1

University of Minnesota Medical Center Community Health Needs Assessment (CHNA) Implementation Plan

University of Minnesota Medical Center, Fairview and University of Minnesota Amplatz Children’s

Hospital provide world class, state-of-the-art patient care. The medical center was ranked as the top

hospital in the Twin Cities metro area by U.S. News & World Report in 2012. Together, the medical

center and children’s hospital have 1,600 licensed beds, employ nearly 7,000 people and serve hundreds

of thousands of patients each year. Areas of specialization include organ and blood and marrow

transplantation, heart disease care and prevention, cancer care, the neurosciences and behavioral health.

The medical center and hospital were created in 1997 as a result of a merger between University of

Minnesota Hospital and Clinic and Fairview Health Services. As a division of Fairview, they’re part of a

statewide network of hospitals, primary care and specialty care clinics, home care and hospice services,

pharmacies, senior housing and long-term care facilities.

This implementation plan summarizes the process to date and priorities established for University of

Minnesota Medical Center, Fairview to sustain and develop community benefit programs that 1) address

prioritized needs from the 2012 Community Health Needs Assessment (CHNA) conducted by the medical

center’s CHNA Steering Committee with assistance from Fairview Health Services Community Health

Department and 2) respond to additional identified community health needs.

Target Areas and Populations Fairview Health Services identified the community and assessment area as the population within the zip

codes that comprise the Primary Service Area for University of Minnesota Medical Center, Fairview. The

entire population within this area is included in the assessment; we did not limit our assessment to only

Fairview patients. See appendix A for a map of the assessment area.

How the Implementation Strategy was Developed The medical center’s implementation strategy was developed based on the findings and priorities

established by its CHNA Steering Committee.

University of Minnesota Medical Center, Fairview, along with Fairview Community Health, provided

leadership for the 2012 CHNA. The medical center reached out to members of the community in the

fourth quarter of 2011, asking a diverse group of community leaders to represent the community by

becoming a member of the CHNA Steering Committee. The following are members of that Steering

Committee:

Tom Clancy, University of Minnesota School of Nursing

Diane Cross, Board Member, University of Minnesota Medical Center, Fairview

Connie Delaney, University of Minnesota School of Nursing, and Board Member,

University of Minnesota Medical Center, Fairview

Sandra Eliason, M.D., Fairview Clinics

Ann Ellison, Director, Fairview Community Health

Mohammed Hassan, M.D., University of Minnesota Physicians

Carrie Link, MD University of Minnesota Department of Family Medicine and

Community Health

Donna McAlpine, University of Minnesota School of Public Health

Gretchen Musicant, Commissioner, Minneapolis Department of Health and Family Support

Sahra Noor, Director, Department of Community Health, University of Minnesota

Medical Center, Fairview

2

Marge Page, Vice President, University of Minnesota Medical Center, Fairview

Hiba Sharif, Department of Community Health, University of Minnesota Medical Center,

Fairview

Carolyn Wilson, President, University of Minnesota Medical Center, Fairview

Major Needs and How Priorities Were Established Both qualitative and quantitative data was gathered in the assessment process. The qualitative data

included:

Focus groups of three populations (mothers, seniors, vulnerable)

Web surveys

Key stakeholder interviews with elected officials, community leaders, physicians and members of

community-based agencies.

Quantitative data included:

Mortality data

Hospital utilization data

Emergency room data

Community Need Index (CNI) scores which are based on underlying socio-economic indicators

of health. Causation has been shown between high CNI scores and inappropriate emergency

room admission for ambulatory sensitive conditions. See appendix B for a map of CNI scores for

the assessment area.

The assessment resulted in a number of themes. The themes identify specifically what University of

Minnesota Medical Center, Fairview community members need to maintain or improve their health

and/or specific medical conditions that require attention. The six top themes that emerged are:

Health information and education

Mental health

Diabetes

Low birth weight/infant mortality

Heart disease

Cultural competency

These six themes were discussed by the Steering Committee members and then prioritized using a Need

Prioritization Worksheet and Criteria, see appendix C. As a result of the discussion, the group reclassified

both “healthcare information and education” and “cultural competency” to be used as strategies

throughout all action planning rather than as individual action items. The prioritization, by the Steering

Committee, resulted in the following top health needs for the community:

1. Mental health

2. Heart disease

A review of current community benefit programs found that the medical center is meeting existing

community needs through provision of charity care, Medicaid services, health professional education

programs, as well as participation in the Health Commons, the Healthy Kids & Communities initiative

and numerous community education and health events. These activities were determined to be valuable

priorities for the medical center’s implementation strategy.

