Transcript 06-27-11 Steering Committee Meeting Presentation

Welcome to the
Community Health Visioning 2017
Steering Committee Status Meeting
June 27, 2011
1
Welcome
Robbie Roepstorff
President, Edison National Bank
Chairman, Community Health Visioning 2017 Steering
Committee
2
Purpose
Convene Steering
Committee of the
Community Health
Visioning 2017 to review
progress toward achieving
recommendations and
make needed course
corrections.
3
Agenda
1. Welcome, Introductions, Opening
Comments
2. Desired Outcomes and Part to Play
3. Local Economic and Market Changes
4. 2011 PRC Community Health
Assessment – Lee County, Florida
5. Break
6. Progress Review of Eight Priorities
7. Lunch
8. Course Corrections
9. Next Steps & Closing
4
Opening Comments
Jim Nathan
President, Lee Memorial Health System
Desired Outcomes, Agenda, Part to Play
Brad Pollins
6
Desired Outcomes
• Build understanding of about key local
economic and market changes comparing
2007 with 2011
• Build understanding about the findings
from the market analysis completed by
PRC
• Build understanding of progress achieved
in the eight prioritized recommendations
– Share community achievements and
lessons learned
• Identify any course corrections that need
to be considered based
7
Eight Priorities
1.
2.
3.
4.
5.
6.
7.
8.
Behavioral Health
Primary Care Alternatives
Electronic Medical Record
Workforce Shortage
Public Awareness of Services
Preventive Healthcare
Chronic Disease
Focus on Quality
8
Part to Play
9
Audience Response System
Practice Responding
10
Local Economic and Market Changes
Regina Eberwein
11
Unemployment – Lee County
Past: 3rd in State for lowest;
Now: 16th (out of 20 metros)
11.9%
12.8%
11.6%
8.0%
4.8%
2002
4.6%
2003
4.0%
2004
4.5%
3.2%
2005
2.9%
2006
2007
2008
Lee County Unemployment Rate
2009
2010
YTD 2011
Source: US Dept of Labor, BLS
Employment Growth – Lee County
43,000 new jobs
14,700
17,000
11,100
5,700
7,500
-1,800
-4,000
36,000 lost jobs .
-14,600 -15,700
2002
2003
2004
2005
2006
2007
Lee County Employment Growth
2008
2009
2010
Source: US Dept of Labor, BLS
Employment Gain/Loss by Industry
Lee County (2006-2010)
2,800
2,000
300
36,000 lost jobs
in total
Government
Education and Health Services
Leisure and Hospitality
-1,100
Other Services
-1,200
Information
-3,100
Financial Activities
-3,400
Manufacturing
-4,100
-6,500
-21,900
Professional and Business Services
Trade, Transportation, and Utilities
Mining and Construction
Lee County Employment Gain/Loss 2006 - 2010
Source: US Dept of Labor, BLS
Growth in Taxable Sales – Lee County
15.7%
16.3%
8.9%
6.9%
3.8%
2.0%
-8.8%
-11.4%
-14.2%
2002
2003
2004
2005
2006
2007
Lee County Taxable Sales Growth Rate
2008
2009
2010
Source: FL Office of EDR
2003
2004
2005
2006
2007
2008
Lee County Poverty Percent All Ages
2009
2003
2004
2005
2006
15.3%
14.4%
15.5%
14.0%
12.8%
10.6%
10.1%
9.2%
9.5%
8.9%
10.2%
15.8%
Under 18
2007
2008
18.2%
All Ages
17.0%
Poverty Percentages – Lee County
2009
Lee County Poverty Percent Under Age 18
US Census, SAIPE
Building Permits – Lee County
25,272
27,562
18,280
13,124
10,627
2,090
2003
2004
2005
2006
2007
2008
1,019
1,281
2009
2010
Lee County Residential Permits (SF & MF)
Source: US Census
Home Sales / Home Price – Lee County
Existing Homes sold via Multiple Listing Service
Home prices have fallen 60+%
$275,000
4,000
$175,000
$90,595
4,000
$93,532
$150,000
6,000
2,000
0
2003 2004 2005 2006 2007 2008 2009 2010
Sales
Home Price
$125,000
3,000
2,500
$275,000
$250,000
$225,000
$200,000
$124,643
$200,000
Total Closings
$163,384
$156,277
8,000
$225,000
$300,000
2,000
1,500
$175,000
Median Closed Price
10,000
3,500
Median Closed Price
Total Closings
12,000
$192,135
$250,000
$325,000
$123,447
4,500
$350,000
$190,394
$300,000
$298,641
5,000
$234,708
14,000
$325,000
$262,694
16,000
Lee County Condo MLS
$254,594
18,000
$271,681
$276,527
Lee County Single-Family MLS
$150,000
$125,000
$100,000
1,000
$100,000
$75,000
500
$50,000
0
$75,000
$50,000
2003 2004 2005 2006 2007 2008 2009 2010
Sales
Home Price
Source: FL NAR
Population Growth – Lee County
35,000
618,754
612,169
608,210
597,156
600,000
550,000
29,496 28,379
23,288
25,000
17,405 18,767
15,000
450,000
400,000
22,846
350,000
300,000
5.7%
250,000
5.2%
4.7%
10,000
5,000
650,000
500,000
30,000
20,000
574,310
516,435
493,147
40,000
474,380
45,000
545,931
Permanent Population
4.0%
4.0%
3.8%
11,054
1.9%
200,000
3,959
0.7%
0
2002
2003
2004
2005
2006
Lee County Population Growth
2007
2008
2009
Total Lee County Population
6,585
150,000
100,000
1.1%
50,000
0
2010
Source: UF, BEBR
Natural Increase
112,446
109,266
128,789
210,407
215,271
228,543
255,897
254,926
260,911
273,874
293,818
315,494
273,756
250,426
318,155
289,965
175,375
277,052
248,101
133,111
379,402
397,491
381,151
355,250
325,909
229,614
79,011 122,706
65,180
53,250
61,800
158,610
317,379
345,039
334,390
314,794
288,141
2020
Migration as a % Population Growth
209,255
86%
2019
2018
55%
2017
2016
2015
2014
2013
2012
2011
2010
87%
2009
2008
2007
2006
2005
2004
2003
2002
Population Growth Components – Florida
Permanent Population
Net Migration
Source: FL Office of EDR
Population Growth Forecast – Lee County
35,000
705,100
696,597
688,197
679,899
671,700
663,600
654,378
645,284
636,317
627,474
618,754
597,156
574,310
545,931
516,435
493,147
40,000
474,380
45,000
608,210
50,000
612,169
Permanent Population
700,000
650,000
600,000
550,000
500,000
29,496
28,379
30,000
23,288
25,000
750,000
450,000
400,000
22,846
350,000
20,000 17,40518,767
1.3% Avg Ann Growth
15,000
250,000
200,000
11,054
10,000
6,585
8,720 8,843 8,967 9,094 9,222 8,100 8,199 8,299 8,400 8,503
150,000
100,000
3,959
5,000
300,000
50,000
Lee County Population Growth
Permanent Population; forecast BEBR-low
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
0
2002
0
Total Lee County Population
Source: UF, BEBR-low forecast
Age Distribution – Lee County
Permanent Population
Lee County
Age Distribution
<18
18 - 64
65+
Total
Growth Rate by Age Group
<18
18 - 64
65+
Total
2010
2015
2020
19.5%
57.0%
23.5%
100%
19.2%
54.7%
26.0%
100%
19.0%
52.8%
28.2%
100%
5.6%
3.0%
19.0%
7.2%
4.7%
2.5%
15.3%
6.3%
65+ cohort growing
2.5x faster than overall population
Source: 2010 Census; UF, BEBR
Non-Urgent Visits to Emergency Department
Lee Memorial Health System
12% Increase in Evenings & Weekends
18% Increase in Mon thru Fri, 9 am – 5 pm
2010
50,154
2009
45,486
2008
44,905
31,568
27,662
26,690
81,722
73,148
71,595
Mon thru Fri, 9 am – 5pm is 39% of Non-Urgent volume
Evenings & Weekends
M-F, 9-5
Source: Lee Memorial Health System
In-Patient Commercial Payor - Lee County Hospitals
% of Total
Approximately 1/5 of In-Patient Cases at Lee County
hospitals paid for by Commercial Payors
30.2%
29.0%
27.1%
24.6%
21.8%
2007
2008
2009
2010
Est. 2011
In-Patient Commercial Payors, Lee County Hospitals
Source: Thomson Reuters
2011 PRC Community Health Assessment:
Lee County, Florida
Bruce Lockwood
25
2011 PRC Community Health Assessment
A Data-Driven Approach to Identifying Community Health Needs
Lee County, Florida
Community Health Findings
Prepared for
COMMUNITY HEALTH
2011 PRC Community Health Assessment
The 2011 PRC
Community Health
Assessment
consists of both
primary and
secondary data.
