Community Health Needs Assessment
Implementation Strategy
Adopted by St. John Medical Center s Governing Board in December 2012.
Introduction
St. John Medical Center (the Hospital ) conducted a community health needs assessment (a CHNA ) of the
geographic areas served by the Hospital pursuant to the requirements of Section 501(r) of the Internal Revenue
Code ( Section 501(r) ).1 The CHNA findings were published on the Hospital s website in December 2012 (the
2012 CHNA ).2 This implementation strategy (the Strategy ), also required by Section 501(r), documents the
Hospital s efforts to address the community health needs identified in the 2012 CHNA.3
The Strategy identifies the means through which the Hospital plans to address a number of the needs that are
consistent with the Hospital s charitable mission during 2013 through 2015 as part of its community benefit
programs. Beyond these programs, the Hospital is addressing some of these needs simply by providing care to
all, regardless of their ability to pay, every day.
The Hospital anticipates the strategies may change and therefore, a flexible approach is best suited for the
development of its response to the 2012 CHNA. For example, certain community health needs may become more
pronounced and require changes to the initiatives identified by the Hospital in the Strategy. During 2013 through
2015, other community organizations may address certain needs, indicating that the Hospital s strategies should
be refocused on alternative community health needs or assume a different focus on the needs identified in the
2012 CHNA. In addition, changes may be warranted by the publication of final regulations.
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2
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The Patient Protection and Affordable Care Act (Pub. L. 111-148) added section 501(r) to the Internal Revenue Code,
which imposes new requirements on nonprofit hospitals in order to qualify for an exemption under Section 501(c)(3), and
adding new reporting requirements for such hospitals under Section 6033(b) of the Internal Revenue Code.
See the 2012 CHNA at www.stjohnmedicalcenter.net.
Final guidance as to the substance and format of a CHNA and an implementation strategy has not been published and
has been provided only on an anticipatory basis as of September 25, 2012.
Overview of the Strategy
The Strategy includes the following information:
1.
2.
3.
4.
5.
6.
7.
Hospital Mission Statement
Community Served by the Hospital
Priority Community Health Needs
Implementation Strategies ‒ 2013 Through 2015
Needs Beyond the Hospital s Mission or Service Programs
Implementation Strategy Development Collaborators
Community Collaborations
1. Hospital Mission Statement
St. John Medical Center is a 50/50 Partnership with the Sisters of Charity Health System and University Hospitals
Health System. St. John Medical Center s Mission:
St. John Medical Center is a community healthcare resource committed to excellence. Our Mission
is rooted in a deep reverence and respect for human life and the dignity of each person. Our
service is characterized by a spirit of love, truth, justice and stewardship. We strive to always
provide care which is compassionate and professional, continuing the healing ministry of Jesus in
our community.
Core Values
St. John Medical Center, sponsored by the Sisters of Charity of St. Augustine, implements the philosophy, charism
and values of the Congregation. Our strategies and goals create an organizational culture which embodies these
core values:
Compassion: To display a profound sense of interconnectedness to others.
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Courage: To dare to take risks that our faith-based care demands.
Respect: To value dignity and sacredness of life from conception through death.
Justice: To develop right relationships internally and externally
Collaboration:
To promote inclusive, compassionate and collaborative relationships.
2. Community Served by the Hospital
Our hospital provides a wide range of community benefits including clinical services, medical education and many
community outreach services.
The community served by the Hospital is defined based on the geographic origins of the Hospital s inpatients. The
Primary Service Area ( PSA ) is the geographic area from which the majority of the Hospital s patients originate. The
Secondary Service Area ( SSA ) is where an additional population of the Hospital s inpatients resides. The PSA is
comprised of 8 zip codes and SSA of nine zip codes. Nine zip codes are in Lorain County and 8 in Cuyahoga County.
In 2010, the PSA and SSA were home to approximately 445,772 individuals. Sixty seven (67) percent of the
hospital s discharges lived within the PSA.
