Cancer Services 2017 Community Needs Assessment
Table of Contents Executive Summary.................................................................................................................................3 Introduction..............................................................................................................................................6 Park Ridge Health Cancer Services........................................................................................................7 Data Collection Analysis..........................................................................................................................7 The Community.....................................................................................................................................10 Community Needs.................................................................................................................................13 Community Responses.........................................................................................................................14 Identified Barriers..................................................................................................................................15 Resources..............................................................................................................................................18 Summary & Next Steps.........................................................................................................................19
Executive Summary According to the American Cancer Society in 2016, nearly 14.5 million Americans are living with a history of cancer. This is testimony to the numerous advances in medicine, as well as the multidisciplinary range of supportive/patient-centered services so critical to patients and families. Cancer treatment is becoming more precise and personalized. In 2007, Park Ridge Health Cancer Services was awarded national accreditation by the American College of Surgeons Commission on Cancer (CoC). Park Ridge Health was the first hospital in Western North Carolina to achieve this award for a first-time program. Patients who receive care at CoC-accredited centers are ensured they have access to comprehensive care, a multidisciplinary team of physicians and clinicians, information about new treatment options, cancer registry and lifelong follow-up and quality care close by, near to family and friends. The Commission on Cancer Accreditation Standard 3.1 requires that a Community Needs Assessment is conducted every three years. The goal of the assessment is to understand and address the disparities and barriers to cancer care in the communities served. Park Ridge Health Cancer Services performed this assessment during the months of August and September 2017 by conducting a focus group, a consumer survey and gathering input from local community leaders. In addition, data from Henderson and Buncombe County Needs Assessments were considered along with primary and secondary data sources from local health departments, State and Federal sources, i.e. 2014 US Census data and the Centers for Disease Control and Prevention. A summary of findings and efforts to address these concerns follows.
Community and Local Population Henderson County has a large elderly population due to the favorable climate and regional location for retirees. Individuals over the age of 65 and older make up 24.5 % of the population, compared to 14.7 % statewide. According to the 2014 US Census, the estimated population has grown to 111,149; 53,689 (48.3%) are male and 57,460 (51.7%) are female. Ninety three percent of the county population are white and 3.4% are African American. Hispanic of any race made up 9.9% of the county population. Henderson County health outcome data indicates that total cancer deaths is the number one condition for mortality. Buncombe County has a total population of 238,318, according to the 2010 US Census, with a median age of 40.6 years; 114,770 (48.1%) are male and 123,548 (51.8%) are female. 14,254 (6%) are of Hispanic or Latino Origin and 15,211 (6.3%) are African American. 208,192 (87.3%) are White with 948 (.4%) being American Indian. Buncombe County health outcome data identifies cancer as the leading cause of death. Overall, the North Carolina Population consists of 9.6 million with 4.6 million (49%) being male and 4.9 million (51.2%) being female. 2,046,628 (21.4%) are African American and 800,120 (8.3%) are of Hispanic or Latino Origin. American Indians make
up 122,110 (1.2%) of the North Carolina Population while the Caucasian population is 6.5 million (68.4%).
Health Disparities and Barriers The National Cancer Institute defines health disparities as gaps in the quality of health and health care. These include socioeconomic status, racial/ethnic background and education level. Barriers to care commonly include all limits that prevent a community from receiving adequate health care. The Park Ridge Health Cancer Services 2017 Community Needs Assessment the following barriers to care.
1. Lack of Access to Care
Lack of financial resources Need for stronger collaboration with safety net providers Awareness of the importance of screening, but failure to act Late stage cancer incidence rates.
2. Need for Greater Education and Awareness
Lack of knowledge Implementation of systematic education screening opportunities Education of and partnership with primary care network
3. Increase Access to Cancer Screenings
Lack of prevention screenings resulting in late stage cancers At-Risk community access to education, screening opportunities and cancer services
Solutions Over the next three years efforts to overcome disparities and barriers will focus upon the follow solutions: 1. Access to Care
Work with Park Ridge Health Foundation and appropriate national grant organizations for funding (i.e. Susan Komen). Meet with and establish alignment for community safety net providers for screening (i.e. Blue Ridge Health Centers). Collaborate with Creation Health/WOW Van for screenings at local community venues. Partner with primary care medical community on the importance of systematic cancer prevention screenings. 4|Page
Develop a comprehensive listing of public cancer care access programs (i.e. BCCCP Program).