Customized Local
PRC Community Health Survey
Identical to the
approach used in
2007.
PRC Community Health Assessment
Secondary
Data
Key Informant
Focus Groups
2011 PRC Community Health Assessment
Telephone Survey
BENCHMARKING
 State BRFSS
data (CDC)
– Stratified random sample of 1,000 adults
o 250 interviews in each of four Market Areas
 US Survey Data
(PRC National
Health Survey)
– 153 survey items; 20-25 minute interview
 Healthy People
2020 targets
– Each percentage
of the total sample
represents roughly
5,355 residents
 State and
national vital
statistics
– Lee County: ±3.1% maximum error
2011 PRC Community Health Assessment
Population & Sample Characteristics
(Lee County, 2011)
Sources:
 Census 2000, Summary File 3 (SF 3). US Census Bureau.
 PRC Community Health Survey, Professional Research Consultants, Inc.
2011 PRC Community Health Assessment
Overall Health Status
Positive Health Findings
Overview of Community Vision 2017 Priority Areas
Areas of Opportunity
• Access to Healthcare Services
• Chronic Disease & Injury
• Immunization & Infectious Disease
• Maternal, Infant & Child Health
• Mental Health & Substance Abuse
• Nutrition, Physical Activity & Overweight
Overarching Issues
Q&A
COMMUNITY HEALTH
2011 PRC Community Health Assessment
Overall Health Status
Positive Health Findings
Overview of Community Vision 2017 Priority Areas
Areas of Opportunity
• Access to Healthcare Services
• Chronic Disease & Injury
• Immunization & Infectious Disease
• Maternal, Infant & Child Health
• Mental Health & Substance Abuse
• Nutrition, Physical Activity & Overweight
Overarching Issues
Q&A
COMMUNITY HEALTH
2011 PRC Community Health Assessment
Self-Reported Health Status
(Lee County, 2011)
52.2%
Excellent/
Very Good
17.4%
Fair/Poor
Sources:
Notes:
 Professional Research Consultants, Inc. PRC Community Health Survey. [Item 6]
 Asked of all respondents.
2011 PRC Community Health Assessment
Experience “Fair” or “Poor” Physical Health
Sources: ● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 6]
● Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey. Atlanta, Georgia: US Department of Health and Human
Services,
Centers for Disease Control and Prevention, 2009 Florida Data.
● Professional Research Consultants. PRC National Health Survey. 2011.
Notes:
● Asked of all respondents.
2011 PRC Community Health Assessment
Experience “Fair” or “Poor” Physical Health
(Lee County, 2011)
Sources: ● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 6]
Notes:
● Asked of all respondents.
● Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size.
2011 PRC Community Health Assessment
Limited in Activities in Some Way
Due to a Physical, Mental or Emotional Problem
Sources: ● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 128]
● Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey. Atlanta, Georgia: US Department of Health and Human
Services,
Centers for Disease Control and Prevention, 2009 Florida Data.
● Professional Research Consultants. PRC National Health Survey. 2011.
Notes:
● Asked of all respondents.
Predominantly age-related: most often attributed to musculoskeletal
issues — back/neck problems, arthritis/ rheumatism, fractures or
bone/joint injuries, or problems walking.
2011 PRC Community Health Assessment
Overall Health Status
Positive Health Findings
Overview of Community Vision 2017 Priority Areas
Areas of Opportunity
• Access to Healthcare Services
• Chronic Disease & Injury
• Immunization & Infectious Disease
• Maternal, Infant & Child Health
• Mental Health & Substance Abuse
• Nutrition, Physical Activity & Overweight
Overarching Issues
Q&A
COMMUNITY HEALTH
2011 PRC Community Health Assessment
Selected Lee County Indicators Better Than the US:
 Death rates due to: heart disease, cancer, chronic lower respiratory
disease, stroke, diabetes, Alzheimer’s disease, cirrhosis/liver
disease, pneumonia/influenza and kidney disease
 Vaccine-preventable conditions
 STD incidence
 Osteoporosis
 Seatbelt usage
 Firearm prevalence
 Physical activity
 Routine vision care
2011 PRC Community Health Assessment
Overall Health Status
Positive Health Findings
Overview of Community Vision 2017 Priority Areas
Areas of Opportunity
• Access to Healthcare Services
• Chronic Disease & Injury
• Immunization & Infectious Disease
• Maternal, Infant & Child Health
• Mental Health & Substance Abuse
• Nutrition, Physical Activity & Overweight
Overarching Issues
Q&A
COMMUNITY HEALTH
2011 PRC Community Health Assessment
Community Vision 2017 Priority Areas
PRIORITY AREAS
ADDRESSED IN
DATA
• Behavioral Health
• Primary Care
Alternatives
• Preventive
Health Care
Behavioral Health
•
Depression indicators are similar to the US, but the
suicide rate is quite high compared to both the state
and US.
•
While most reported high-risk alcohol and drug
behaviors are close to national findings, the druginduced death rate is worse than both the state and
nation.
•
Behavioral health was the #1 ranked health priority
among participants in the key informant focus groups.
• Chronic Disease
2011 PRC Community Health Assessment
Community Vision 2017 Priority Areas
PRIORITY AREAS
ADDRESSED IN
DATA
• Behavioral Health
• Primary Care
Alternatives
• Preventive
Health Care
Primary Care Alternatives
•
A relatively low proportion of residents have a “medical
home,” and fewer than found in 2007.
•
Receipt of routine medical care has likewise declined
since 2007.
•
A high proportion of parents report trouble accessing
healthcare for their child.
•
Access to healthcare services, especially for low-income
and uninsured populations, was the second top-ranked
priority among key informant focus group participants.
• Chronic Disease
2011 PRC Community Health Assessment
Community Vision 2017 Priority Areas
PRIORITY AREAS
ADDRESSED IN
DATA
• Behavioral Health
• Primary Care
Alternatives
Preventive Health Care
•
Three out of 10 school-aged children are overweight or
obese, similar to what is found nationally.
•
Diabetes death rates are favorable, however, the
prevalence of diabetes (those living with diabetes) is
high.
•
More than one out four births in Lee County does not
receive timely prenatal care. This is similar to the
statewide proportion.
• Preventive
Health Care
• Chronic Disease
2011 PRC Community Health Assessment
Community Vision 2017 Priority Areas
PRIORITY AREAS
ADDRESSED IN
DATA
• Behavioral Health
• Primary Care
Alternatives
• Preventive
Health Care
• Chronic Disease
Chronic Disease
•
Two-thirds of Lee County adults are overweight or
obese, close to the national proportion. However,
obesity has increased since 2007.