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St. John Medical Center Community By the Numbers •
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17 ZIP codes in 2 counties: Cuyahoga and Lorain Total population 2010: 445,772 o Primary Service Area (PSA): 41% of total population o Secondary Service Area (SSA): 59% of total population 67% of inpatient discharges originate from the PSA 16% of discharges in 2012 were found to be Ambulatory Care Sensitive (ACS) or potentially preventable if patients are accessing primary care resources at optimal rates; 69% of ACS discharges were for patients 65 years of age and older Many of these ACS discharges have occurred for Medicare and uninsured patients Population change 2010-­‐2015: o Cuyahoga County: 5.6% decrease o Lorain County: 2.6% increase o 1% decline in overall population o 9% increase in 65+ population •
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Cuyahoga County’s 2009 poverty rate higher than state or national averages 26% of households within SJMC’s service area have incomes < $25,000 The greatest proportions of lower-­‐income households were located in the western and eastern service area towns of Lorain and West Park 2010 Population of community served by SJMC is 87% White, 6% African American Population by race, 2010-­‐2015: o Projected decline in White populations o Substantial increase in Asian, Multi-­‐
Racial, and Other non-­‐white populations Two service area ZIP codes contain Medically Underserved Areas Cuyahoga and Lorain counties contain multiple Health Professional Shortage Area designations 4
St. John Medical Center
Service
Area
Primary
ZIP Code
44011
44012
44039
44070
44116
44138
44140
44145
Subtotal
44001
44035
44052
44053
44054
Secondary
44055
44107
44126
44135
Subtotal
Town
Avon
Avon Lake
North Ridgeville
North Olmsted
Rocky River
Olmsted Falls
Bay Village
Westlake
County
Lorain
Lorain
Lorain
Cuyahoga
Cuyahoga
Cuyahoga
Cuyahoga
Cuyahoga
Amherst
Elyria
Lorain
Lorain
Sheffield Lake
Lorain
Lakewood
Fairview Park
West Park
Lorain
Lorain
Lorain
Lorain
Lorain
Lorain
Cuyahoga
Cuyahoga
Cuyahoga
Combined
Population
2010
17,778
24,711
29,353
30,392
18,395
18,878
14,217
30,066
183,790
20,953
64,077
32,415
18,802
12,197
22,819
49,587
15,341
25,791
261,982
445,772
Figure 1 (above) depicts the Hospital’s PSA and SSA. The most recent data at the time the 2012 CHNA was conducted was from 2010. 5
3. Priority Community Health Needs
Identified Needs
Access to Care
• Lack of Access to Providers
• Lack of Affordable and Accessible Care
• Lack of Collaboration
• Lack of Services and Care for Seniors
• Lack of Transportation to Health Services
• Need for Increased Health Education and Positive Cultural Influences to Change
Lifestyles
Plan to
Address
Yes/No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Dental Care
• Poor Dental Health ‒ Lorain County
No
Health Behaviors
• Prevalent Drug Abuse
No
Health Conditions
• Prevalent Diet and Exercise ‒ Related Conditions
Yes
Maternal and Child Health
• Poor Infant Outcomes
• High Rate of Teen Pregnancy ‒ Cuyahoga County
Yes
No
Mental and Behavioral Health
• Poor Mental and Behavioral Health Status and Lack of Services
No
Mortality Rates
• High Rates of Cardiovascular Disease Mortality ‒ Cuyahoga County
• High Rates of Chronic Liver Disease and Cirrhosis Mortality ‒ Cuyahoga County
Yes
No
Social and Economic Factors
• High Rates of Financial Hardships
• Needs of Children and Youth
No
Yes
Figure 2 (above) describes the community health needs identified through the 2012 CHNA as priorities.
Those needs that the Hospital plans to help address during 2013 through 2015, at least in part, are noted.
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Health needs are listed in alphabetical order. Documentation of the findings presented in this summary is provided in the Appendix
to the Hospital s 2012 CHNA.
