St. Mary's Regional Medical Center
Community Health Needs
Implementation Strategy 2013-2015
St. Mary's Health System (SMHS), founded by the Sisters of Charity in 1888, is a not-for-profit Catholic health system serving central Maine. St. Mary's Regional Medical Center (SMRMC) is a 233-bed acute care facility including medical/surgical and behavioral units.
MISSION AND VALUES
Our Mission is to continue the healing ministry of the Catholic Church in the Spirit of St. Marguerite d'Youville by providing preventive, curative, restorative, and supportive services with compassion and respect for everyone.
We commit to these values as guides to our decisions and behavior:
The intentional affirmation that all human beings are gifted with life and uniqueness and deserve to be treated with dignity.
The deliberate effort toward achieving outcomes of the highest quality while striving for innovation and continual improvement.
The individualized and personalized caring and comforting offered through our holistic presence as health care providers.
The responsible and accountable use of all our human, material, and financial resources.
St. Mary's takes seriously the vision of our founding religious congregation and in the spirit of St. Marguerite d'Youville, we believe care of the poor and vulnerable to be integral to our mission. This is lived out through our commitment to the poor in our community whether it through direct services and programs, our willingness to commit financial resources beyond state mandates or designating some of our development resources to raise funds for programs to benefit the poor and vulnerable. This document provides a summary of St. Mary's implementation strategy to develop new and enhance established community benefit programs and services from 2013-2015. The plan addresses the top community health priorities identified in the community health needs assessment conducted by St. Mary's and Central Maine Medical Center in 2013.
St. Mary's service area includes most of Androscoggin County in central Maine, which is approximately 43,490 households (just over 107,000 people). According to the 2010 Census Bureau, the demographic distribution is:
- 0 to 18 years – 29%
- 18 to 64 years – 57%
- 65 years and over – 14%
- 15% of families live below the poverty level (in Lewiston the figure is 25% and for child poverty in Lewiston the figure is 41%)
- White 92.8%
- Black/African-American 3.6%*
- Other 3.6%
Language Spoken at Home
- English 85%
- Other than English 15%
*The Black/African American population in the city of Lewiston is 8.7% according to 2010 Census Bureau data.
St. Mary's Regional Medical Center is the 5th largest hospital in the state of Maine. MaineCare (a federal/state program which provides health and dental insurance assistance to people with limited resources) serves 20% of the total patient population (the highest utilization in the state), 40% are Medicare insured, 37% private pay and 3% self-pay. Lewiston is a federally designated medically underserved city.
Maine has several socio-demographic characteristics that may impact the health indicators in Androscoggin County. For example, Androscoggin County has the oldest population in the state (and Maine has one of the oldest populations in the U.S.) While being older does not necessarily equate to poor health, the reality is that aging populations use more health services than younger populations.
Maine has a lower median income than the U.S. and Androscoggin County has a higher than state average rate of people living below the federal poverty line. Unemployment rates in Androscoggin County are higher than the national benchmark and the proportion of the population with a high school diploma is lower than the state average.
COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS
St. Mary's and Central Maine Medical Center conducted a community health needs assessment in collaboration with a community stakeholders group. The data used for determining the community health needs of Androscoggin County was primarily obtained from the OneMaine Community Health Needs Assessment (CHNA) published in 2011.
The local community stakeholder group began meeting monthly in the spring of 2012 to review this data, crosswalked it to data from Healthy People 2020 health indicators, the County Rankings, the local United Way survey, the state health plan and a neighborhood survey. The identified health problems were assigned to a quadrant using a decision matrix. This matrix, based on the Precede model, focused on the importance and changeability of a given health issue. For the purpose of our assessment, the category of "importance" was related to a gap analysis-services where there were already existing resources were included in the "less important" category even though the health issue might be an identified need.
Androscoggin County community forums were held in March 2013 in Lewiston and Poland, Maine. Thirty eight community members attended, including representatives from vulnerable populations such as Tri County Mental Health Services, Advocates for Children, public health nursing, and a member of the Somali community.
Goals of the forum were:
- Share relevant, local health status
- Affirm health priorities Androscoggin County
- Gain insight to:
- Determine best means of communicating priorities
- Determine service strengths and needs
- Determine next steps
The community forum consensus affirmed the identified priorities of cardiovascular, respiratory, sexual health and mental health, substance abuse and added oncology based on community forum feedback.
PRIMARY HEALTH CONCERNS
Access to Health Care and Primary Care
While Androscoggin County has a relatively low percentage of uninsured residents, access to care is an issue. Residents of this county have the highest rates of emergency department (ED) visits in the state for overall visits and high rates of ED visits for respiratory disease. This includes ED visits for patients with symptoms and conditions that could be prevented with care provided in primary care settings. As the OneMaine Health assessment notes, the issue is complex; "it could be due in part to a maldistribution of primary care providers (PCPs), the inability of patients to be seen on a timely basis or the methods of financing primary care providers. It also reflects the inability of some populations (especially MaineCare participants and the uninsured) to locate or obtain a PCP as their usual source of care." (OneMaine Community Health Needs Assessment, p. 7, 2011.)