•
Prevalence levels for diabetes and high blood pressure
are both relatively high.
•
Nearly 10% of adults and children have asthma, similar
to national findings, although adult asthma has
increased since 2007.
2011 PRC Community Health Assessment
Overall Health Status
Positive Health Findings
Overview of Community Vision 2017 Priority Areas
Areas of Opportunity
• Access to Healthcare Services
• Chronic Disease & Injury
• Immunization & Infectious Disease
• Maternal, Infant & Child Health
• Mental Health & Substance Abuse
• Nutrition, Physical Activity & Overweight
Overarching Issues
Q&A
COMMUNITY HEALTH
2011 PRC Community Health Assessment
Overall Health Status
Positive Health Findings
Overview of Community Vision 2017 Priority Areas
Areas of Opportunity
• Access to Healthcare Services
• Chronic Disease & Injury
• Immunization & Infectious Disease
• Maternal, Infant & Child Health
• Mental Health & Substance Abuse
• Nutrition, Physical Activity & Overweight
Overarching Issues
Q&A
COMMUNITY HEALTH
2011 PRC Community Health Assessment
Healthcare Insurance Coverage
(Among Adults Age 18 to 64; Lee County, 2011)
Sources:
Notes:
● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 206]
● Reflects respondents aged 18 to 64.
Private Insurance
61.0%
Gov’t Insurance
18.5%
No Insurance
20.5%
2011 PRC Community Health Assessment
Lack of Healthcare Insurance Coverage
(Among Lee County Adults Under 65, 2011)
Healthy People 2020 Target = 0.0% (Universal Coverage)
Sources:
Notes:
● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 206]
● Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey. Atlanta, Georgia: US Department of Health and Human Services,
Centers for Disease Control and Prevention, 2009 Florida Data.
● Professional Research Consultants. PRC National Health Survey. 2011.
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective AHS-1]
● Asked of all respondents under the age of 65.
2011 PRC Community Health Assessment
Lack of Healthcare Insurance Coverage
(Lee County Adults Under 65, 2011)
Healthy People 2020 Target = 0.0% (Universal Coverage)
Sources:
Notes:
● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 206]
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective AHS-1]
● Asked of all respondents under the age of 65.
● Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size.
2011 PRC Community Health Assessment
Experienced Difficulties or Delays of Some Kind
in Receiving Needed Healthcare in the Past Year
Barriers Tested:
• Cost of Doctor Visits
• Cost of Prescriptions
• Appointment Availability
• Trouble Finding a Doctor
• Inconvenient Office Hours
• Lack of Transportation
Sources:
Notes:
(Lee County, 2011)
Overall,
similar to US
● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 210]
● Asked of all respondents.
● Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size.
19.0% of adults did not see a doctor
in the past year because of the cost
(higher than US, an increase since 2007).
2011 PRC Community Health Assessment
Had Trouble Obtaining Medical Care for Child in the Past Year
(Lee County Parents of Children <18, 2011)
Parents with trouble obtaining medical care for their child
reported barriers due to cost or lack of insurance coverage,
limited insurance acceptance, and lack of accessibility.
Sources:
Notes:
● Professional Research Consultants, Inc. PRC Community Health Survey. [Items 138-139]
● Professional Research Consultants. PRC National Health Survey. 2011.
● Asked of all respondents with children under 18 at home.
2011 PRC Community Health Assessment
Have a Specific Source of Ongoing Medical Care
(Lee County, 2011)
Sources:
Notes:
●
●
●
●
Professional Research Consultants, Inc. PRC Community Health Survey. [Item 207]
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objectives AHS-5.3, 5.4]
Asked of all respondents.
Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size.
Lower than US (76.3%),
lower than in 2007 (76.5%)
Again, access to healthcare services, especially for
low-income and uninsured populations, was the #2
priority identified in the key informant focus groups.
2011 PRC Community Health Assessment
Rating of Overall Healthcare
Services Available in the Community
(Lee County, 2011)
54.2%
Excellent/
Very Good
19.2%
Fair/Poor
Sources:
Notes:
● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 7]
● Asked of all respondents.
2011 PRC Community Health Assessment
Perceive Local Healthcare Services as “Fair” or “Poor”
Sources:
Notes:
● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 7]
● Professional Research Consultants. PRC National Health Survey. 2011.
● Asked of all respondents.
2011 PRC Community Health Assessment
Perceive Local Healthcare Services as “Fair” or “Poor”
(Lee County, 2011)
16.0% of residents left Lee County for healthcare in the past year.
• Predominantly for specialty care
• Predominantly because of a perceived lack of services,
physician referral, or perceived better quality elsewhere
Sources:
Notes:
● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 7]
● Asked of all respondents.
● Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size.
2011 PRC Community Health Assessment
Overall Health Status
Positive Health Findings
Overview of Community Vision 2017 Priority Areas
Areas of Opportunity
• Access to Healthcare Services
• Chronic Disease & Injury
• Immunization & Infectious Disease
• Maternal, Infant & Child Health
• Mental Health & Substance Abuse
• Nutrition, Physical Activity & Overweight
Overarching Issues
Q&A
COMMUNITY HEALTH
2011 PRC Community Health Assessment
Prevalence of Heart Disease & Stroke
Sources:
Notes:
● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 155]
● Professional Research Consultants. PRC National Health Survey. 2011.
● Asked of all respondents.
Although death rates are comparatively low,
prevalence levels are high.
2011 PRC Community Health Assessment
Prevalence of High Blood Pressure
Number of Times Diagnosed:
Once = 24.9%
More Than Once = 75.1%
Sources:
Notes:
● Professional Research Consultants, Inc. PRC Community Health Survey. [Items 52-53, 156]
● Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey. Atlanta, Georgia: US Department of Health and Human Services,
Centers for Disease Control and Prevention, 2009 Florida Data.
● Professional Research Consultants. PRC National Health Survey. 2011.
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective HDS-5.1]
● Asked of all respondents.
2011 PRC Community Health Assessment
Prevalence of High Blood Cholesterol
Sources:
Notes:
● Professional Research Consultants, Inc. PRC Community Health Survey. [Items157]
● Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey. Atlanta, Georgia: US Department of Health and Human Services,
Centers for Disease Control and Prevention, 2009 Florida Data.
● Professional Research Consultants. PRC National Health Survey. 2011.
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective HDS-7]
● Asked of all respondents.
● *The Florida data reflects those adults who have been tested for high cholesterol and who have been diagnosed with it.
2011 PRC Community Health Assessment
Prevalence of Skin Cancer
Sources:
Notes:
● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 39]
● Professional Research Consultants. PRC National Health Survey. 2011.
● Asked of all respondents.
2011 PRC Community Health Assessment
Prevalence of Cancer (Other Than Skin Cancer)
Sources:
Notes:
● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 38]
● Professional Research Consultants, Inc. PRC National Health Survey. 2011.
● Asked of all respondents.
2011 PRC Community Health Assessment
Diabetes: Age-Adjusted Mortality by Race
(2005-2007 Annual Average Deaths per 100,000 Population)
Overall, death
rate is below FL
& US, but is
increasing
Sources:
Notes:
● Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. CDC WONDER Online Query System.
Data extracted May 2011.
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective D-3]
● Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).
● Rates are per 100,000 population, age-adjusted to the 2000 US Standard Population.
● County, state and national data are simple three-year averages.
● The Healthy People 2010 target for Diabetes is adjusted to account for only diabetes mellitus coded deaths.