3

Description of What University of Minnesota Medical Center, Fairview Will Do to Address

Community Needs The University of Minnesota Medical Center, Fairview CHNA Steering Team has identified specific

initiatives to address these top community health needs. Significant consideration was given to those

opportunities that align priority needs with research opportunities of the University of Minnesota

Academic Health Center.

Mental Health Action Plan

The medical center will collaborate with University of Minnesota researchers and the University of

Minnesota Department of Psychiatry to create a community-based educational campaign to raise

awareness regarding mental health, particularly early identification of symptoms and links to community

and clinical resources to improve the mental health of the communities we serve. We will use data and

research findings from studies conducted by researchers from the University of Minnesota’s Academic

Health Center to develop a culturally inclusive curriculum in partnership with the community. Training

will be provided to neighborhoods with high community needs index scores. It will be delivered in school

settings, through faith based organizations and at Health Commons—a drop-in health and wellness center

that serves low-income, immigrant populations in the Cedar Riverside neighborhood.

Hennepin County has identified mental health as a top priority for county residents through its 2012

community health assessment. The medical center will collaborate with Hennepin County and participate

in its Community Health Improvement workgroups to address mental health needs through education and

community-connected initiatives being developed by the City of Minneapolis and Hennepin County.

Heart Disease Action Plan

The medical center will continue community-based initiatives around access to healthy foods and

physical activity programming currently under way at Health Commons in collaboration with the medical

center’s Dietetic Internship program and University of Minnesota’s Extension Services with funding from

the UCare Fund. These initiatives are focused around the development of community gardens, nutrition

education and cooking classes and the establishment of farmers markets that can be accessed by

employees and community members.

The medical center will identify additional opportunities to align with research initiatives at the Academic

Health Center that focus on prevention and treatment of heart disease and will work with University of

Minnesota Physicians Cardiovascular Service Line to identify clinical initiatives that align and address

the identified community needs. University of Minnesota Medical Center, Fairview also will explore

opportunities to partner with the City of Minneapolis Public Health Department in its Healthy Corner

Store Initiative which promotes access to fruits and vegetables by redesigning convenience stores in high

CNI score neighborhoods.

Other Community Needs

While not identified as one of the community’s top two health needs, health information and education is

something that the medical center sees as a priority. The CHNA data related to health information and

education will be communicated across the organization. Efforts will be made to increase and improve all

aspects of health information and education that is provided broadly to the community.

4

Next Steps for Priorities For each of the priority areas listed above, the medical center will work with the CHNA Steering

Committee and community partners to:

Identify any related activities being conducted by others in the community that could be built

upon.

Develop measurable goals and objectives to evaluate the effectiveness of the any interventions.

Build support within the community for the identified initiatives.

Develop detailed work plans.

Priority Needs Not Being Addressed and the Reasons

The needs of our community are many and diverse. To provide focus, the priority areas were

selected where the medical center, with its partners at University of Minnesota Physicians and

University of Minnesota, can have the greatest impact due to our particular strengths and

expertise.

Resources The work of the action plans will be supported by a 1.8 dedicated community health staff and $73,000 for

programming.

Approval Each year, University of Minnesota Medical Center, Fairview’s Board will review the prior fiscal year’s

Community Benefit Report and approve the Community Benefit Implementation Strategy for addressing

priorities identified in the most recent Community Assessment and other plans for community benefit.

This report was prepared for the Nov. 9, 2012 meeting of the Patient Care Committee of the Board and

was approved at that meeting.

Appendices

A. Primary Service Area Map

B. Community Need Index (CNI) Score Map

C. Need Prioritization Worksheet and Criteria

D. Definition of Community – Zip Codes by Hospital PSA

E. Qualitative Data Tools and Questions

F. Top Ten Health Conditions by Population and Hospital

Appendix A: Primary Service Area Map

University of Minnesota Medical Center, Fairview/

University of Minnesota Amplatz Children’s Hospital

Primary Service Area

Appendix B: Community Need Index (CNI) Score Map

University of Minnesota Medical Center, Fairview/

University of Minnesota Amplatz Children’s Hospital

CNI Scores

Need Prioritization Worksheet

Criterion and Considerations Guide

Criteria #1: Is the need health related?

Considerations:

To what degree is the need health related?

Criteria #2: Is the need tied to Community Need Index (CNI) scores or similar measure of vulnerability?