2. Education and Awareness
Partner with the following community organizations: Storehouse, Safe Light, El Centro, IAMS, the School System, and faith-based communities and churches. Ensure screening information reaches At-Risk communities and groups including mobile screenings. Creation of recommended screenings by age and gender guide booklet. Add screening information and screening by age guideline booklet to Cancer Services website.
3. Cancer Screenings Partner with local media for public service awareness and importance of screening. Incorporate screening message into a comprehensive media campaign.
Next Steps This Community Needs Assessment will guide the Park Ridge Health Cancer Services program in supporting its community specifically by improving access to cancer care and advocating for stronger cancer prevention. Each year the Cancer Committee will revise what goals were achieved and set goals for the following year. Statistics will be updated on a as needed basis. A new Community Needs Assessment will be completed in 2020.
Introduction Park Ridge Health strives to ensure that patients are offered the absolute best in cancer care. The Program’s firm desire is that patients experience a compassionate, caring environment that surpasses expectations with the support of a talented team of clinical and administrative experts. Accredited by the American College of Surgeons Commission on Cancer since 2007 and the National Accreditation Program of Breast Centers since 2009, we seek to exceed standards of care. Our mission is to meet the needs of our community by extending the healing ministry of Christ and incorporate Christian values at every level. We are committed to providing cancer screenings and wellness programs to promote early detection, state-of-the-art treatments using advanced technology and supportive care services, i.e. nurse navigators and psychosocial services to ensure patients can assess comprehensive closer to home. The Commission on Cancer Accreditation Standard 3.1 requires a Community Needs Assessment every three years. The goal of this assessment is to understand and address the disparities and barriers to cancer care in our communities. Park Ridge Health Cancer Services performed its triennial assessment in September 2017. Findings and resolutions are provided in this report. This Community Needs Assessment and its supplemental findings will be presented and approved by the Park Ridge Health Cancer Committee, the Medical Staff Executive Committee and Hospital Executive leadership. In addition, the Community Needs Assessment and related documents are publicly available on the Park Ridge Health Website at ParkRidgeHealth.org The Community Needs Assessment is used to identify the following goals:
Learning the communities most pressing health needs Understanding the health behaviors, risk factors and social determinants that impact the community’s health Identifying the community resources Prioritizing the needs of the community Collaborating with community partners to create collective strategies for maximum impact.
Park Ridge Health Cancer Services Park Ridge Health Cancer Services provides comprehensive services to help the patient remain as independent as possible throughout their treatment. Our services include a multidisciplinary team of physicians: medical oncologists, radiation oncologists, surgeons, radiologists, pathologists, hospitalists and other physician subspecialists. In addition, the supportive care team of clinicians include: oncology certified RNs, a licensed social worker, nurse navigators, a registered dietitian, an oncology-certified speech pathologist and spiritual care. In addition, Park Ridge Health also offers services for rehabilitation, palliative care and home health care. Two support groups, a Breast Support Group and a Wellness Support Group are available for patients to connect with others within the community. Genetic testing is also available for patients who are at risk for breast, colon and ovarian cancer. Park Ridge Health Cancer Services offers an extensive network of cancer care services designed to meet the needs of the patients. Park Ridge Health operates four infusion center locations located across the Western Carolina counties. The services offered at each center encompass Medical Oncology, Radiation Oncology and hospital-based care. Clinical Trials are also available as an optional form of treatment. Designed with the patient in mind, these centers provide infusions of the latest chemotherapy, biological and immunological drugs. Other related treatments offered include antiangiogenesis therapy and therapeutic phlebotomy.
Data Collection Analysis Each year data collected from the Park Ridge Health Cancer Services is analyzed to determine the goals and outcomes for the years to follow.
