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2012 Community Health Needs Assessment

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the U.S. Census Bureau, 11% of the adult population was in poverty between 2005 and 2009, while 15% of children were below the poverty level in the same time period. Percent of diabetic Medicare enrollees in the parish that receive HbA1c screenings is at 77% compared to the national benchmark of 89%.2

According to the 2011 County Health Rankings, Ascension Parish ranks 10 out of Louisiana’s 64 parishes. Louisiana ranks 49th in the nation.

Selected 2011 County Health RankingsArea Rank (Out of Louisiana’s 64 Parishes)Mortality 7Morbidity 13Health Behaviors 7Clinical Care 10Social and Economic Factors 3Physical Environment 64

St. Elizabeth Hospital’s service area has various designations according to the Department of Health and Hospitals/Bureau of Primary Care and Rural Health as a Health Professional Shortage Area (HPSA). Currently Ascension Parish is designated as HPSA in mental and dental care.

The CHNA conclusions were based in part on information related to the Catholic Healthcare West and Thomson Reuters Community Needs Index (CNI) of areas served by St. Elizabeth Hospital.

The intent of the assessment is to use the information gathered to plan for community healthcare that is responsive to the residents’ needs. The criteria that St. Elizabeth Hospital (STEH) utilized to prioritize the CHNA identified needs included: feedback from key community stakeholder surveys and interviews, examination of research data, the numbers of persons affected, the seriousness of the issue, whether the health need particularly affected persons living in poverty or reflected

Description of Community Served

St. Elizabeth Hospital (STEH) is located in Ascension Parish in Region 2 of Southeast Louisiana. St. Elizabeth Hospital‘s Community Health Needs Assessment (CHNA) service area primarily includes the residents of Ascension Parish. 1

The decision to select Ascension Parish as the CHNA service area is supported by the fact that 85% of Patients served by STEH are from within Ascension Parish. Based on quantitative and qualitative findings resulting from the CHNA process, diabetes, heart disease, access to healthcare for the uninsured/underinsured and aging and adult services have been identified as the hospital’s community health needs priorities.

The total 2010 population of Ascension Parish was 107,215, and is currently the fastest growing Parish in the state. The growth of the parish is largely explained by the public school system which is ranked as one of the best in the state.

Ascension Parish once had a largely agrarian economy, but in the past 25 years, has an increasingly diversified economy including the chemical, petroleum, telecommunications, and hospitality industries. The parish is dichotomous in nature. Residents of the northern portions are relatively younger and more affluent while residents of the southern portions tend to be less affluent.

Health statistics collected indicate residents of the service area suffer higher rates of stroke, obesity, cancer, and hypertension; have higher than average incidence of smoking; and lack comprehensive services for the geriatric population, access to recreational facilities, and access to transportation. The community also has teen birth rates higher than the nation as a whole. Data on behavioral risk factors indicate that parish residents are at a disadvantage when compared to the state as a whole. Residents rank higher for morbidity than the national average with 20% reporting being in poor or fair health.2

In addition, 24% of residents do not have health insurance. According to 1 Business Resource & Market Factbook, Spring 2011

2 County Health Rankings, 2011

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health disparities, and whether or not community resources are available to address the need. Members of the STEH Senior Leadership Team met to discuss the ranking strategy. Discussion of the prioritization and implementation strategy was shared with other key stakeholders in the community for their input.

Health Assessment Program Partners

STEH consulted with other Franciscan Missionaries of Our Lady Health System facilities and local organizations, including Our Lady of the Lake Regional Medical Center, St. Francis Medical Center, Our Lady of Lourdes, Assumption Hospital, and FMOLHS Senior Services Division. STEH engaged the Ascension Parish Health Unit as well as St. Elizabeth Hospital’s Community Health Clinic in the development of this CHNA. The hospital worked with Robert-Rose Consulting, LLC (RRC) [http://robertroseconsulting.com/contact-us/]. RRC is a full-service consulting firm in Baton Rouge, Louisiana offering an extensive range of business solutions in the areas related to healthcare, government, education and community development. RRC staff provided expertise and knowledge in developing survey questions, interviewing key stakeholders and gathering community demographic information.