● The Hispanic and Non-Hispanic Other death rates are unreliable due to the low number of deaths within each population.
2011 PRC Community Health Assessment
Prevalence of Diabetes
(Lee County, 2011)
Overall,
higher than
FL (10.7%)
& US (10.1%)
Sources:
Notes:
● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 50]
● Asked of all respondents.
● Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size.
2011 PRC Community Health Assessment
Currently Have Asthma
Sources:
Notes:
● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 166]
● Professional Research Consultants. PRC National Health Survey. 2011.
● Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey. Atlanta, Georgia: US Department of Health and Human Services,
Centers for Disease Control and Prevention, 2009 Florida Data.
● Asked of all respondents.
15.6% of adults with asthma report a
related trip to the ER or urgent care
center in the past year
2011 PRC Community Health Assessment
HIV/AIDS: Age-Adjusted Mortality by Race
(1999-2007 Annual Average Deaths per 100,000 Population)
Overall, death rate
is better than FL,
worse than US
Sources:
Notes:
● Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. CDC WONDER Online Query System.
Data extracted May 2011.
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective HIV-12]
● Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).
● Rates are per 100,000 population, age-adjusted to the 2000 US Standard Population.
● HIV death rates represent deaths between 1999 and 2007.
2011 PRC Community Health Assessment
Unintentional Injuries: Age-Adjusted Mortality Trends
(Annual Average Deaths per 100,000 Population)
Sources:
Notes:
● Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. CDC WONDER Online Query System.
Data extracted May 2011.
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective IVP-11]
● Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).
● Rates are per 100,000 population, age-adjusted to the 2000 US Standard Population.
● State and national data are simple three-year averages.
2011 PRC Community Health Assessment
Motor Vehicle Crashes: Age-Adjusted Mortality
(2005-2007 Annual Average Deaths per 100,000 Population)
Notably higher
for Hispanics
Sources:
Notes:
● Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. CDC WONDER Online Query System.
Data extracted May 2011.
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective IVP-13.1]
● Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).
● Rates are per 100,000 population, age-adjusted to the 2000 US Standard Population.
● County, state and national data are simple three-year averages.
2011 PRC Community Health Assessment
Firearm-Related Deaths: Age-Adjusted Mortality
(2005-2007 Annual Average Deaths per 100,000 Population)
Notably higher
for Blacks
Sources:
Notes:
● Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. CDC WONDER Online Query System.
Data extracted May 2011.
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective IVP-30]
● Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).
● Rates are per 100,000 population, age-adjusted to the 2000 US Standard Population.
● County, state and national data are simple three-year averages.
2011 PRC Community Health Assessment
Homicide: Age-Adjusted Mortality by Race
(2005-2007 Annual Average Deaths per 100,000 Population)
Higher than
FL & US
Sources:
Notes:
● Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. CDC WONDER Online Query System.
Data extracted May 2011.
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective IPV-29]
● Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).
● Rates are per 100,000 population, age-adjusted to the 2000 US Standard Population.
● County, state and national data are simple three-year averages.
● All Lee County homicide death rates are unreliable due to the low number of deaths in the county.
2011 PRC Community Health Assessment
Overall Health Status
Positive Health Findings
Overview of Community Vision 2017 Priority Areas
Areas of Opportunity
• Access to Healthcare Services
• Chronic Disease & Injury
• Immunization & Infectious Disease
• Maternal, Infant & Child Health
• Mental Health & Substance Abuse
• Nutrition, Physical Activity & Overweight
Overarching Issues
Q&A
COMMUNITY HEALTH
2011 PRC Community Health Assessment
Immunization & Infectious Disease
Influenza
•
Flu vaccination coverage for seniors 65+ is generally
good (although low in Market Area 3), but coverage for
other high-risk adults is below US levels.
Tuberculosis
•
Tuberculosis incidence is higher than FL and US rates,
and has increased in recent years.
Hepatitis B
•
Self-reported hepatitis B vaccination is lower than found
nationally.
2011 PRC Community Health Assessment
Overall Health Status
Positive Health Findings
Overview of Community Vision 2017 Priority Areas
Areas of Opportunity
• Access to Healthcare Services
• Chronic Disease & Injury
• Immunization & Infectious Disease
• Maternal, Infant & Child Health
• Modifiable Health Risks
Overarching Issues
Q&A
COMMUNITY HEALTH
2011 PRC Community Health Assessment
Family Planning
Births to Teens
• 11.1% of Lee County births (2007-2009) were to teens.
o Lower than statewide (12.9%), higher than nationally (10.4%)
o By race, higher (16.4%) in births to Black women
Births to Unmarried Mothers
• 48.7% of Lee County births (2007-2009) were to
unmarried mothers.
o Similar to FL (46.9%), higher than US (39.6%)
o By race, highest (70.5%) in births to Black women
2011 PRC Community Health Assessment
Overall Health Status
Positive Health Findings
Overview of Community Vision 2017 Priority Areas
Areas of Opportunity
• Access to Healthcare Services
• Chronic Disease & Injury
• Immunization & Infectious Disease
• Maternal, Infant & Child Health
• Mental Health & Substance Abuse
• Nutrition, Physical Activity & Overweight
Overarching Issues
Q&A
COMMUNITY HEALTH
2011 PRC Community Health Assessment
Suicide: Age-Adjusted Mortality
(2005-2007 Annual Average Deaths per 100,000 Population)
Notably higher
for Whites,
trending upward
Sources:
Notes:
● Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. CDC WONDER Online Query System.
Data extracted May 2011.
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective MHMD-1]
● Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).
● Rates are per 100,000 population, age-adjusted to the 2000 US Standard Population.
● County, state and national data are simple three-year averages.
Prevalence of chronic depression symptoms and diagnosed
major depression appear similar to national levels.
2011 PRC Community Health Assessment
Drug-Induced Deaths: Age-Adjusted Mortality Trends
(Annual Average Deaths per 100,000 Population)
Sources:
Notes:
● Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. CDC WONDER Online Query System.
Data extracted May 2011.
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective SA-12]
● Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).
● Rates are per 100,000 population, age-adjusted to the 2000 US Standard Population.
● State and national data are simple three-year averages.
Only 1.6% of adults acknowledge use of illicit
drugs in the past month (similar to US).
2011 PRC Community Health Assessment
Top-Ranked Priorities as Identified by Key Informants
#1. BEHAVIORAL HEALTH SERVICES
(mental health/substance abuse treatment)
Mentioned resources available to address this issue:
• Alcoholics Anonymous/Al-Anon/Alateen
• Churches
• ERs
• HOPE Clubhouse of Southwest Florida
• Jennings Behavioral Health
• Lee Memorial Health System
• Lee Mental Health Center
• National Alliance on Mental Illness of Lee County
• Police Departments
• Private Clinics
• Ruth Cooper Center/Lee Mental Health Center
• Senior Behavioral Center at Lee Memorial Hospital
• Southwest Florida Addiction Services
COMMUNITY HEALTH
2011 PRC Community Health Assessment
Overall Health Status
Positive Health Findings
Overview of Community Vision 2017 Priority Areas
Areas of Opportunity
• Access to Healthcare Services
• Chronic Disease & Injury
• Immunization & Infectious Disease
• Maternal, Infant & Child Health
• Mental Health & Substance Abuse
• Nutrition, Physical Activity & Overweight
Overarching Issues
Q&A
COMMUNITY HEALTH
2011 PRC Community Health Assessment
Prevalence of Total Overweight
(Overweight or/Obese Adults; Body Mass Index of 25.0 or Higher)
Sources:
Notes:
● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 193]
● Professional Research Consultants. PRC National Health Survey. 2011.
● Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey. Atlanta, Georgia: US Department of Health and Human Services,
Centers for Disease Control and Prevention, 2009 Florida Data.
● Based on reported heights and weights, asked of all respondents.
● The definition of overweight is having a body mass index (BMI), a ratio of weight to height (kilograms divided by meters squared), greater than or equal to 25.0,
regardless of gender. The definition for obesity is a BMI greater than or equal to 30.0.
2011 PRC Community Health Assessment
Prevalence of Obesity
(Body Mass Index of 30.0 or Higher)
Sources:
Notes:
● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 193]
● Professional Research Consultants. PRC National Health Survey. 2011.
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective NWS-9]
● Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey. Atlanta, Georgia: US Department of Health and Human Services,
Centers for Disease Control and Prevention, 2009 Florida Data.
● Based on reported heights and weights, asked of all respondents.
● The definition of obesity is having a body mass index (BMI), a ratio of weight to height (kilograms divided by meters squared), greater than or equal to 30.0,
regardless of gender.
2011 PRC Community Health Assessment
Prevalence of Obesity
(Body Mass Index of 30.0 or Higher; Lee County, 2011)
Sources:
Notes:
●
●
●
●
●
●
Professional Research Consultants, Inc. PRC Community Health Survey. [Item 193]
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective NWS-9]
Asked of all respondents.
Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size.
Based on reported heights and weights, asked of all respondents.
The definition of obesity is having a body mass index (BMI), a ratio of weight to height (kilograms divided by meters squared), greater than or equal to 30.0,
regardless of gender.
2011 PRC Community Health Assessment
Nutrition
• 42.9% of Lee County adults have 5+ servings of
fruits/vegetables per day.
o Lower than found nationally (48.8%)
o Vegetable consumption, in particular, is low
• 71.5% of adults say they read nutrition labels when
deciding what foods to buy.
• Favorably, more adults report getting nutrition advice from
their physicians than in 2007.
Key Informant Focus Groups
• Obesity/weight management was the #3 top-ranked
priority.
• Health education (especially nutrition education) was the
#4 top-ranked priority.
2011 PRC Community Health Assessment
Physical Activity
Adults
• Physical activity indicators are generally better than or
similar to state and national findings.
Children
• 45.9% of school-aged children have 3+ hours/day of
screen time (TV, video games, computer), similar to what
is found nationally.
• However, 19.1% of children have 3+ hours per day of
computer/video game screen time. (US = 9.9%)
2011 PRC Community Health Assessment
Overall Health Status
Positive Health Findings
Overview of Community Vision 2017 Priority Areas
Areas of Opportunity
• Access to Healthcare Services
• Chronic Disease & Injury
• Immunization & Infectious Disease
• Maternal, Infant & Child Health
• Mental Health & Substance Abuse
• Nutrition, Physical Activity & Overweight
Overarching Issues
Q&A
COMMUNITY HEALTH
2011 PRC Community Health Assessment
Income Disparity in
Selected Lee County Health Indicators
2011 PRC Community Health Assessment
Preventive Healthcare
(By Insured Status; Lee County, 2011)
2011 PRC Community Health Assessment
Lee County Disparities
By Geography
• Where geographic differences exist, it is often
Market Area 2 (North/Northeast Lee County) that fares
worst.
By Race/Ethnicity
• Blacks have overall poorer health status, less dental
care, and greater problems associated with diabetes,
cardiovascular disease, cancer, kidney disease,
HIV/AIDS and violence.
• Hispanics and Blacks have greater access difficulties
and insurance instability, less often have a medical
home, and face more depression and higher rates of
obesity.
2011 PRC Community Health Assessment
Overall Health Status
Positive Health Findings
Overview of Community Vision 2017 Priority Areas
Areas of Opportunity
• Access to Healthcare Services
• Chronic Disease & Injury
• Immunization & Infectious Disease
• Maternal, Infant & Child Health
• Mental Health & Substance Abuse
• Nutrition, Physical Activity & Overweight
Overarching Issues
Q&A
COMMUNITY HEALTH
20 Minute Break
87
Community Scorecard
Sally Jackson
88
County Health Rankings Model
Mortality (length of life) 50%
Health Outcomes
Morbidity (quality of life) 50%
Tobacco Use
Diet & Exercise
Health Behaviors
(30%)
Alcohol Use
Unsafe Sex
Clinical Care
(20%)
Access to Care
Quality of Care
Health Factors
Education
Employment
Social & Economic Factors
(40%)
Income
Family & Social Support
Community Safety
Program and
Policies
Physical Environment
(10%)
Environmental Quality
Built Environment
89
Health Outcomes & Health Factors
Health Outcomes
Health Factors
– Collier County #1
– Collier County #10
– Lee County #23
– Charlotte County #19
– Charlotte County #26
– Lee County #27
– Hendry County #39
– Glades County #57
– Glades County #58
– Hendry County #61
Out of 67 Counties
Health Outcomes Rankings
Mortality
Morbidity
– Collier County #4
– Collier County #3
– Charlotte County #26
– Hendry County #14
– Lee County #31
– Lee County #16
– Hendry County #56
– Charlotte County #28
– Glades County #61
– Glades County #39
Out of 67 Counties
Health Factor Rankings
1. Health Behaviors
2. Clinical Care
3. Social & Economical
4. Physical Environment
Questions
93
Community Health Visioning 2017
Progress Review of Eight Priorities
Brad Pollins & Topic Presenters
94
Presentation Format
• 10 minute presentation
– Original Recommendation
– Key Accomplishments
– Barriers/Challenges
– Opportunities
• 5 minute Question & Answer
95
Eight Priorities
1.
2.
3.
4.
5.
6.
7.
8.
Behavioral Health
Primary Care Alternatives
Electronic Medical Record
Workforce Shortage
Public Awareness of Services
Preventive Healthcare
Chronic Disease
Focus on Quality
96
Community Health Visioning 2017
Behavioral Health Update
Greg Gardner
97
Behavioral Health
Convene a community collaborative to
develop a comprehensive continuum of
care for Behavioral Health, based on a
current needs assessment for Lee County.
The collaborative should identify a
champion and incorporate successful
models for both leadership structure and
service. (Key elements may include
inpatient beds, access to assessment,
availability of medications, case
management, supportive/affordable
housing, staffing, criminal justice
partners/resources, preventative care,
and unique needs of adults , adolescents
and children.)
98
Key Accomplishments
•
Overview
– Task Force – Bob Janes and Brian Lucas
– 15 bed Lee Memorial Hospital Geriatric
Psychiatric Program with Reliant
Healthcare
– 58 bed Bob Janes Triage Center
– 2010 NOVA Award from American
Hospital Association for Triage Center
– 2010 Florida Hospital Association
Community Benefit Award for Triage
– JBH Behavioral Health Systems, LLC
• New Community-based Partial
hospitalization investment
– 76 bed Park Royal Psychiatric Hospital
– HOPE Clubhouse (work transitions)
99
Key Accomplishments
•
NAMI
• Expanded Crisis Intervention
Training
• over 120 officers a year now
• 383 Police Officers & Sheriff
Deputies since 2007
• Expanded Mental Health
Information and Referral System
– more than 3800 people helped
• Dunbar United Way House
• Cape Coral United Way House
• East Fort Myers Goodwill Job Link
Center
100
Key Accomplishments
•
SWFAS
• Adult Detoxification Services Facility
– opened in March 2009 (29-beds
operational-40 available)