A number of the access problems and community health needs do not fall within the Hospital s Mission and therefore will not be
addressed in the Strategy
4. Implementation Strategies 2013 through 2015
The Hospital, through its Mission, has a strong tradition of meeting community health needs through
its provision of ongoing community benefit programs and services. The Hospital will continue this
commitment through the strategic initiatives set forth below that focus primarily on high-priority health
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needs, as well as other selected needs identified in the 2012 CHNA. The Hospital has provided
community benefit programs for many years and will continue to provide such programs. Not all
programs provided by the Hospital that benefit the health of patients in the Hospital s PSA and SSA
are discussed in the Strategy.
Further, given changes in health care, the strategies may change, and new programs may be added
or programs may be eliminated during the 2013 ‒ 2015 period.
a. Access to Care
• Lack of Access to Providers
o Develop a Deaf Access Program
o Expand physician recruitment into Lorain County areas of need
o Expand medical services (including ancillary and specialty services) into the community and
geographically closer to areas of need
o Expand evening and weekend primary care hours through West Shore Primary Care
o Utilize technology to provide Pediatric Specialists from UHHS main campus to patients in the
community, eliminating travel outside area
o Expand our resources to promote our free health screenings in areas of greatest need.
o Continue to provide physician participation in North Coast Health Ministry Free Clinic (West Shore
Primary Care)
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Lack of Affordable and Accessible Care
o Financial assistance and charity care are provided to all those who qualify through the SJMC
Financial Assistance Program*
o Continue to maintain an emergency prescription assistance fund for patients who cannot afford
their medications upon discharge
o Expand outpatient social worker Health Care Access Program. Social worker to assist the
uninsured and underinsured in gaining access to prescriptions and medical care, as well as to
enroll in appropriate financial assistance programs.
o Provide space and advertising for a weekly Low Cost Immunization Clinic provided by the
Cuyahoga County Board of Health
o Partner with Hospice of the Western Reserve to create a Patient Navigator Program for hospice
and palliative care patients
* See www.stjohnmedicalcenter.net
Policy FI-027 “Governing Financial Assistance to the Uninsured”
Policy FI-028 “Credit & Collection”
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Lack of Collaboration
o Train staff and provide infrastructure to participate in CHAP program (Cuyahoga Health Access
Partnership). CHAP is a collaboration dedicated to helping uninsured adults gain access in an
efficient and cohesive manner while decreasing administrative hurdles.
o Host networking and continuing education meetings for WHO (Westside Healthcare
Professionals Organization), coordinated by Community Outreach
o Continue collaborative efforts in WESHARE Program (West Shore Area Rescue Association)
wherein SJMC provides medical control for the communities of Lakewood, Rocky River,
Fairview Park, Bay Village, North Olmsted, Olmsted Falls, Westlake, Avon Lake and North
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Ridgeville. SJMC is the primary medical control in partnership with the University Hospitals
EMS Institute for the Eaton Fire Department and Sheffield Lake Fire Departments. Through
collaboration, medical emergencies (such as cardiac arrest) are responded with greater
efficiency. In partnership, we provide EMS outreach and education for the above communities,
including:
o EMS protocol development
o EMS education and training
o EMS quality initiatives
o Participation in community events related to health and safety
o Continue working with local police and school officials on providing health and safety programs
o Continue to provide healthcare expertise and participation in community wide committees such
as the Westlake City Hoarding Committee and Westlake School System s Wellness Committee
(collaborating with First Responders)
• Lack of Services and Care for Seniors
o Implement a web-based application designed to bridge the gap between patients, health care
systems and extended care facilities. Patients and families can learn about local facilities via
web-based tours and can also learn comparative information about facilities based on their
needs (specialty care, private rooms versus semi-private, etc.)
