Summary of Community Needs Assessment

Click here for a complete PDF of the 2004 Community needs Assessment (2mb)

COMMUNITY NEEDS ASSESSMENT SCHEDULE
North Country Hospital’s Community Health Needs Assessment will be conducted on the following time schedule:

• Initial Assessment completed January 1, 2005
• Assessment updated January 1, 2007 (see update below)
• Next Assessment completed January 1, 2009

Description of a Community Needs Assessment
A community needs assessment is a thorough review and analysis of various factors within a specific community. The community can be defined as a geographic or political area such as a single town or county or a region that includes several towns or counties. The factors that can be considered include both the strengths, known as assets or resources, and the weaknesses or deficits of many various aspects of the community. These various aspects include but are not limited to geography, natural resources, economy, educational status, health status and lifestyle behaviors of community members, economic, educational and healthcare resources, recreational opportunities, condition of roads and buildings, housing, and other aspects. A community needs assessment can also focus on just one of these aspects, such as healthcare.

North Country Hospital Healthcare Needs Assessment
North Country Hospital, as a leading provider of healthcare to communities in Orleans County and the northern part of Essex County, conducted a healthcare needs assessment of the communities it serves during the autumn of 2004. The purpose of the assessment is to help communities identify healthcare needs, establish priorities based on these identified needs, and establish priorities around the resources required to meet these needs. The assessment is summarized below and complete details are available in the North Country Hospital Community Assessment Report.

Methodology
As part of its community assessment process and in order to obtain input from various sectors of the communities it serves, North Country Hospital implemented two strategies to obtain input from community members and leaders from throughout its service area. The first is a survey that was mailed to over 1100 residents from towns throughout the hospital’s service area. Over 286 responses were received for a response rate of about 25%. The second is a Public Forum on Healthcare Needs that was held on November 1, 2004 in Newport.

Data Sources
The North Country Hospital Community Assessment Report consists of both quantitative and qualitative components. In addition to the quantitative and qualitative data obtained through the survey and public forum, the quantitative component includes many measures related to the health status and health behaviors of residents living in communities served by the hospital. It also includes data regarding the utilization of some North Country Hospital services. The Vermont Department of Health made this information available for this report in conjunction with the Vermont Association of Hospitals and Health Systems. These measures help community members identify healthcare needs and set priorities to meet these needs.

Process for Collaborating with Community Leaders
North Country Hospital recognizes the importance of working with community members and leaders that represent various sectors of the community in establishing priorities and in identifying organizations and agencies that can best meet the identified healthcare needs. In view of this, North Country Hospital has extensive experience in being an active participant, facilitator or collaborator with at least twelve community-wide partnerships and groups that focus on a variety of community needs – health, education, economic, social, environmental – in the Orleans and northern Essex area. These partnerships are identified in the Methodology Section of the North Country Hospital Community Assessment Report.

Mechanisms for Obtaining Ongoing Public Comment
North Country Hospital has a number of mechanisms in place to receive comments and input from community members regarding healthcare needs, healthcare resources and priorities. These mechanisms will continue and include at least the following:

• North Country Hospital’s current participation and collaboration in at least twelve community-wide partnerships and groups that focus on a variety of community needs – health, education, economic, social, environmental – just to name a few. As noted above, these partnerships are listed in Methodology Section of the North Country Hospital Community Assessment Report. 
• North Country Hospital’s staff – We are a small community. About 500 people work here either full or part time. Another 60 people are hospital volunteers. Comments from family and friends are continuously brought to our attention.
• Results of patient satisfaction surveys, both inpatient and outpatient
• A staff member who focuses half time on receiving, communicating, and resolving patient concerns
• An annual public meeting to share and discuss comments on healthcare needs such as the Public Forum held on November 1, 2004

Public Meeting Held for the Purpose of Community Comment
North Country Hospital held a Public Forum on Healthcare Needs on November 1, 2004 at the Gateway Center in Newport, VT.
Notices about the meeting were distributed in the following manner:

• The general public was invited via newspaper ads that ran in two local papers and via radio ads on two local stations.
• Invitations were sent electronically to all members of a number of currently established groups and partnerships in the North Country Hospital service area as previously described.
• Invitations were sent electronically to local health care leaders and local legislators.
• Invitations were sent electronically to North Country providers and employees via the hospital’s intranet system. 

A total of 25 persons attended the Public Forum. These 25 persons are best described as follows:

• Local legislators and others running for public office
• Local partnership representatives
• Local healthcare agency representatives
• Healthcare providers
• Other community members

A series of discussions focused on the following:

• The survey and its results
• Identification of the five most important healthcare services for the North Country Hospital service area
• Identification of the healthcare services in the North Country area that are realistically easiest to start changing for improvement, given the area’s current assets, resources and challenges.

The results of these discussions demonstrate that there are many diverse interests in healthcare needs and issues that are brought to the table by as few as 25 community members. It is also important to note from these discussions that healthcare services identified by community members as being the most important or requiring the most improvement are not necessarily those that they can agree on as being the easiest to begin changing, considering all the factors. Nevertheless, it is extremely important overall to help make communities aware of these similarities and differences. Raising awareness and helping to educate interested community members is one of the first steps in producing change – whether that change occurs in healthcare services, individual health behaviors, or any other facet of the community.

Priorities for Healthcare Improvement in the North Country Hospital Service Area
Through the survey process, respondents identified local healthcare services that are priorities for improvement. The top four priorities, according to survey respondents, are:

• Specialty services (such as seeing a heart or cancer specialist)
• Mental health and substance abuse services
• Home care services
• Nursing home services

Participants of the Public Forum held on November 1 also identified priorities for improvement. These participants identified the following as being the healthcare services that are the easiest to begin changing based on what is realistic for the area given the area’s current assets, resources and challenges:

• School health services
• End of life /home care services
• Emergency care services

Priorities for Healthcare Resources in the North Country Hospital Service Area
Survey respondents also clearly identified three healthcare services that they perceive as most important for the North Country Hospital service area. These are

• Primary care
• Emergency care
• Specialty care (defined briefly as seeing a heart or cancer specialist)

Participants of the Public Forum identified five most important healthcare services for the North Country communities. They are:

• Specialty services, defined as dialysis, orthopedics, oncology
• Preventive care/health education
• Case management/coordination
• Urgent care services, defined as a walk-in clinic
• Mental health/substance abuse services 

Update on Community Needs Assessment - September 2006

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 R. Ronald Holland Community Dialysis Center opened in April 2006. We are 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.

A full-time Ear, Nose, and Throat (ENT) specialist opened a practice in this area in 2005.

A full-time ophthalmologist joined the practice of a retiring ophthalmologist and continues providing services to these patients.

A full-time oncologist will join our oncology department in November.

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 Dartmouth, dermatology, and nephrology from Fletcher Allen.

Further information about North Country’s survey and Public Forum is available in the North Country Hospital Community Assessment Report. 

How to Obtain a Copy of the North Country Hospital Community Assessment Report
A complete copy of the North Country Hospital Community Assessment Report is available from the North Country Hospital Administrative Office by calling 334-3202 or by writing to North Country Hospital, Administration Department, 189 Prouty Drive, Newport, VT 05855, FAX 802.334.3240; or visit our website at www.nchsi.org.