Community Needs Assessment Update
March 1, 2007
Executive Summary
On January 1, 2005, North Country Hospital (NCH) completed an assessment of health care needs for the communities it serves in Orleans County and the northern part of Essex County.
This report includes many statistics that describe the health status and health behaviors of residents in the communities served by North Country Hospital. There are also statistics on how some hospital services are utilized. This information was made available for this report from the Vermont Department of Health in conjunction with the Vermont Association of Hospitals and Health Systems. A full description of this process and the results are available in the 2005 Community Needs Assessment at www.nchsi.org.
Since the publication of the 2005 document, North Country Hospital has held two public meetings to share the progress that we have made on accomplishing the priorities for healthcare improvement and the priorities for healthcare resources in the North Country Hospital service Area.
The First Public Meeting
The first Public Meeting was held on Friday, March 11, 2005 at 9am at the Barton Memorial Building in Barton, Vermont. Entitled “Healthcare in the Northeast Kingdom,” the meeting was co-sponsored by North Country Hospital and the Northeast Kingdom Collaborative. The meeting was advertised by a press release and ads in the Newport Daily Express, The Caledonian Record, and the Chronicle newspapers, as well as ads on WMOO92-FM and WIKE1470-AM radio and email list serve distribution. Refreshments were served.
A panel including healthcare leaders from North Country Hospital, Northeastern VT Regional Hospital, NEK Area Agency on Aging, Orleans Essex VNA & Hospice, and NEK Human Services discussed:
• Key successes and challenges in the past year
• Main goals and potential obstacles for next year
• Questions and audience discussion.
Act 53 Community Reports and Community Needs Assessments from both North Country and NVRH hospitals were distributed. Approximately 40 people attended.
The Second Public Meeting
The second Public Meeting was held on Tuesday, February 28, 2006, 3-4 pm, at the North Country Hospital Meeting Room. The meeting was advertised email distribution, posters, a press release and ads in the Newport Daily Express, The Caledonian Record, and the Chronicle newspapers, as well as ads on WMOO92-FM and WIKE1470-AM radio at a cost of over $500. Refreshments were served.
Karen Weller, president of the hospital addressed those present. The following update on the progress that the hospital has made on the needs assessment priorities was distributed, as well as copies of the 2005 Act 53 Report and Community Needs Assessment and the Hospital’s Annual Report. Six people attended.
February 2006 Update on the 2005 Community Needs Assessment
In the autumn of 2004, North Country Hospital implemented a survey process and held a public forum to obtain input regarding the community’s perception of healthcare needs and resources in the North Country Hospital service area. A full description of this process and the results are available at www.nchsi.org.
In summary, the following were identified as priorities for healthcare resources in this area:
1. Primary Care
2. Emergency Care
3. Specialty Care – defined most often as dialysis, orthopaedics, oncology
This is a report on progress in these areas.
1. Primary Care
The State Resource Allocation Plan (BISHCA, October 2005) identified this area as one of four in the state with a shortage of primary care physicians. We did not need a report to tell us that!
There is an increasing national shortage of primary care physicians. A multitude of factors has led to physicians wishing to be “specialists” rather than primary care physicians. The two areas hit hardest by the shortage are inner cities and rural.
What has happened over the last year?
These are the current number of primary care physicians (all but one are Board Certified).
(6) Family Practitioners (adults and children)
(4) Internal Medicine (adults)
(2) Internal Medicine/Pediatrics (adults and children)
(3) Pediatricians (children)
(2) OB/GYN (women)
(1) General Practice (adults)
In addition, the area has eleven nurse practitioners and physician assistants who provide primary care.
Three physicians left primary care for specialties. Two stayed in the community and one moved.
One physician assistant was added.
Are we trying to change things? What’s next?
Many of our primary care physicians are not taking new patients. Waits to be seen can be very long. Our efforts are two-pronged. First, we are trying to support the physicians so their practices and hospital work can be done as quickly and thoroughly as possible. These efforts include installation of a computerized medical record. Second, we are working with the physicians to recruit new doctors to our community. Because of the shortage, recruitment is difficult, but we never give up!
2. Emergency Care
When people cannot get in to see a primary care physician, they go to the Emergency Room. Although delivering primary care is not seen as an “appropriate” use of an Emergency Department, people need to go somewhere. Our Emergency Department is the backup for area physicians.
The current staff of the Emergency Department includes four full-time physicians, two full-time nurse practitioner/physician assistants, and several part-time physicians.
What happened this year?
The current staffing is the result of a great many changes over the past year. One of the full-time physicians moved over from a family practice. This helps the Emergency Department, but does not help our primary care shortage! Another part-time emergency doctor became full-time. The mid-levels (nurse practitioner/physician assistants) are new and are working during times of highest volume.
What is next?
Our Emergency Department is now well staffed. We are in a position to monitor the changes and see if they are meeting the needs of our community.
3. Specialty Care
Dialysis: The Certificate of Need (CON) process was successfully completed in the summer of 2005, with much support demonstrated from a large number of community members. Construction has been underway since the “cement-breaking” ceremony held in the fall of 2005 and currently there are plans for a grand opening in April 2006.
Orthopaedics: Through arrangements with Copley Hospital in Morrisville, there is now orthopaedic coverage at least two days per week at North Country. A full-time orthopaedic surgeon begins services here in August 2006.
ENT: A full-time Ear, Nose, and Throat (ENT) specialist opened a practice in this area in 2005.
Ophthalmology: A full-time ophthalmologist joined the practice of a retiring ophthalmologist and continues providing services to these patients.
Other North Country specialty services continue to include urology, psychiatry, occupational medicine, and neurology. Additionally, specialty services continue on a regular basis through North Country Visiting Physicians. These include cardiology and oncology from DHMC, dermatology and nephrology from FAHC.