o Provide nutritional, economic and social support to seniors through the hospital sponsored
Senior Supper Club, which provides a 40% discount for senior meals
o Enhance work with Post Acute Care facilities with implementation of CliniSync Health
Information Exchange System (through the Ohio Health Information Partnership), which
ultimately improves care for seniors
o Continue to provide preventative primary care in the home for housebound elderly through a
Mobile Medical Care Program
o Continue to host the Post Acute Care Council with the goal of collaborating with senior care
facilities to promote excellent care management
o Continue to provide free Health Fairs throughout the community, especially in facilities easily
accessed and frequented by seniors
o Continue to provide support groups and health talks for seniors
• Lack of Transportation of Health Services
o Provide webinar (web-based) educational opportunities on topics Healthy Lifestyle, Health Literacy
topics, eliminating the barrier of transportation
o Free Community Shuttle provides transportation to and from SJMC inpatient and outpatient
services for ambulatory patients
o Participate in American Cancer Society Transportation Summit
• Need for Increased Health Education and Positive Cultural Influences to Change
Lifestyles
o Expand communication and distribution of information regarding health events, screenings, classes,
support groups, and resources.
o Enhance services for our Stroke Patients facilitated by a Stroke Coordinator and Community
Outreach staff who also provide educational talks, a support group and social services to assist
patients in preventing stroke and or preventing future medical event
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o Continue to provide a Breast Health Navigator to provide healthy lifestyle knowledge in
preventing breast cancer, as well as education and support for women and families who are
affected by breast cancer
o Develop a Women s Service Line in 2013 that encompasses all aspects of women s health:
preventative, disease management and/or treatment
b. Health Conditions
• Prevalent Diet and Exercise ‒ Related Conditions
o Broaden opportunities for Diabetes Education, Prevention and Exercise in the community,
particularly for the uninsured and underinsured.
o Provide free Diet and Exercise webinar programs
o Continue to provide space and promotion of UHHS Healthy Kids Healthy Weights program,
which is a free, comprehensive and multidisciplinary weight management program for
children ages 4-18 and their families
o Continue to provide Health Education in the community on nutritional topics
c. Maternal and Child Health
• Poor Infant Outcomes
o Develop a non-certified class through Community Outreach, tailored to new mom s/new
families to teach basic infant CPR and First Aid
o Continue to provide weekly Breast-feeding Support Group, as well as New Mom s Support
Group (for non-breastfeeding mothers), led by Lactation Experts who monitor infant weights
and provide basic education and support
o Provide Congenital Heart Disease Screening for every newborn
o Promote Infant Safety
• Provide Car Seat Safety and Fit Checks
• Participate in Community Health Fairs
• Provide education and demonstration of Safe Sleep/Back to Sleep
• Provide preventative education about Shaken Baby Syndrome
d.
Mortality Rates
o Collaborate with local nursing homes to continue management of chronic disease
o Provide low-cost American Heart Association BLS - CPR and First Aid opportunities to the
community through Community Outreach
o Provide Diabetes Education and Cardio-Pulmonary Rehabilitation services, including
opportunities for discounted rates on programs, as well as free community talks and
screenings on a regular basis
e.
Social and Economic Factors
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Needs of Children and Youth
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Expand model of School Wellness Partnerships to other communities such as North Olmsted
and West Park (where our Adopt-A-School West Park Catholic Academy, is located)
Continue our partnership with Westlake School District, wherein we provide leadership to a
District-Wide Health & Safety Committee, which works with all of the PTA s. This committee
plans and provides Health & Safety Services to school children and their families.
Expand the present shadowing program for high school or college students who are
interested in the medical profession
• Encourage greater participation of students interested in becoming physicians in the St.
John Medical Center Graduate Medical Education Program
• St. John Medical Center Graduate Medical Education Program will explore the possibility
of reaching out to our Cristo Rey Network School, St. Martin de Porres, for interested
minority students
• Continued hospital support of the work/study program for St. Martin de Porres School
• Continued membership in NEONI, the Northeast Ohio Nursing Initiative for high school
juniors and seniors to shadow a St. John Medical Center Ambassador
Expand the number of high school student volunteers
Continue membership on Westlake Schools Wellness Committee to oversee School
Wellness Policies and events; these events can also include training and educational
opportunities for staff and families, as well as youth
Anticipated Impacts on Health Needs
Through implementing the above strategies, the Hospital anticipates the following improvements in
community health:
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Improved health care access.
Improved awareness of health educational programs and resources.