Cancer Registry The Cancer Registry uses a data system designed for the collection, management, analysis and reporting of information on patients with cancer who have been diagnosed and/or treated at Park Ridge Health Cancer Services. Each diagnosis of cancer or benign brain or central nervous system tumors in any person who is screened, diagnosed or treated by the facility, is reported to the North Carolina Central Cancer Registry, a unit of the North Carolina State Center of Health Statistics within the Division of Public Health, Department of Health & Human Services.
Summary of Data for 2016 During the 2016-year data from analytic cases (initially diagnosed and/or treated at the facility) and non-analytic cases (diagnosed and/or treated elsewhere but receiving subsequent treatment at the facility) was collected for analysis and reporting. The table below demonstrates Park Ridge Health data compared to the state and national averages.
PARK RIDGE HOSPITAL TOP 10 CANCER SITES DIAGNOSED AND/OR TREATED 2016 *NATIONAL COMPARISON OF SELECTED CANCER SITES *Estimated Numbers of New Cases from: The American Cancer Society Cancer Facts & Figures 2016 PARK RIDGE HEALTH NORTH CAROLINA NATIONAL PRIMARY SITE
Geographic Data Geographic data indicates over 64% of patients diagnosed and/or treated during the year 2016 came from Henderson and Buncombe Counties. In addition, 15% came from Haywood County and 20% came from multiple counties in the Park Ridge Health secondary market area.
Diagnosis by County NUMBER
Counties less than 5%
Burke, Cabarrus, Caldwell, Catawba, Cherokee, Clay, Guilford, Jackson, Macon, Madison, McDowell, Mitchell, Out-of-State, Polk, Swain, Transylvania and Yancey
The Community The primary service area of Park Ridge Health includes all of Henderson County and portions of Buncombe County. The portions of Buncombe County include Arden (28704), Black Mountain (28711), Fairview (28730), Fletcher (28732), Skyland (28776) and Swannanoa (28778). The data below has been provided courtesy of the hospital’s 2016 Community Needs Assessment which can be viewed in full online as ParkRidgeHealth.org
Henderson County Henderson County is in the western section of the state and is bordered by the state of South Carolina and Transylvania, Haywood, Buncombe, Rutherford and Polk Counties. The present land area is just over 373 square miles. Henderson County is considered a “typical” mountain county because it is comprised of mountain ranges, isolated peaks, a rolling plateau and level valley areas. Elevations range from 1,400 feet near Bat Cave at the foot of the Blue Ridge Mountains to 5,000 feet on Little Pisgah Mountain. Interstate 26 runs through Henderson County. Hendersonville is the county seat and is 120 miles to the nearest major city, which is Charlotte. Henderson County also includes the municipalities of Flat Rock, Mills River, Laurel Park and Fletcher. Towns in the county include Bat Cave, Balfour, East Flat Rock, Edneyville, Etowah, Dana, Gerton, Horse Shoe, Mountain Home, Naples, Tuxedo and Zirconia. The nearest commercial airport is Asheville Regional Airport, which is located on the Henderson/Buncombe county line off Interstate 26. Henderson County has a large elderly population due to a favorable climate and regional location for retirees. Individuals age 65 and older make up 24.5% of the population, compared to 14.7% statewide. According to the 2014 US Census, the estimated population has grown to 111,149; 93% of the population is white and 3.4% is African-American. In 2014, Hispanics (of any race) made up 9.9% of the county population. Henderson County has experienced steady population growth for over four decades and is projected to continue a similar trend for at least the next fifteen years, despite declining birth rates. It is estimated that the elderly population will continue to grow as well, with the highest percentage of growth to occur in the age group of 85 and older. Though unemployment rates in the county have been decreasing and are lower than the state, total poverty has increased overall. More children than adults live in poverty in Henderson County. Economic burden is often measured by how many households 10 | P a g e
spend 30% or more in housing. Renters in Henderson County on average are spending more of their income on housing compared to those in the region and state, and those rates have been steadily rising. Mortgage holders are spending closer to the state rates, though many are still spending more than 30%. Henderson County health outcome data indicates cancer as the number one condition for mortality. This trend has decreased over time due to cancer conditions for many disease types being preventable and treatable. This affords the community the opportunities for improvement in the overall health of the county. The table below was obtained from the Henderson County Website and displays the number of deaths, Mortality Rate, Rate Difference for NC, and the Trend over time for Henderson County.