• Kleist Public Education Center –
professional training for behavioral
health staff – located in SWFAS
Building
• Women’s Halfway House – 16 bed
facility opened in 2009
• Adult Residential Program Facility opened February, 2011
101
Key Accomplishments
• Lee Mental Health
– Currently on Pace to Serve 11,000 clients in FY2011
– Partnerships Formed
• Bob Janes Triage Center/Lee County/SWFAS/LMHS/ Salvation
Army/United Way
• Share Chief Information Officer w/SWFAS
• Members of Lee County Hoarding Task Force
– Services Expanded/Added/Altered
•
•
•
•
•
Physicians – increased number to 13
Client-Driven Scheduling System
Relocation of Physicians to Ruth Cooper Campus
Evening Hours Added
Outpatient Therapy Services Expanded
–
–
–
–
Unduplicated clients served: 2007= 1,241 vs. 2010 = 2,212
22 Outpatient Therapy Groups
Utilization of Cape Coral United Way House
Infant Mental Health Initiatives
Key Accomplishments
• Lee Mental Health
– Enhanced Communication
• Improved Baker Act Communication and Client Flow
• Welcome Center Staff of Five to field Incoming Calls
– Other
• Telemedicine Equipment Secured Through Grant
– Community Outreach
• Partnered with SWFAS for Legislative & County Commission
Candidates Forum
• Formalized Speakers Bureau
– More than 30 presentations over 10 months – reaching nearly 700
people
Awards and Accomplishments
354 Beds!
104
Barriers/Challenges
1.
2.
3.
4.
5.
6.
Governor’s Veto of Triage Grant
Potential Cuts in Federal and State Funding
(Medicaid, other)
Continued Lack of Child/Adolescent Psych
Services
Separation of Mental and Physical Health in
Treatment Decisions
Public Mental Health System Management
Challenges
Provider Collaboration Issues
105
Opportunities
1.
2.
3.
4.
Apply for SAMSA Grant for
Comprehensive Community
Mental Health Services for
Children and Families (2012)
Reconvene Task Force with
support
New School Board Leadership –
possible strategic initiatives
New Integrated Mental and
Physical Health Delivery Model
106
Questions
107
Community Health Visioning 2017
Primary Care Alternatives
Dr. Frank Mazzeo, Jr., Meg Geltner and Sally Jackson
Primary Care Alternatives
Convene stakeholders to develop a
comprehensive, community-based
system of primary care alternatives to
the Emergency Room, targeting areas
of greatest need. (Key elements may
include neighborhood centers/clinics,
mobile units, 24/7 access, service for
under/uninsured, and possible roles
for retired physicians and major
employers.) Develop a method for
educating non-emergent patients to
use the appropriate care settings.
Key Accomplishments
•
ARRA funded renovation/expansion of Family Health Centers’ downtown
campus which will result in the addition of 5 new adult and pediatric medical
providers serving an estimated 6,400 new patients annually…
•
Establishment of the first ever Florida AEGD residency program in partnership
with the Lutheran Medical Center of Brooklyn, NY resulting in 4 new dentists
being placed on staff at the Downtown Fort Myers Center…
•
Moving and expansion of our Broadway Adult Medicine Office to the DTFM
Center resulting in it serving more patients at a location in and nearer to the
33916, 33905, and 33901 zip codes…
•
Hiring of a registered nurse to launch a disease management outreach office at
the Renaissance Preserve Community Center at the Fort Myers Housing
Authority beginning June 28th…
•
Assignment of FHC staff member Mr. Ismael Hernandez to assist the Health
Committee of the 21st Century Collaboration with their work to improve health
outcomes of the residents of the 33916, 33905 and 33901 zip codes.
Key Accomplishments
•
Undertaking a study of the effectiveness of the ASK ME 3 and ASK ME/ME
health literacy program on the health outcomes of Family Health Centers’
patients diagnosed with hypertension and diabetes…
•
Participation in the Lee Mental Health’s Telemedicine Project integrating
primary care and behavioral health services…
•
Initiation of enhanced dental services for children at schools in Lee County
beginning this fall…
•
Launching of a Pharmacy Collaborative Study with HRSA…
•
Expansion of the Coumadin Monitoring Initiative…
•
Offering of autism screenings in the Ronald McDonald care mobile at Family
Health Centers’ pediatric offices…
•
Provision of child safety instruction/car seat monitoring at Family Health
Centers’ pediatric sites by the Kohl's Center for Child Safety…
•
Continued expansion of breast and cervical cancer screenings for uninsured
low-income women under the Healthy Body-Healthy Soul Program.
Primary Care Clinic
Number of New & Repeat Patients
Service Years (Jan-Dec)
Percentages of Presenting Illness
Presenting Illness Percentages
D
2500
5%
25%
2067
1922
2000
5%
1916
10%
P
M
10%
1500
H
D
1000
500
458
20%
583
523
0
2008
New Patients
2009
2010
Repeat Patients
25%
U
R
Medical Respite Unit
Percentages of Presenting Illness
Number of New & Repeat Patients
Presenting Illness Percentages
70
11%
62
60
10%
Assault
37%
49
50
Misc
Cancer
TB
40
39
40
Diabetes
Surgery
Hyperten
14%
30
30
25
20
6%
9%
10
2
2
3
2008
2009
2010
0
New Patients
Repeat Patients
Referred from Lee Memorial
13%
Medical Outreach Services
February – May 2011 Results
61 Clients had their Blood Pressure Taken
44 Clients had their Blood Sugar Taken
29 Clients received Medical Education
100+ Clients utilize the Shower Service Monthly
Key Accomplishments
• Lee Physician Group Dunbar United Way
House
– Opened May 16, 2011
– $1.5 million LIP Grant (ER Diversion for
Primary Care)
– Adult Primary Care
– Chronic Disease Management (Asthma,
COPD, CHF, Diabetes, Sickle cell,
Hypertension)
– Diagnostic testing
– Sliding Scale payment options
• Lee Physician Group North Fort Myers
United Way House – projected opening
September 2011
• Possible other locations –TBD
Barriers/Challenges
• Cuts to Medicaid/Medicare
Reimbursement
• Growth in Underinsured
• Continued Unemployment
• 81,722 ER Patients for
Primary Care
Opportunities
•
United Way LPG Clinic Model
Expansion
•
Seek Additional Federal Resources
•
Possible 2nd Year $1.5 million LIP
Grant
117
Context: Connecting Health
And Human Services
Community-based Health
& Human Services
Circles
reflect relative
reach of services
22% of a population
routinely seen in
core; 28% either not
Seen or without need
Human services programs
Usually designed for
poor and/or well
Ambulatory, Ancillary &
Complementary
Physician &
Hospital Services
LMHS & Physicians
Questions
119
Community Health Visioning 2017
Electronic Medical Record
Mike Smith
120
Electronic Medical Record
Develop a method for transferring
electronic patient information
among physicians, caregivers, and
facilities to improve delivery of
care and transition of patients
between acute care settings and
other locations. LMHS
implements infrastructure and
platform to establish a universal
medical record, which may include
smart card technology.
121
Key Accomplishments
•
Insert here
122
Barriers/Challenges
1. Insert here
123
Opportunities
1. Insert here
124
Questions
125
Community Health Visioning 2017
Workforce Shortage
Dr. Denise Heinemann
2007 Medical Expenditure Panel
Survey
• Based on a sample of 15,000 US households
• $1.13 Trillion Dollars expended:
– Location of Care
• 31.3% inpatient care
• 23.5% office-based care
• 20.7% prescription drugs
– Patient Condition
• 47% on chronic illness
• 25% on acute illness
• <8% each on trauma/poisoning, pregnancy/birth, preventive care,
and “other”.
Healthcare Disciplines with Highest
Vacancy % Now and 2015 (USDOL)
DISCIPLINE
2011
2015
Athletic Training
4.3
82.6
Health Administration
7.0
34.9
Health Information Mgmt.