Most of the work done in this CHNA was through research of current health statistics and trends, surveys of community members, healthcare providers and interviews with community partners. STEH received input from persons with special knowledge or expertise in health issues and from key stakeholders in the community. The indicated goal of completing a comprehensive community health needs assessment took a three-pronged approach. The first prong involved a survey of community members. The second prong of the community needs assessment involved a survey of healthcare providers practicing in the area. The third and final prong of the community needs assessment which occurred in the fall of 2012 included interviews with other types of providers, such as education and social service providers. In preparing this CHNA, the following sources, with special knowledge or expertise in healthcare, provided significant guidance and information. On review of the data of the CHNA, STEH did

not identify any information gaps.

Individuals/Organizations Surveyed/InterviewedIndividual/Organization Area(s) of

Expertise*Comments

Kenny MatassaDirector, Ascension Parish Health Unit

1,2,3

Mr. Matassa is the current Director of the Ascension Parish Health Unit. He also serves as regional Parish Councilman. He has many years of experience in public health and is a leader in many community activities, including mental health. He also has many years experience in providing public health services for low income minority group community members.

Kristin MartinNurse Practitioner, St. Elizabeth Hospital Community Clinic

Karen AllenPresident and CEO, FMOLHS Senior Services

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Allen has served as President and CEO of the Senior Services Division at FMOLHS, including nursing homes for the underserved and Programs for All Inclusive Care for Elders (PACE). She has many years of experience in managing services for low income community members.

Tracie IngramProgram Manager, Health Systems Development Bureau of Primary Care and Rural Health, La Department of Health and Hospitals

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Gerrelda DavisDirector, Bureau of Primary Care and Rural Health, La Department of Health and Hospitals Office of Public Health

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Martha LeBlanc and Laurinda Calongne Robert Rose Consulting

James D’Antoni, MD Medical Director, St. Elizabeth Hospital Community Clinic, St. Elizabeth Physicians

Jon HirschMarketing Director, St. Elizabeth Hospital

Chad Freeman Strategic Marketing Research

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Individuals/Organizations Surveyed/InterviewedIndividual/Organization Area(s) of

Expertise*Comments

Fernando Gutierrez Pastor, Healing Place Church, Spanish Campus

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Pastor Gutierrez is the chief Pastor for the Spanish campus of Healing Place Church. He has many years of experience working with minority low income under-served population. His congregation consists of many low income minority community members.

Wilfredo Garcia Pastor, Iglesia Centro De Vida 3

Pastor Wilfredo Garcia is the chief Pastor of a large Hispanic church in Ascension Parish that provide services for minorities, low income medically under-served.

Pete Guarisco VP of Mission Integration, FMOLHS

Pam McMahon, PhD, MPH

Kathleen S. BaudeanDiabetes Clinic Coordinator, St. Elizabeth Physicians

Victor VidaurreAssistant VP of Mission Integration, St. Elizabeth Hospital

* 1 Has special knowledge or expertise in public health. 2 A federal, tribal, regional, state, or local health or other departments or agencies with data relevant to the health needs of the community. 3 A leader, representative, or member of the medically under-served, low-income or minority group within the community or population with chronic diseases.

Statistical Research Sources

Centers for Disease Control and Prevention (CDC)Ascension Parish School BoardAscension Parish Sheriff’s OfficeCapital Area Human Service DistrictCounty Health Rankings, 2011 (Louisiana)Ascension Council on AgingSt. Theresa of Avila Catholic Church Financial Assistance and Food BankThomson-ReutersThe United Way of the Capital AreaUnited States Census BureauUnited Health Foundation - America’s Health Rankings

Community Health Needs Assessment Planning Committee

The Community Health Needs Assessment Planning Committee reviewed reports of current health statistics trending reports, surveys of community members, healthcare providers and interviews with community partners. STEH received input from persons with special knowledge or expertise in health and key stakeholders in the community. Members of the STEH Senior Leadership Team discussed the CHNA outcomes and prioritized the findings utilizing: feedback from key community stakeholder surveys and interviews, examination of research data, the numbers of persons affected, the seriousness of the issue, whether the health need particularly affected persons living in poverty or reflected health disparities, and whether or not community resources are available to address the need. Discussion of the prioritization and implementation strategy was shared with other key stakeholders in the community for their input. STEH consulted with members of the FMOLHS Mission and Vision Performance Improvement Team (MVPIT). The recommended priorities were approved by the STEH Senior Leadership Team, President and CEO, and endorsed by the STEH Board of Directors and the FMOLHS Senior Leadership Team. The result was that four of the many community needs which surfaced during the CHNA process were deemed to be priority needs. They are, equally weighted:

• Aging and Adult Services• Diabetes• Heart Disease• Access to Healthcare

St. Elizabeth Hospital Senior Leadership Team

Robert Burgess, President and CEOSue Knight, Chief Operating OfficerLeslie Norman, Chief Nursing OfficerScott Richard, Chief Financial OfficerJill Lee, VP of Ancillary Services and Business DevelopmentCraig Vitrano, VP of Medical AffairsCaroline Conerly, Assistant VP of QualityVictor Vidaurre, Assistant VP of Mission Integration

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CHNA Planning Committee

James D’Antoni, MD, Medical Director, St. Elizabeth Hospital Community Clinic, St. Elizabeth PhysiciansKathy Edmonston, Parent Facilitator, LeBlanc Special Services Pete Guarisco, VP of Mission Integration, FMOLHSTy Gautreau, Nurse PractitionerJason Jobes, Director of Performance Excellence, St. Elizabeth HospitalMartha LeBlanc, Robert-Rose Grant Coordinator, Our Lady of the Lake Regional Medical CenterApril Madere, Nurse Practitioner, River Regions Cancer Center Kristin Martin, Nurse Practitioner, St. Elizabeth Hospital Community ClinicKenny Matassa, Director, Ascension Parish Health Unit and Gonzales City CouncilmanGina Melancon, RN Care Manager, Total Health ProgramShannon Simpson, Director of Information Services, St. Elizabeth Hospital Beverly Sonnier-Plaisance, Director of Accounting, St. Elizabeth Hospital Victor Vidaurre, Assistant VP of Mission Integration, St. Elizabeth Hospital Craig Vitrano, Chief Medical and Strategy Officer, St. Elizabeth Hospital

Selected Community Benefit Priorities and Why They Were Selected

Aging and Adult ServicesQuantitative Evidence

On January 1, 2011, baby boomers began to celebrating their 65th birthdays. 10,000 people are turning 65 every day. This turnover will continue virtually every day for two decades.

In Louisiana, the percentage of residents aged 65 and older grew 10.5% between 1999 and 2009, and the percent living below poverty in 2009 was estimated to be 12.4%.

Ascension Parish’s average percentage of households below the poverty line, with head of household age 65 or more is 17%.

The percentage of persons aged 65 and older living in Ascension Parish was 9% according to the 2010 census.

CHNA data indicated life expectancy in Ascension Parish is 75.0 years, compared to peer counties of 76.5 years.

In 2008 Ascension Parish Medicare beneficiaries (Age 65+) numbered 8,054.

Qualitative Evidence

By 2030, the number of people over the age of 65 will double to 70 million.

The number of seniors over the age of 100 will increase six-fold to 381,000.

The major issues disclosed by Ascension Parish respondents included limited financial resources, abuse and neglect, and lack of transportation.

Hospital Strengths

STEH is the major acute health care provider in Ascension Parish. Senior services is a strategic focus for STEH and FMOLHS.

Alignment with Local, Regional, State or National Health Goals

• FMOLHS Senior Services Division • Nursing Improvement Care for Health System Elders (NICHE) program.• Acadian Ambulance Telehealth Monitoring

Other Justifications

In 2005, over half of those over the age of 65 in the USA lived at or below 300 percent of the poverty line.

Since last year, in Ascension Parish there has been an overall 4.4 percent increase in the number of eligible people joining the Medicaid rolls.

DiabetesQuantitative Evidence

2011 County Health Rankings (CHR) similarly estimates the percentage to be 12% for Louisiana and 9.0% for Ascension Parish.

Diabetics death rate per 100,000 population in Ascension Parish is 31 compare to national rate of 22.

Percent of STEP patients with diagnosis of diabetes 10.3%

The CHR data also indicates that 77% of diabetic Medicare patients in Ascension Parish were screened with a follow up glycated hemoglobin (HbA1c) level in the past year. This is below the national benchmark of 89%.

The Louisiana Department of Health and Hospitals data indicates the adjusted mortality rate associated with diabetes to be 30.8 for Ascension Parish, 37.9 for Louisiana, and 22.4 for the United States.

Qualitative Evidence

Diabetes, hypertension and obesity are the top chronic patient diagnosis at the STEH community clinic.

CHNA survey/interview results identified diabetes as a top concern.

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Hospital Strengths

STEH maintains and promotes a diabetic education program.

St. Elizabeth Hospital Community Clinic provides diabetic education to low income residents of the community.