At-Risk Population While Henderson County is a relatively healthy county, segments of the population continue to suffer from poor health status. These At-Risk Populations include: ď‚ˇ
Hispanic population: Largest population that may be at risk due to documentation issues and language barriers.
Elderly population: Challenges include isolation, transportation issues and hearing/visual impairment.
Poverty: Those living in poverty often face barriers to accessing affordable housing, transportation, health care and food.
The identified At-Risk Populations in Henderson County can face additional barriers depending on the population. The Hispanic population may have additional difficulties obtaining health and dental care due to their minority. The elderly population could face additional unique challenges including location and income status. Lastly, more children than adults live in poverty in Henderson County and total poverty has increased despite decreasing unemployment rates. These At-Risk Populations are contributing residents to the community and will be included in the data derived from the Community Needs Assessment.
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Buncombe County Buncombe County encompasses 660 square miles along the Blue Ridge Mountains with six distinct municipalities: Asheville, Biltmore Forest, Black Mountain, Montreat, Weaverville and Woodfin. The county is located in the Blue Ridge Mountains at the confluence of the Swannanoa and French Broad Rivers. Asheville is the county seat of Buncombe County. It is the largest city in Western North Carolina and the 11th largest city in North Carolina with a population of 83,393 (2010 Census). Buncombe County has a total population of 238,318, according to the 2010 US Census, with a median age of 40.6 years; 114,770 (48.1%) are male and 123,548 (51.8%) are female. 14,254 (6%) are of Hispanic or Latino Origin and 15,211 (6.3%) are African American. 208,192 (87.3%) are White with 948 (.4%) being American Indian. The median household income (includes all people in a housing unit sharing living arrangements) in Buncombe County during 2009-2013 was $44,713 (higher than WNC at $38,887 but lower than NC at $46,334). The median family income (people living in household related by birth, marriage or adoption) for the same time was $56,616 (above WNC by $8,065 and below NC by $312). (US Census Bureau, 2015). The number of children living in poverty in Buncombe County is 22% (compared to 25% of NC). Buncombe County health outcome data identifies cancer as the leading cause of death in the county. The table below is from the 2016 Buncombe County Community Needs Assessment and identifies the top four leading causes of death in the county.
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At-Risk Population While Buncombe County is a relatively diverse county by ethnicity, it too has populations at risk which include:
Those impacted by health disparities;
Those impacted by adverse childhood experiences including domestic violence and child abuse and neglect; and
Homeless population subgroups (specifically veterans & those impacted by mental illness and domestic violence).
Community Needs Park Ridge Health began the Community Needs Assessment process by conducting a focus group, distributing consumer surveys and gathering input from local community leaders. The process created opportunity for stronger links between Park Ridge Health and key community organizations. The comprehensive assessment allowed for a stronger focus on the key issues impacting the community. Representatives from the following organizations provided insight into the key issues affecting the community. Focus Group Representatives
VISION Henderson County Council on Aging Faith-based community leaders Non-profit organizations (i.e. The Storehouse and Resource Corporation of America) Various department representatives from Park Ridge Health
Additionally, a 26-question survey was administered both electronically to 25,000 email addresses and hand distributed at a Latino event within the community. This offered a cross-sectional view of the community, including minority specific involvement. Community leader input was assessed through numerous interviews to gain insight into the specific needs of the community.
Public Health Data Sources Primary and secondary data analyzed for the Community Needs Assessment included local, county, state, federal and nationally recognized data sources. Key health 13 | P a g e
indicators included morbidity, mortality and various social determinants of health were obtained from the 2014 U.S. Census from the Centers for Disease Control and Prevention. Lastly, data from Henderson and Buncombe County Community Needs Assessments were considered.