Increased awareness of disease management and healthy lifestyle choices
Improved health resource system and continuum of care for senior population
Improved knowledge of maternal and infant health
5. Needs Beyond the Hospital s Mission or Service Programs
No hospital facility can address all of the health needs present in its community. The Hospital is
committed to adhering to its Mission and remaining financially healthy so that it can continue to
provide a wide range of community benefits. The Strategy does not address the following community
health needs identified in the 2012 CHNA:
a. Dental Care ‒ Poor Dental Health SJMC does not offer dental services and, therefore, will
not address this specific need. Patients or community members who have dental needs are
referred to Case Western Reserve University School of Dental Medicine, or Metro Hospital, or the
Lorain Family Health and Dentistry Clinic, depending on where they are geographically located.
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b. Health Behaviors ‒ Prevalent Drug Abuse SJMC does not have a Behavioral Health
Department, so we do not have the resources or expertise to provide more targeted efforts,
however we do provide the following: Patients are appropriately treated for medical detoxification
when it is a medical necessity, and then are referred for treatment. Weekly AA meetings are
conducted on-site, and are provided this space free of charge. SJMC will also promote the usage
of the Prescription Drug Drop Boxes located at the Police Departments of the following
communities: Bay Village, Fairview Park, Lakewood, North Olmsted, Rocky River and Westlake.
These boxes provide a safe and secure way for residents to dispose of their unwanted, unused
prescriptions (with the exception of liquid drugs or syringes). This effort helps with the prevention
of prescription drug abuse and crime and also helps to keep the environment safe.
c. Maternal and Child Health ‒ High Rates of Teen Pregnancy ‒ Cuyahoga County
As SJMC is a Catholic Hospital, we do not support the use of contraception that impedes new life.
We adhere to the Ethical & Religious Directives for Catholic Health Care. We do, however,
support organizations that assist young women in understanding the dignity of human life, such
as Cornerstone Among Women.
d. Mental and Behavioral Health ‒ Poor Mental and Behavioral Health S tatus and
Lack of Services
SJMC does not have a Behavioral Health Department and therefore we cannot provide treatment
of mental or behavioral disorders. We direct those in need to our partnering facilities, University
Hospitals, St. Vincent Charity Medical Center, or other appropriate facility. We will increase our
offerings of mental health awareness and education by partnering with the Far West Center.
They will participate with us at Health Fairs, providing free depression screenings, and they will
provide health talks which we will promote in the community. We will also continue to provide
support groups and talks on mental health topics such as stress, grief/depression and ADHD.
e. Mortality Rates ‒ High Rates of Chronic Liver Disease and Cirrhosis Mortality ‒
Cuyahoga County. Managing chronic liver disease is not one of our core competencies.
f.
Social and Economic Factors ‒ High Rates of Financial Hardship ‒ SJMC will continue to
provide charity care and financial assistance, as well as assistance with Health Care Access.
6. Implementation Strategy Development Collaborators
In developing this implementation strategy, the Hospital collaborated with:
• Sisters of Charity Health System
• University Hospitals
7. Community Collaborations
The Strategy will be implemented in collaboration with other entities including, but not limited to:
Alzheimer s Association
American Cancer Society
American Diabetes Association
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American Heart Association
Area Churches of different denominations
Area Senior Centers (including but not limited to: North Olmsted, North Ridgeville,
Avon, Avon Lake, Bay Village, and Westlake)
Area Senior Living Facilities (independent through skilled)
Area YMCA s
Catholic Community Connection
CHAP ‒ Cuyahoga Health Access Partnership
Cuyahoga County Board of Health
Far West Center
Gathering Place
Home Health Providers
Hospice Centers
Lorain Family Health & Dentistry Clinic
Lorain Free Clinic
North Coast Health Ministry
North Olmsted City Schools
Sisters of Charity Health System
St. Peter s Catholic School, North Ridgeville
UH MacDonald Women and Children s Hospital
UH SafeKids Coalition
Westlake Center for Community Services
Westlake City Schools
Westlake Fire Department
Westlake Police Department
Westlake Recreation Department
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