The Third Public Meeting
The third Public Meeting was held on Wednesday September 27, 2006, 5-6 pm, at the North Country Hospital Meeting Room. The meeting was advertised by email distribution, posters, a press release and ads in the Newport Daily Express, The Caledonian Record, and the Chronicle newspapers, as well as ads on WMOO92-FM and WIKE1470-AM radio at a cost of over $500. Refreshments were served.
Karen Weller, president of the hospital addressed those present and copies of the 2006 Act 53 Report, 2005 Community Needs Assessment, and the Hospital’s Annual Report. The following update on the progress that the hospital has made on the needs assessment priorities was distributed, as well. Three people attended.
September 2006 Update on Community Needs Assessment
In the autumn of 2004, North Country Hospital implemented a survey process and held a public forum to obtain input regarding the community’s perception of healthcare needs and resources in the North Country Hospital service area. A full description of this process and the results are available at www.nchsi.org.
In summary, the following were identified as priorities for healthcare resources in this area:
1. Primary Care
2. Emergency Care
3. Specialty Care – defined most often as dialysis, orthopaedics, oncology
This is a report on progress in these areas.
1. Primary Care
The State Resource Allocation Plan (BISHCA, October 2005) identified this area as one of four in the state with a shortage of primary care physicians. We did not need a report to tell us that!
There is an increasing national shortage of primary care physicians. A multitude of factors has led to physicians wishing to be “specialists” rather than primary care physicians. The two areas hit hardest by the shortage are inner cities and rural.
What has happened over the last year?
These are the current number of primary care physicians (all but one are Board Certified).
(6) Family Practitioners (adults and children)
(4) Internal Medicine (adults)
(2) Internal Medicine/Pediatrics (adults and children)
(3) Pediatricians (children)
(2) OB/GYN (women)
(1) General Practice (adults)
In addition, the area has eleven nurse practitioners and physician assistants who provide primary care.
Three physicians left primary care for specialties. Two stayed in the community and one moved.
One physician assistant was added.
Are we trying to change things? What’s next?
Many of our primary care physicians are not taking new patients. Waits to be seen can be very long. Our efforts are two-pronged. First, we are trying to support the physicians so their practices and hospital work can be done as quickly and thoroughly as possible. These efforts include installation of a computerized medical record. Second, we are working with the physicians to recruit new doctors to our community. Because of the shortage, recruitment is difficult, but we never give up!
2. Emergency Care
When people cannot get in to see a primary care physician, they go to the Emergency Room. Although delivering primary care is not seen as an “appropriate” use of an Emergency Department, people need to go somewhere. Our Emergency Department is the backup for area physicians.
The current staff of the Emergency Department includes four full-time physicians, two full-time nurse practitioner/physician assistants, and several part-time physicians.
What happened this year?
The current staffing is the result of a great many changes over the past year. One of the full-time physicians moved over from a family practice. This helps the Emergency Department, but does not help our primary care shortage! Another part-time emergency doctor became full-time. The mid-levels (nurse practitioner/physician assistants) are new and are working during times of highest volume.
What is next?
Our Emergency Department is now well staffed. We are in a position to monitor the changes and see if they are meeting the need of our community.
3. Specialty Care
Dialysis: The Ron Holland, MD, Community Dialysis Center opened in April 2006. Operated by FAHC, the center is currently serving 24 patients.
Orthopaedics: Christopher W. Peer, MD, a full-time orthopaedic surgeon began services here in August 2006. Dr. Peer recently completed a fellowship in sports medicine and is dedicated to caring for athletes at every level.
ENT: A full-time Ear, Nose, and Throat (ENT) specialist opened a practice in this area in 2005.
Ophthalmology: A full-time ophthalmologist joined the practice of a retiring ophthalmologist and continues providing services to these patients.
Oncology: A full-time oncologist, Leslie Lockridge, MD, will join our oncology department in November.
Nephrology: Dr. Richard Solomon, MD, Nephrology, FAHC, is medical director for the dialysis center and holds office hours weekly in Newport.
Other North Country specialty services continue to include urology, psychiatry, occupational medicine, and neurology. Additionally, specialty services continue on a regular basis through North Country Visiting Physicians. These include cardiology from DHMC, dermatology, and nephrology from FAHC.
In addition to the above public meetings, North Country Health System has widely advertised our Annual Meetings throughout the community and distributed our Annual Reports as well.
Preliminary plan for the next assessment in 2009
We are aware that there may be a change to the statutory requirement for community needs assessments that would affect our plans. Until such time, however, we plan to follow the current requirements of Act 53 of 2003 (18 V.S.A. § 9405b).
We plan to produce a “Community Needs Assessment” that describes health care related needs of the population living in our community and involves the community in our strategic planning process. We will include such quantitative information as the Vermont Department of Health can supply and as the state requires. We will collaborate with other community organizations in designing the survey instrument, collecting mailing lists, and developing new ways to foster community involvement and additional ways to publicize. Initially, we would again send a survey to mailing lists, donors, stakeholders, employees, and patients, followed by a Public Forum on Healthcare and perhaps community focus groups. Since we did have a 25% return rate of a total of 1167 mailed surveys, we would increase the number of surveys. In addition, we will continue to produce an annual “Community Report” to show community members how the hospital performs on a variety of quality, patient satisfaction, safety and financial measures.
Our best estimate of costs in 2004 for both of these items together is $21,300. This is not an overestimation, but rather an underestimation. In other words, it is likely that the cost is greater than this, but where there were uncertainties, lower estimates were listed, rather than higher estimates. Posting the reports on the website rather than printing them would lower costs slightly. Considering the low response to the very well publicized community assessment meeting and the subsequent public meetings, the community needs assessment process does not produce a significant return on investment. |