15.4
30.8
Cardiovascular Perfusion
10.7
28.6
Dietetics
15.4
28.2
Nursing
9.9
27.2
Radiography
4.9
26.8
Respiratory Therapist
2.2
26.7
Emergency Med. Tech.
0.0
25.6
Medical Technology
6.7
24.4
Nuclear Med. Tech
0.0
23.5
Workforce Shortage
Colleges, universities, and clinical
facilities are collaborating to address
shortages of nurses and other health
care professionals.
The concierge form of medical
practice may enhance physician and
patient satisfaction at the expense of
patients in the community who
cannot access a primary care
physician.
Key Accomplishments
• Health professions programs at all levels continue to receive more
applications than the number of seats available.
• Salaries continue to remain attractive to licensed professionals.
• Edison State College has the largest capacity for educating RNs.
• At FGCU, new initiatives include the following degree programs:
Doctor of Physical Therapy (DPT)
MS in Occupational Therapy
Acute Care Nurse Practitioner and Certified Nurse Anesthetist
• Private universities continue to offer the SW Florida market nursing,
physician assistant, and health administration programs.
• FGCU and ESC clinical programs use simulation labs to prepare
students to think critically, maximizing student performance in the
limited clinical settings we share among all programs.
130
Barriers/Challenges
• Physician Manpower
– The shortage of primary care physicians and selected specialties
continues, but medical schools expect a 30% increase in enrollments
by 2015.
• Continue Regional Planning and Cooperation among Programs
Preparing Health Professionals
– Decreased State Funding for New Facilities and Faculty Positions
Limits Admissions and Threatens Program Accreditation
• Optimize the Scope of Practice for all Providers
– Florida is one of the last two states in the nation to restrict the
prescriptive privileges of ARNPs
131
Opportunities
• Reliable manpower data available from DOL
• Interagency cooperation has increased between Lee
and Collier County health providers with an
emphasis on pediatric services
• Flexible Interdisciplinary Care Models Are Needed
– The FMA continues to lobby against full scope of practice
for FL ARNPs, further limiting their role in primary care.
• Recognition and reward for the challenges generalist
practitioners face in practice remain a serious
concern.
132
Opportunities
• Reinvigorate the Public Health System:
– Reform Medicaid, increase community collaboration and care
management targeting obesity, smoking, diabetes, and
hypertension.
• Lobby for Federal Programs to Support Practitioners Willing
to Invest in Becoming University Faculty
• Increasing numbers of primary care ARNPs from FL programs
will further relieve the burden of primary care.
• The LMHS partnership with the FSU Medical School will bring
primary care medical residents to the system in 2013, creating a pool of
physicians who have a high probability of remaining in SWFL.
133
Questions
134
Community Health Visioning 2017
Public Awareness of Services
Kevin Newingham
135
Public Awareness of Services
Educate/inform the public about the
availability and quality of key health
care services/providers in
collaboration with Lee County
Medical Society, governmental
agencies, health and human service
agencies, schools, and others.
Communicate why certain programs
do not exist in Lee County.
136
Key Accomplishments
Increased selection of Lee Memorial Health System chosen
as “best” for major service lines from baseline research
conducted in January 2010 as compared to Q4 2010:
• Pediatric Care: 25% Increase in positive response
• Orthopedic Care: 16% Increase in positive response
• Cardiac Care: 3% Increase in positive response
• Neurological Care: 17% Increase in positive response
• Cancer Care: 18% Increase in positive response
137
Key Accomplishments
•
•
•
•
•
Entry into social media – Facebook, Twitter,
YouTube and Vimeo – has increased visibility of
services. Example: Prior to using YouTube we had
200 hits per month on our videos, now we have over
2000 per month.
Substantial exposure through print ad placements
throughout Lee, Collier and Charlotte counties.
System publication - Healthy News – distribution of
nearly 250,000 per month in all 3 counties.
Major service line patients featured on billboard
placements throughout Lee county.
Outreach to the Hispanic community through
multimedia placements.
138
Key Accomplishments
•
•
•
•
Through 2011, over 365 members of our medical
staff will be featured in Health Matters video
segments airing on NBC and repurposed on the web
and through social media
American Health Journal sponsorship featuring 10
staff physicians focused on 5 major service lines
airing weekly on WINK-TV
Earned media placements on television news and
news publications
Involvement in over 70+ annual health fairs and
Speakers Bureau engagements that reach over
10,000 community and business development
attendees
139
Examples of current campaign
140
Barriers/Challenges
•
•
•
•
•
•
Financial challenges
Departmental resources
Limited bed capacity (seasonal)
Increased competition from other health
systems and independent physician groups
to maintain and increase market share
Internal messaging challenges
Consistency in Lee Memorial Health System
branding
141
Opportunities
•
•
•
•
•
Development of seminar series in Bonita
Springs/Estero with gated communities
Further expansion of social media and new
technologies
More fully leverage our web presence to
engage visitors
Consolidation of Lee Physician Group
allowing for more concise messaging of the
features of the group to target audiences
EPIC
142
Questions
143
Community Health Visioning 2017
Preventive Health Care
Sarah Owen , Cliff Smith, and Sally Jackson
144
Preventive Health Care
Develop a community-wide program
for preventive health care,
considering childhood obesity,
diabetes or prenatal care and
distribute through schools and other
community/neighborhood partners.
(Key elements may include
personal/parental responsibility,
infrastructure for delivery of service,
grassroots/door-to-door campaign
using old Polio model or
neighborhood champions.)
145
Dunbar United Way House
•
•
•
•
•
•
More than a Medical Clinic
Synergy created between partners
Transformational care vs. Transactional care
Over 350 “walk –in” customers in June
Over 100 received services from LPG
The House started with one simple question
and that model continues today…but with
more answers for the customer.
146
United Way 211 Top 10 Reported Needs
1. Utility Assistance
2. Rent Assistance
3. Emergency Food
4. Medical/Prescription Assistance
5. Employment Assistance
6. Food Stamps
7. Emergency Shelter
8. Senior Services
9. Medical Transportation
10.Child Care
147
148
Dunbar United Way House
4,601 Individuals Served in 2010
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Community Cooperative Ministries- Lead Agency
Lee Memorial Healthcare System-Host Agency
Lee Memorial Physicians Group
ACCESS Kiosk, Department of Children and Families
NAMI
Alvin A. Dubin Alzheimer’s Resource Center
Hind’s Feet Mentoring Program
Haitian American Coalition
Senior Friendship Center
Goodwill Industries
Healthy Start
Volunteer Income Tax Assistance
149
East Fort Myers United Way Campus
3,098 Individuals Served in 2010
1. Children’s Advocacy Center-Lead
Agency
2. Lee Memorial Hospital-Host Agency
3. Family Health Centers
4. Home Ownership Resource Center
5. Sickle Cell Disease Association
6. Community Cooperative Ministries
7. ACCESS Kiosk, Department of
Children and Families
8. AARP - Senior Community Service
Employment Program
9. GRIP (Grandparents Returning into
Parenting)
10. Alcoholics Anonymous
10. United Way 2-1-1
11. Wake Up America
12. Harry Chapin Food Bank
13. Healthy Start
14. Bonita Literacy: Mom's and Tot's
15. Literacy Volunteers of Lee County
16. NAMI
17. Catholic Charities
18. Goodwill Industries
19. Volunteer Income Tax Assistance
Program
150
Health and Wellness Programs and Initiatives:
12 United Way Houses
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Sexually Transmitted Disease Education and
Testing
Blood Pressure Screening
Mental Health Information, Referral and
Counseling
Substance Abuse Counseling
Pre-natal Counseling
Child Birth Classes
Sickle Cell Education
Epilepsy Education
Cancer Support Services
Alzheimer Support Groups and Education
Positively Aging Services
Nursing Internship Opportunities
Choice Market and Nutritional Food Opportunities
151
Key Accomplishments
•
The Children’s Hospital of
Southwest Florida Advocacy
Programs
– 90,000 Contacts at Health and
Safety Fairs for
Prevention/Education
– 16,300 Lee and Collier Grade
School Students Received Health
Education Programs
– 1,579 Car Seat Safety Checks
– 1,039 Bicycle Helmets
Fitted/Distributed
152
Key Accomplishments
•
LMHS Trauma District
Injury Prevention Programs
– Over 200,000 Annual Contacts
• Bicycle Safety, Child Passenger Safety, High
Risk Driver Training, Young Driver
Training, Trauma Nurses Talk Tough for
School Age Children, Defensive Driving
Training, Step Wisely Falls Prevention,
Mature Adult Safety, Boating Safety,
Workplace Injury Prevention, GATE
Program, Suicide Prevention (NEW)
– Injury Prevention Coalition
• Drug House Odyssey, Pediatric Injury
Prevention Health Fair, 3 D Month, Trauma
Awareness Month, Falls Awareness Month,
Health Fairs
153
Questions
154
Lunch
Community Health Visioning 2017
Chronic Disease
Regan Goldberg and Judith Hartner, M.D.