Community Responses The consumer survey generated over 360 responses via email and hard copy. Areas assessed included:
Access to care Community health perception Proactive health Education and awareness Driving healthcare choices.
Nearly 20% of the respondents determined there was a challenge accessing care in the last 12 months. Top reasons included: not being able to afford care, didn’t know where to access care, didn’t have insurance, and it was difficult to schedule an appointment. A majority of the community felt they were “healthy” or “very healthy” overall.
57% of respondents feel the community is healthy or very healthy 32% responded that the community was somewhat healthy 6% were unsure and 2% feel it is very unhealthy
Eighty percent of the respondents knew it was important to be screened and still a portion chose not to be proactive about their health screening tests. Specific cancerrelated screenings presented some of the biggest gaps (colonoscopy, prostate, GYN and skin screenings). Forty percent of respondents were unaware of who provided cancer care in the area. Those that were aware had seen cancer advertising in the last 12 months and remembered seeing specific advertising for the following facilities: Mission 54%, Pardee 47% and Park Ridge 45%. Lastly, when respondents were asked what drove their health care choices, the following responses were provided:
Doctor – 99% Hospital – 93% Family/Friends – 89% Health Department – 87% Health Clinic – 84% Internet – 77%
Demographic highlights from the survey provided interesting results. Geographically, 38% came from Buncombe County and 62% came from Henderson County. Additional 14 | P a g e
demographics included ethnicity, gender, education, age and health insurance. The following breakdown provided some insight into the demographic layout of the community:
Geography – 38% Buncombe/62% Henderson Ethnicity – 95% Caucasian Gender – 33% Male/67% Female Education – 29% College, 27% Masters, 25% some college, 19% all other Age – 18-44 n=35 or 11%, 45-64 n=116 or 35% and 65+ n=182 or 54% 95% of respondents are insured (52% with Medicare/MC HMO and 43% Commercial/PPO) Approximately 5% were self-pay, Medicaid or other
Identified Barriers The National Cancer Institute defines health disparities as gaps in the quality of health and health care that mirror differences in socioeconomic status, racial/ethnic background and education level. These disparities may stem from many factors including accessibility of health care, increased risk of disease from occupational exposure and increased risk of disease from underlying genetic, ethnic or familial factors. The 2017 top barriers specifically identified by the Park Ridge Health community included: 1. Access to Care 2. Education and Awareness 3. Cancer Screening 1. Access to Care: responses highlighted the following:
Lack of financial resources Need for stronger collaboration with safety net providers Awareness of the importance, but failure to act Late-stage cancer incidence rates
2. Education and Awareness: comments highlighted the need for:
More knowledge about cancer Implementation of systematic educational and screening opportunities needed Education of and partnership with primary care networks
3. Cancer Screening: responses indicated:
Lack of prevention screening, resulting in late-stage cancers identified 15 | P a g e
At-Risk community access to education, screening opportunities and cancer services
These top barriers and the key issues associated with them are addressed in the following action plan.
