mental health staff. More recent data, 8/96, indicates that the wait list problem has been rectified.
In long term care, a need for more skilled nursing home beds was mentioned most often, especially by the growers. Other long term care needs identified by the participants were for more adult day care, home care, and hospice services. In dental health, the most frequently mentioned needs were for dentists to serve the Medicaid residents of Orleans County and for better dental hygiene and education. Other dental health concerns were for greater fluoridation and the treatment of special populations like the disabled and migrants.
The major issue in emergency medical service was for more appropriate use of hospital emergency rooms and emergency medical services. Volunteer recruitment, training and retention was a particular concern of emergency medical workers. Other concerns were the lack of urgent care in central Orleans County, the better utilization of paramedic staff, and the financing of emergency medical services.
The wealth of recommendations and suggestions for resolving the problems that were identified by the participants can be found in the complete Community Perceptions report.
The second component of the community health needs assessment was an analysis of vital statistics information on death rates and reproductive health. Statistical data on Orleans County for 1992-93 was compared primarily to its rank as one of 62 counties in New York State (see table 3). The community's health warrants examination for:
The community's health rated well for:
In addition to this county level analysis, the health status of each
town and village in the primary service area during 1990-1992 was examined.
The health status analysis also included tables of data containing actual
numbers, population ratios, and variance analyses. Maps that depict significant
variation of each cause of death by age group for the towns and villages
located within the LORHN service area were also provided. This extensive
analysis will assist LORHN members in monitoring the needs of communities
and population age groups. A sample of these maps is shown in Table 4.
The third component of the community health needs assessment used New York Statewide Performance and Research Cooperative System (SPARCS) data to study hospital inpatient service utilization in the LORHN service area. A review of admissions by major diagnostic categories, selected diagnostic groups, age, and sex was conducted to identify potential unmet needs for inpatient services, as well as potential overuse of inpatient services. An additional analysis was completed on resident use of hospitals not located in the LORHN service area to ascertain potential new "markets" or areas warranting improvements. The major findings were:
A variety of local needs were identified through this extensive needs
assessment. Many of these needs can be met and are being met through independent
or joint action of LORHN members, such as the expansion of primary care
services in the Albion and Lyndonville areas, dental services in the Lyndonville
area and renal dialysis services in Medina.
The three priorities selected by LORHN require collaboration on the part of interested organizations and provide a base for future networking of health care providers in the area.
The success of these programs is predicated upon the commitment of key local health care providers to work together to develop integrated systems of health care services rather than competing for scarce resources and patients. The accomplishment of these priorities requires that many organizations work together to pinpoint future types of interventions and implement them through coordination of efforts. Joint action of this type represents a way in which the local health care system can be improved and remain in the control of the local community.