156
Chronic Disease
With community partners, develop
community/neighborhood clinics
for chronic disease prevention,
education, management, such as
sickle cell, diabetes, obesity,
hypertension and asthma. Target
populations with greatest need
(e.g., African Americans for
diabetes).
157
Key Accomplishments
• We have 35 companies/communities
using our Walking Kits in Lee County
• We have grown to 11 Fit Friendly
Companies in SWFL
(Gold Companies: Fowler White, LMHS, Hope
Healthcare Services, Lee County Health Dept.,
LCBoCC, Arthrex , Physicians Regional, Gulfshore
Insurance, Collier County School District) (Platinum
Company: Lee County School District), (Innovation
Award: Chico’s)
• We have 37 Walking Paths in SWFL
158
Here’s where we Started!...
StartWalkingNow.org




MyStart! Tracker
Community
Custom Walking Plans
Start! Walking Paths
National Media/PR




Start Walking Program
National Spokespeople
Strategic Year-Round Media
Integrated w/ Nat’l Sponsors
TV/Radio/Long-Lead/Digital




1.5 K Kits/Month
Worksite Wellness
Great Sponsor Activation
Helps People Year-Round
Nat’l Start! Walking Day
1st Wednesday - April
National & Local Media
500K people participate
7K companies participate




Start! Heart Walk
Start! Fit-Friendly




AHA Worksite Recognition
1,500+ Current Companies
2.5 M + Employees reached
Best-In-Class WW Program




Nearly 350 Events
Experiential Marketing
Local Media/Promotion
CEO Events
How My Heart. My Life will touch our
SWFL Community…
Focus Areas: Healthy Eating Physical Activity and Children’s Health
Impact Goal: Improve cardiovascular health of all Americans by 20% by 2020
Call to Action: Building Healthier Communities
My Heart My Life City Sponsor
Community Assets Select 3 - Blue Assets
1 Teaching
Garden
Playground
Heart Walk
National Walking Day –
Includes Family Fitness
Eating Healthy Day Includes Cooking TTT
Walking
Paths/Walking
Clubs
Food
Revolution
Kitchen
Do you know your heart score? Learn the 7 simple
steps to live better...in just 7 minutes!
www.heart.org/MyLifeCheck
161
Chronic Disease
Expanded Goal – Public Health Perspective
With community partners,
develop programs and policies
designed to prevent chronic
diseases by promoting
healthier life-style choices.
162
Key Accomplishments
Fit Friendly Southwest Florida
•
•
•
•
Organizational meeting July 7, 2010
Strategic plan adopted March 2011
Presentation to the MPO on health
considerations in community
planning
Supported Complete Streets
Resolutions and Pedestrian/Bicycle
Master Plan
163
Fit-Friendly SWFL Strategic Plan
Our Purpose:
Create and sustain a community culture of healthier life-styles
Our Mission:
To reduce the risk factors associated with chronic disease by:
Our Goals:
1.
2.
3.
4.
5.
Achieving a health and wellness mindset
Improving the nutritional habits of the citizens of SW FL
Increasing the physical activity of the citizens of SW FL
Expanding Southwest Florida commitment to the Fit-Friendly campaign
Influencing policy and environment changes in support of healthier lifestyles
164
Opportunities
•
We are not alone – many
resources and best
practices available
•
Community
Transformation Grant
165
Barriers/Challenges
1. Maintaining momentum
2. Volunteer time
3. Campaign resources
4. Competing short-term
needs
166
Questions
167
Community Health Visioning 2017
Focus on Quality
Chuck Krivenko, M.D.
168
Focus on Quality
Improve existing acute
care programs based on
quality analysis/criteria
rather than adding new
low volume
programs/specialties.
169
Key Accomplishments Update 2011
• Implemented programs to reduce hospitalacquired infections
– Intensive care units going months to years
without an infection
– Result in a system-wide reduction in mortality
• Developed the LMHS Transfer Center in
conjunction with Lee County EMS
– Add functionality of centralized direct
admissions
• Expanded Q-Life, a palliative care program
supporting patients with end-of-life conditions
– Added a full-time trained palliative care
physician
• Reductions in mortality continue with
implementation of multi-disciplinary rounds and
strategies to prevent complications at all hospitals
Key Accomplishments
• Transitioned from Joint Commission
Accreditation to DNV accreditation
• Accredited by DNV - National Integrated
Accreditation for Healthcare Institutions
(NIAHO standards)
– Integrates ISO 9001 standards with CMS
Conditions of Participation standards
adding a quality management system
• Preparing for ISO 9001 compliance and
certification by 2013
• Planning for a Family Practice Residency
program in conjunction with Florida State
University School of Medicine to assure an
adequate supply of primary care physicians
for the future.
Focus on Safety
Patient safety is now the
overriding core value of the
Lee Memorial Health System.
Patient Safety Cultural
Transformation over the past
24 months.
172
Focus on Safety
• HPI consultants
engaged in 2009
– Focuses on behavioral
accountability
– Survey of >700
employees
– Identify a Top Ten List
173
Focus on Safety
•
•
•
Physicians - Safety Steering
Committee and Physician
Leadership Council Actions
Leadership Education - > 700
leaders trained on safety
behaviors and tools
Staff Education - > 9,000
employees and volunteers
trained on error preventing
behaviors and tools
174
Focus on Safety
• Make Harm Visible with a monthly
SafeLee progress report showing Serious
Safety Event Rate, Precursor Events and
Near Misses
• Cause analysis and mitigation of all
Serious Safety Event Rate, Precursor
Events and Near Misses by using root
cause, apparent cause and common cause
analysis methodology
• Introducing Crew Resource Management
(Interactive Collegial Teams) to
Electrophysiology Catherization Labs
175
Challenges/Opportunities
1. HOLDING THE GAINS
2. Sustaining and enhancing the safety
culture by a continuous obsessive
focus on reducing harm and risks of
harm
3. Becoming a highly reliability
organization which recognizes that
optimizing outcomes requires a
concurrent focus on system design
and human behavior accountability
4. Maintaining our motto “Safety
begins with You and Me and ends in
Zero”
176
Questions
177
Community Health Visioning 2017
Course Corrections
Brad Pollins
178
Community Health Visioning 2017
Next Steps & Closing
Jim Nathan and Robbie Roepstorff
179