Considerations:

To what degree is the need tied to CNI scores or other measure such as the percentage of school Free and

Reduced Lunch (FRL) participants (e.g. A community may have a low CNI score, but a school within that

community may have a high percentage of students who qualify for FRL).

The Community Need Index (CNI) Scores were developed by Catholic Healthcare West and Thompson Reuters.

Their underlying data is used to create an objective measure of socio-economic barriers to health care access

among populations and their effect on hospital admissions. CNI Scores range from a 5 (highest health

disparity/highest community need) to a 1 (lowest health disparity/lowest community need). CNI Scores provide a

high-level measure of community need and allow for comprehensive comparative analysis to be made on many

levels ranging from individual zip code comparison to regional or multi-state comparisons.

Criteria #3: Is the need tied to assessment or otherwise documented?

Considerations:

To what degree is the need tied to assessment (i.e. where did the need fall on your list of priorities)?

Are there contributing factors that may indicate the need for more immediate intervention (i.e. the need may fall

lower on the assessment, but there are additional considerations that make it a higher priority)?

Criteria #4: What is the magnitude of the need?

Considerations:

How many persons does the need affect, either actually or potentially?

Criteria #5: What is the seriousness of the consequences?

Considerations:

What degree of disability or premature death occurs?

What are the potential burdens to your community such as economic or social burdens?

What happens if we don’t respond?

Criteria #6: What is the feasibility of addressing?

Considerations:

Is it amenable to intervention? Is the problem preventable?

Are there scientifically feasible (evidence-based) interventions available?

Is intervention acceptable to the community (i.e. are there economic, social, cultural or political issues that may

influence the communities ability to address the health need)?

Does intervention have the potential to produce measurable outcomes?

Are there adequate technology, knowledge, human and financlal resources to effect change?

Criteria #7: Does the need tie to Fairview Strategy?

Considerations:

Fairview Strategy is defined as prevention, awareness and treatment of conditions related to cardiovascular,

orthopedics, oncology, mothers/children and behavioral health.

Appendix D: Definition of Community – Zip Codes by Hospital Primary Service Area, 2012 Fairview Lakes Medical Center Fairview Ridges Hospital University of Minnesota