Alignment with Local, Regional, State or National Health Goals

St. Elizabeth Physicians Diabetic Management Program

Other Justifications

Among U.S.. residents aged 65 years and older, 10.9 million, or 26.9%, had diabetes in 2010.

In 2008, Louisiana had the 2nd highest diabetes death rates in the nation and diabetes was the cause of 1,332 deaths.

In 2010, the total cost of hospital discharges for people with diabetes in Louisiana was approximately $231,000,000 dollars (LAHIDD).

Diabetes is a major cause of heart disease and stroke.

Heart DiseaseQuantitative Evidence

Louisiana ranked 45th in the country for deaths resulting from cardiovascular disease.

Heart disease is one of the leading causes of death in Ascension Parish for community members ages 25-65 and older.

23% of Ascension Parish residents suffer from high blood pressure.

20.3% of parish residents suffer from obesity.

14.3% of providers surveyed considered education of proper diet and exercise an important community healthcare need.

Qualitative Evidence

Louisiana ranked 45th in the nation for cardiovascular disease related deaths.

Heart disease and cancer are the major sources of death for residents of Ascension Parish ages 45-65.

Ascension Parish ranked as “unfavorable” in cardiovascular disease compared to peer counties.

Cardiology service (heart disease) was identified as a need on the CHNA survey/interviews.

Hospital Strengths

STEH is the major acute health care provider in Ascension Parish.

St. Elizabeth Physicians practice is the largest practice in Ascension Parish.

STEH Community Clinic provides access to primary care for heart related issues.

Alignment with Local, Regional, State or National Health Goals

• Ascension Parish Health Unit • American Heart Association • Our Lady of the Lake Regional Medical Center

Uninsured/Under-Insured Access to Health CareQuantitative Evidence

Twenty-six percent of the population under age 65 in Louisiana is without health insurance.

Ascension Parish has a 24% uninsured rate compared to the national rate of 13%.

Individuals living below the poverty level in 2009: Ascension : 11.2% Louisiana : 17.6% USA: 14.3%

Ascension Parish children living in poverty in 2012: 19% Louisiana children living in poverty in 2012: 27% National benchmark for children living in poverty in 2012: 13%

Percent of adults in Ascension Parish without social/emotional support: 20.0%

Qualitative Evidence

CNI data indicated that three out of seven zip codes in Ascension Parish had an insurance rank score of 4.0 or greater (5.0 being the area with most needs).

Hospital Strengths

STEH is a member of the Franciscan Missionaries of Our Lady Health System.

STEH is the major acute health care provider in Ascension Parish.

St. Elizabeth Physicians practice is the largest practice in Ascension Parish.

STEH Community Clinic provides access to primary care for health related issues.

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Alignment with Local, Regional, State or National Health Goals

• Ascension Parish Health Unit • Capital City Family Health Center• St. Gabriel Health Clinic, Inc.• St. Elizabeth Hospital Community Clinic• Capital Area Human Services

Other Justifications

Vulnerable Populations of Ascension Parish include people who: • Have no high school diploma (among adults age 25 and older): 12,796• Are unemployed: 2,087• Are severely work disabled: 2,918• Have major depression: 5,968• Are recent drug users (within the past month): 6,668

Louisiana has the highest incarceration rate in the nation.

Community Benefit Activities That Support Key Identified Health Needs

Condition/Issue Classification Name of Program/Description of Service

Key Partner

Cancer

Age-adjusted death rate from breast cancer (female)

Wellness and Education Cancer awarenessOn-going education programsBreast Cancer Support GroupSusan G. Komen yearly awareness monthSt. Elizabeth Hospital Women’s Health Center

Mary Bird Perkins Cancer CenterAmerican Cancer SocietySt. Gabriel Cancer Center

Age-adjusted death rate from colon cancer

Wellness and Education St. Elizabeth Hospital Health Fair- free screening for colon cancerSt. Elizabeth Hospital colon cancer on-going community education seminarsNational Cancer Awareness Month

Mary Bird Perkins Cancer CenterSt. Gabriel Cancer Center

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Condition/Issue Classification Name of Program/Description of Service

Key Partner

Obesity

Percentage of Service Area Adults: 31.0% Benchmark: 25%

Wellness and Education St. Elizabeth Hospital Health Fair: Free annual weight management (BMI) screeningsSt. Elizabeth Hospital community on-going education on healthy lifestyles and healthy choicesIntroduction of a school-based garden to improve access to fresh fruits and vegetables to children