Behavioral Risk Factors
Behavioral health risk factors are significant issues in Androscoggin County. Smoking rates are higher than the state average (20% vs. 19% ME ) and physical inactivity rates are worse than the state average (27% vs. 23% ME.) Adult obesity levels are also higher than the state average (31% vs. 28% ME.)
Prevalence rates of medical risk factors for cardiovascular disease are concerning in Androscoggin County. Androscoggin County has the second highest prevalence of high cholesterol (34%) in the state and a higher than state average rate for high blood pressure (31% vs. 30% ME). Residents are also more likely to have heart disease (7.3% vs. 6.3% ME).
Androscoggin County has a high prevalence of respiratory disease risk factors and respiratory disease. Asthma prevalence is high (12% vs. 10% ME) as is COPD (4.3% vs. 4.2% ME). Hospital admission and ED visit rates for bronchitis, asthma, COPD and pneumonia are also higher than state averages.
Diabetes prevalence rates are high among 45-64 year olds (16% vs 13% ME). As with other counties, diabetes prevalence is associated with high rates of obesity and sedentary lifestyle.
Maine has among the highest age-adjust cancer incidence and mortality rates in the U.S. Androscoggin County has lower incidence of female breast cancer but high mortality rates for bladder cancer and females with smoking related neoplasms. The county also has high rates of cervical cancer.
Substance Abuse and Mental Health
Androscoggin County residents have the highest rates of hospital admission for most mental health conditions and substance abuse conditions, as well as the highest ED utilization rates for bipolar disorder, anxiety and acute drug related mental disorders (which could be due to both access issues to mental health services, as well as the fact that SMRMC offers a specialized behavioral emergency department.)
There are several concerning aspects for reproductive health in Androscoggin County. The teen birth rate is higher than the state average (6.9% vs. 4.1% ME) and the number of hospital admissions for high risk pregnancies is also high (499 vs. 360 ME). The infant mortality rate is 6.2% (vs. 5.5% ME).
Androscoggin County has very high rates of sexually transmitted diseases (the highest incidence of chlamydia of any county and alarmingly increasing rates of gonorrhea).
The state of Maine has a low ratio of practicing, primary care dentists to population, compared to national rates. Androscoggin County has higher rates of "no dental visit in the past two years" than the state average (27% vs. 24% ME). In addition, dental pain is the one of the most frequently cited reasons for Emergency Room visits in the state of Maine.
Logic Model & Implementation Strategy
NEEDS NOT ADDRESSED
Some needs identified through the community health needs assessment have not been addressed in this implementation strategy. In initial discussion and subsequent prioritization, St. Mary's considered the levels to which some needs were already being addressed in the service area. Additionally, some community health needs are beyond the scope of expertise and resources of St. Mary's Hospital. The following chart outlines how these needs are being addressed in the community and are therefore not part of St. Mary's prioritized strategy:
Identified Community Need
- How Need is Addressed in Androscoggin County
- The Maine Centers for Disease Control (CDC) has specific programming to address reproductive health needs
- Educational presentations were offered at the community stakeholder group to share data, resources and evidence-based treatment guidelines which both St. Mary's and Central Maine Medical Center shared with their respective providers
- Community Clinical Services offers an existing pediatric dental clinic and is planning an expansion in 2013-2014 (in partnership with St. Mary's Health System)
- The local community college is partnering with the University of New England to offer 2 year preparatory courses in dentistry to attract more local residents into dental programs (and hopefully staying in the state of Maine to practice dentistry)
- Local dentists do offer free dental clinics annually
St. Mary's Board of Directors approves this implementation strategy that has been developed to address the priorities of the 2013 Community Health Needs Assessment. St. Mary's will utilize this implementation strategy as a roadmap to collaborate with the community to address these identified health priorities.
They included: Brenda Joly*, MPH, PhD Assistant Research Professor in Health Policy and Management Program. Muskie School of Public Service, University of Southern Maine, Cynthia Rice*, Director of Community Health, Wellness and Cardiopulmonary Rehab, Central Maine Medical Center, Elizabeth Keene, VP of Mission Integration, St. Mary's Health System, Steve Johndro*, Executive Director, Healthy Androscoggin, Catherine Ryder*, Executive Director, Tri-County Mental Health Services, Ginny Andrews, Nutrition Services Program Manager, Western Maine Community Action, Becky Grant, Western Maine Community Action, Brenda Czado, Director Home Care, Androscoggin Home Care and Hospice, Cara Ouellette, Director of Outreach Services, Safe Voices, Darby Ray, Executive Director, Harwood Center at Bates College, Joan Churchill, Director of Resource Development Community Concepts, Karen White, Community Transformation Grant Coordinator, Community Concepts, Alexander Veguilla-Aponte, Wellness and Recover Services Coordinator, Tri-County Mental Health Services. (* Members of Lewiston/Auburn Public Health steering committee)