Medical Center, Fairview/ Amplatz Children’s Hospital

Zip Code Community Zip Code Community Zip Code Community

55012 Center City 55020 Elko 55102 St. Paul Downtown

55013 Chisago City 55024 Farmington 55104 Midway

55014 Lino Lakes 55044 Lakeville 55105 MacGroveland

55025 Forest Lake 55054 New Market 55108 Falcon Heights

55032 Harris 55068 Rosemount 55112 New Brighton

55038 Hugo 55121 Eagan 55113 Roseville

55045 Lindstrom 55122 Eagan 55114 Como/Hwy 280

55056 North Branch 55123 Eagan 55116 Highland Park

55063 Pine City 55124 Apple Valley 55401 Mpls – North Loop

55067 Rock Creek 55306 Burnsville 55402 Mpls – Downtown

55069 Rush City 55337 Burnsville 55403 Mpls – Loring

55073 Scandia 55372 Prior Lake 55404 Mpls – Franklin

55074 Shafer 55378 Savage 55405 Mpls – Cedar

55079 Stacy Fairview Southdale Hospital 55406 Mpls – East Lake

55084 Taylors Falls Zip Code Community 55407 Mpls – Phillips

55092 Wyoming 55035 Hopkins 55408 Mpls – LynLake

Fairview Northland Med Ctr. 55317 Chanhassen 55409 Mpls – Harriet

Zip Code Community 55318 Chaska 55410 Mpls – Linden Hills

55017 Dalbo 55331 Excelsior 55411 Mpls – Near North

55309 Big Lake 55343 Hopkins 55412 Mpls – Camden

55330 Elk River 55344 Eden Prairie 55413 Mpls – Central NE

55371 Princeton 55345 Minnetonka 55414 Mpls – SE

55398 Zimmerman 55346 Eden Prairie 55415 Mpls – Downtown

56313 Bock 55347 Eden Prairie 55416 St. Louis Park

56329 Foley 55386 Victoria 55417 Mpls – Nokomis

56330 Foreston 55391 Wayzata 55418 Mpls – Northeast

56353 Milaca 55409 Mlps – Harriet 55419 Mpls – SW

56357 Oak Park 55410 Mlps – Linden Hills 55421 Columbia Heights

56358 Ogilvie 55416 St. Louis Park 55423 Richfield

56363 Pease 55417 Mpls – Nokomis 55432 Fridley

Fairview Range Regional Health Services

55419 Mpls – SW 55454 Cedar Riverside

Zip Code Community 55420 East Bloomington 55455 University

55703 Angora 55423 Richfield

55709 Bovey 55424 Edina

55710 Britt 55425 Bloomington

55719 Chisolm 55426 St. Louis Park

55723 Cook 55431 Bloomington

55738 Forbes 55435 Edina

55742 Goodland 55436 Edina

55746 Hibbing 55437 Bloomington

55751 Iron 55438 Bloomington

55765 Elmer 55439 Edina

55768 Mountain Iron

55769 Nashwauk

55775 Pengilly

55781 Side Lake

Appendix E: Qualitative Data Tools & Questions

Focus Group Notes—Fairview Health Services 2012 CHNA Fairview Health Services Community Health Needs Assessment Focus Group Summary Hospital: Name of Group: Date Held: Summary by: Questions:

1. What current health issues trouble you and your family?

2. What is the number one health issue for you or (your clients) your family?

3. What roadblocks do you experience when you are working to maintain your health?

4. Now tell us what roadblocks you experience when seeking healthcare from a professional?

5. To whom do you turn or where do you go when you need help with a health issue?

6. What is needed in our community to help you maintain or improve your health?

7. What is the role of the hospital to help you or others maintain or improve your health?

8. What do you see as your role in maintaining or improving your health?

Appendix E: Qualitative Data Tools & Questions

Stakeholder Interview Summary—Fairview Health Services 2012 CHNA

Fairview Community Health Needs Assessment 2012 Fairview Health Services Community Health Needs Assessment Stakeholder Interview Summary Hospital: Name of Individual: Date Held: Summary by: Background: 1. What do you believe to be the number one health issue in our community? 2. What are the difficulties, challenges and roadblocks faced by community members when they

seek healthcare from a professional? 3. When community members seek help about a health issue, where do you think they go for help? 4. What do you think is needed in your community to help individuals like yourself maintain or

improve your health? 5. What do you see as the health systems/hospitals role? 6. What do you see as your role in these improvements?

Appendix F: Top 10 Health Conditions by Population and Hospital University of Minnesota Medical Center, Fairview/ University of Minnesota Amplatz Children’s Hospital

Primary Service Area—All Population

Top 10 Reasons for Hospitalization, All Population

With Birth Data Without Birth Data

1. Birth, vaginal ^ 1. Pneumonia (nos)

2. Birth, cesarean 2. Blood poisoning (nos)

3. Pneumonia (nos) 3. Osteoarthritis, lower leg (nos)

4. Birth, second degree laceration 4. Hardening of the heart arteries

5. Overdue pregnancy 5. Irregular heart beat

6. Blood poisoning (nos) 6. Chest pain (nec)

7. Osteoarthritis, lower leg (nos) 7. Kidney failure (nos)

8. Hardening of heart arteries 8. Rehabilitation (nec)

9. Birth, previous cesarean 9. Urinary tract infection (nos)

10. Birth, first degree laceration 10. Obstructive chronic bronchitis Source: Minnesota Hospital Association, 2008-2010 ^ designates a 0.5% or higher percentage of difference between hospital and state of MN nos = not otherwise specified (unspecified diagnosis) nec = not elsewhere classified (diagnosis does not fit into a different category)

Top 10 Reasons for ER Visits Not Resulting in Hospitalization, All Population

1. Upper respiratory infection (nos)

2. Middle ear infection (nos)

3. Headache

4. Chest pain (nos)

5. Altered mental status (symptom of other illness)

^

6. Lower back pain

7. Fever (nos)

8. Chest pain (nec)

9. Abdominal pain (nec)

10. Abdominal pain (nos) Source: Minnesota Hospital Association, 2008-2010 ^ designates a 0.5% or higher percentage of difference between hospital and state of MN nos = not otherwise specified (unspecified diagnosis) nec = not elsewhere classified (diagnosis does not fit into a different category)

Top 10 Causes of Death, All Population

1. Cancer

2. Heart diseases

3. Mental disorders ^

4. Symptoms, ill-defined conditions ^

5. Stroke

6. Chronic obstructive pulmonary disease

7. Alzheimer’s disease

8. Diseases of nervous system/sense organs

9. Diabetes

10. Kidney diseases Source: Minnesota Department of Health, 2008-2010 ^ designates a 0.5% or higher percentage of difference between hospital and state of MN

Appendix F: Top 10 Health Conditions by Population and Hospital University of Minnesota Medical Center, Fairview/ University of Minnesota Amplatz Children’s Hospital