Franciscan Missionaries of Our Lady Health System Healthy Choices DivisionAscension Parish Health UnitSt. Elizabeth PhysiciansFranciscan Missionaries of Our Lady Health System Mission and Values Performance Improvement Team

Other Identified Health Needs Which Were Not Selected as a Priority NeedCondition/Issue

Classification Name of Program/Description of Service

Existing Healthcare Facilities and Resources

Low Infant Birth Weight

Wellness and Prevention

Low birth weight — Percent of live births with low birth weight (< 2500 grams): Ascension Parish, 8.9%; national, 6.0%

Teen birth rate per 1,000 females ages 15-19: Ascension Parish, 47; national, 22

Ascension Parish Health Unit OB/Gyn Physicians in Ascension Parish

Respiratory Diseases Including Asthma

Wellness and Prevention

Respiratory related conditions, Asthma, Allergies and Chronic Obstructive Pulomary Disease were identified during the survey as healthcare needs in the community.

Chronic Respiratory Diseases: Mortality rate in Ascension Parish, 36; Louisiana, 41

St. Elizabeth PhysiciansSt. Elizabeth Hospital

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Condition/Issue

Classification Name of Program/Description of Service

Existing Healthcare Facilities and Resources

Mental Health (Including drug and alcohol abuse)

Access to Care

Poor mental health days — Average number of mentally unhealthy days reported in the past 30 days (age-adjusted): Ascension Parish, 3.2;Louisiana, 3.1; national, 2.3

Lack of access to mental health providers or specialists was identified during the survey as healthcare needs in the community.

Gonzales Mental Health UnitCapital Area Human Services DistrictSt. Elizabeth Physicians

Physical Environment Quality of Life

Air pollution-particulate matter days — Annual number of unhealthy air quality days due to fine particulate matter: Ascension Parish, average 21; Louisiana, 4

Parish of Ascension GovernmentLouisiana State Department of Environmental Quality

Transportation Services Quality of Life The lack of transportation was mentioned frequently as

a need in the community to access health care services.

Conclusion

The issues identified through the CHNA process have a negative impact on the health and wellness of the people of Ascension. The CHNA identifies four priority needs of the community that St. Elizabeth Hospital serves, and we have chosen to place our primary focus on all four needs as detailed in our Implmentation Strategy Document. The four needs are:Aging and Adult Services, Diabetes, Heart Disease, and Uninsured/Underinsured Access to Health Care. In addressing these four priority needs, special priority will be placed upon building existing programs such as the St. Elizabeth Hospital Community Clinic that provides primary care for the uninsured, and working with community partners to reach out to lower-income, disadvantaged populations with a high CNI. Additionally, we will continue to address other identified needs by assisting community partners with their endeavors related to these issues.

ResourcesCenters for Disease Control and Prevention (CDC) http://www.cdc.gov/CDCBehavioral Risk Factor Surveillance System (BRFSS), 2009www.cdc.gov/brfss Capital Area Human Service Districthttp://cahsd.org/County Health Rankings, 2011 (Louisiana)http://www.countyhealthrankings.org/2010 Thomson Reuters (Healthcare) Inc.http://thomsonreuters.com/United States Census Bureauhttp://www.census.gov/United Health Foundation America’s Health Rankingshttp://www.americashealthrankings.org/La Dept. Health & Human Services http://new.dhh.louisiana.gov/Community Health Status Indicatorshttp://communityhealth.hhs.gov/homepage

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Our Mission

Inspired by the vision of St. Francis of Assisi, and

in the tradition of the Roman Catholic Church,

we extend the healing ministry of Jesus Christ

to God’s people, especially those most in need.

We call forth all who serve in this healthcare ministry

to share their gifts and talents to create a spirit of

healing – with reverence and love for all of life, with

joyfulness of spirit, and with humility and justice for

all those entrusted to our care.

We are, with God’s help, a healing and spiritual

presence for each other and the communities we are

privileged to serve.

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Our Vision

To make a significant difference in the communities

that we serve.

Our Values

ServiceThe privilege of reaching out to meet the needs of others.

Reverence and Love for All of LifeAcknowledging that all of a life is a gift from God.

Joyfulness of SpiritAn awareness of being blessed by God in all things.

HumilityBeing authentic in serving as an instrument of God.

JusticeStriving for equity and fairness in all relationships with special concern for those most in need.

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225.647.5000 | www.steh.com1125 West Highway 30 | Gonzales, Louisiana 70737