Primary Service Area—Children

Top 10 Reasons for Hospitalization, Children Ages 18 and under

With Birth Data Without Birth Data

1. Birth, vaginal ^ 1. Pneumonia (nos)

2. Birth, cesarean 2. Dehydration

3. Birth, cesarean (twins) 3. Asthma (nos) ^

4. Pneumonia (nos) 4. Bronchiolitis

5. Dehydration 5. Depression (nec)

6. Asthma (nos) 6. Appendicitis (nos)

7. Bronchiolitis 7. Bronchiolitis (nec)

8. Depression (nec) 8. Pneumonia, bacterial (nos) ^

9. Appendicitis (nos) 9. Mood disorder (nos)

10. Bronchiolitis (nec) 10. Respiratory failure ^ Source: Minnesota Hospital Association, 2008-2010 ^ designates a 0.5% or higher percentage of difference between hospital and state of MN nos = not otherwise specified (unspecified diagnosis) nec = not elsewhere classified (diagnosis does not fit into a different category)

Top 10 Reasons for ER Visits Not Resulting in Hospitalization, Children 18 and Under

With Birth Data

1. Middle ear infection (nos)

2. Upper respiratory infection (nos) ^

3. Fever (nos) ^

4. Vomiting ^

5. Strep, sore throat ^

6. Inflammation, gastrointestinal (nos/nec) ^

7. Asthma (nos) ^

8. Sore throat

9. Head injury (nos)

10. Cough ^ Source: Minnesota Hospital Association, 2008-2010 ^ designates a 0.5% or higher percentage of difference between hospital and state of MN nos = not otherwise specified (unspecified diagnosis) nec = not elsewhere classified (diagnosis does not fit into a different category)

Top 10 Causes of Death, Children Ages 18 and Under

With Birth Data Without Birth Data

1. Perinatal conditions ^ 1. Birth defects ^

2. Birth defects ^ 2. SIDS ^

3. SIDS ^ 3. Homicide ^

4. Homicide ^ 4. Other accidents (e.g. falls, poison)

5. Other accidents (e.g. falls, poison) 5. Residual (other) ^

6. Residual (other) ^ 6. Motor vehicle accidents

7. Motor vehicle accidents 7. Suicide

8. Suicide 8. Cancer

9. Cancer 9. Heart diseases

10. Heart diseases 10. Diseases of nervous system/sense organs

Source: Minnesota Department of Health, 2008-2010 ^ designates a 0.5% or higher percentage of difference between hospital and state of MN

Appendix F: Top 10 Health Conditions by Population and Hospital University of Minnesota Medical Center, Fairview/ University of Minnesota Amplatz Children’s Hospital

Primary Service Area—Seniors

Top 10 Reasons for Hospitalization, Ages 65 and Over

1. Pneumonia (nos)

2. Blood poisoning (nos)

3. Irregular heart beat

4. Osteoarthritis, lower leg (nos)

5. Urinary tract infection (nos)

6. Kidney failure (nos) ^

7. Hardening of the heart arteries

8. Obstructive chronic bronchitis

9. Stroke (nos)

10. First heart attack Source: Minnesota Hospital Association, 2008-2010

^ designates a 0.5% or higher percentage of difference between hospital and state of MN nos = not otherwise specified (unspecified diagnosis) nec = not elsewhere classified (diagnosis does not fit into a different category)

Top 10 Reasons for ER Visits Not Resulting in Hospitalization, Ages 65 and Over

1. Chest pain (nos)

2. Chest pain (nec) ^

3. Dizziness and giddiness

4. Fainting

5. Urinary tract infection (nos)

6. General discomfort, fatigue (nec)

7. Nose bleed

8. Limb pain ^

9. Head injury (nos) ^

10. Headache ^ Source: Minnesota Hospital Association, 2008-2010 ^ designates a 0.5% or higher percentage of difference between hospital and state of MN nos = not otherwise specified (unspecified diagnosis) nec = not elsewhere classified (diagnosis does not fit into a different category)

Top 10 Causes of Death, Ages 65 and Over

1. Cancer

2. Heart diseases

3. Mental disorders ^

4. Symptoms, ill-defined conditions ^

5. Stroke

6. Chronic obstructive pulmonary disease

7. Alzheimer’s disease

8. Diseases of the nervous system/sense organs

9. Kidney diseases

10. Accidental falls Source: Minnesota Department of Health, 2008-2010

^ designates a 0.5% or higher percentage of difference between hospital and state of MN