The following action items will serve as a blueprint over the period 2018-2020 for the Park Ridge Health Cancer Services clinical and administrative teams. Statistics and data will continue to be analyzed to ensure each community-identified barrier is improved and/or eliminated. To overcome the barriers identified, the following strategies and actions are recommended for action: 1. Access to Care Access to care includes a combination of factors, including a lack of awareness of where to receive cancer screenings and treatment, along with the inability to afford it. Collaborating with community safety net partners and submitting proposals for monetary grants will provide financial assistance in addressing this identified barrier. In addition, educational opportunities will be pursued to highlight advances in treatments and program offerings. Recommended Actions Develop media, social media, physician articles and monthly medical lunch and learn presentations. Collaborate with community safety new providers for education opportunities. Work with Park Ridge Health Foundation and appropriate national grant organizations for funding (i.e., Susan Komen Foundation). 2. Education and Awareness Survey results indicate there is a knowledge gap as to where consumers can get cancer screenings. Additionally, although they know that cancer screenings are important, they lack taking action. Providing the community with opportunities to access screenings, promote risk factors, and assist those in need of navigation will impact the late stage incidence rates that are prevalent in the community. Recommended Actions Incorporate the screening message into a full year comprehensive campaign. Create a full year screening calendar and promote. Collaborate with the Park Ridge Health Wellness/CREATION HEALTH for educational material and screening kits to be distributed to At-Risk communities. 3. Cancer Screening
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Of the respondents, 80% knew it was important to get screened and only 36% incorporated proactive health screenings into their annual health routine. When asked about the specific cancer-related screenings they participated in, the biggest gaps were colonoscopy, prostate, GYN and skin screenings. Individuals educated in the importance of screenings, who choose not to act, can be reached through their primary care network. Therefore, partnering with the medical community to impact these late-stage incidence rates is critical with this audience. For those who have shared they are unaware of the importance of screening or are unaware of where to access screenings, we must reach them with the facts in a language and communication level they can understand and act on. Creating a tool kit focused on the importance of screenings and relevant screenings by age and gender will be an important part of this process. The At-Risk Population is among those in great need of further education and prevention of cancer. By partnering with community safety net providers, we can share more information about the importance of screening and provide screening opportunities. Recommended Actions Primary Care Physician educational and medical presentations to consumers where they live Create screenings-by-age and gender guideline booklet Digital tactics: Add screening booklet guideline to the Cancer Services website and develop a comprehensive listing of public access programs. Promote a full-year screening schedule, including mobile screenings, and take information to the At-Risk Population, i.e. churches, non-profit partners Partner with local media for public service awareness leverage of screening
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Resources Resources advocated to overcome barriers and disparities within the current population are defined as anything or anyone that can improve the quality of community life. Gaps in resources within the community include access to health care. Access to health care includes both mental and dental health and those who are uninsured/underinsured. Resources found within the community include partnering with organizations that serve the At-Risk Community and influencing potential outreach partners. Many of these organizations are local and already included within Park Ridge Health’s community network. Some of the organizations include Storehouse, Safelight and the Chamber of Commerce. Once the barriers were identified, a complete asset inventory of existing community-wide programs and services was determined to better address partnerships and priorities:
Park Ridge Health Cancer Services Asset Inventory CURRENT COMMUNITY EXISTING HOSPITAL PROGRAM PROGRAM/SERVICE
Access to Care
Free Clinics of Hendersonville Blue Ridge Health Centers Council on Aging North Carolina Breast and Cervical Cancer Control Program (BCCCP) WCCA Apple Country Transportation
Charity Care Policy 1910 Cancer Fund for un- and underinsured.
American Cancer Society Potential Community Partners for Education and Awareness o Storehouse o Safelight o El Centro o IAMS o School system o Faith-based communities
WOW Van and Wellness Team Cancer Services Navigators/Social Worker Park Ridge Health – Monthly Lunch and Learns Digital Resources o ParkRidgeHealth.org o PRHColoncare.org o PRH Facebook Page o PRHCancerServices.org PRH Cancer Services Program
North Carolina Breast and Cervical Cancer Control Program (BCCCP) Lifeline Screenings (Colon (FIT) and Prostate (PSA)
Diagnostic Imaging Services Physician Enterprise Park Ridge Health Wellness/CREATION HEALTH
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fee-based screenings at area locations.
Summary & Next Steps Over the next three years, this Community Needs Assessment will serve as a blueprint and guide Park Ridge Health Cancer Services as we support our community. Each year, the Cancer Committee will review the identified barriers, determine the goals achieved and set goals for the upcoming year. Statistics will be updated and a new Community Needs Assessment will be completed in 2020. Throughout this time, efforts to overcome disparities, to meet the needs of the community, will focus on the following solutions within the identified barriers.
Access to care provides a unique opportunity for Park Ridge Health to work with organizations including the Park Ridge Health Foundation and Susan B. Komen Foundation to obtain funding for community outreach. Meeting and establishing alignment with community safety net providers will afford the opportunity for cancer screenings and additional education. Lastly, developing and providing a comprehensive list of public cancer care access programs will ensure the establishment of stronger connections within the community population. By partnering with local media outlets, a comprehensive media campaign will be developed and implemented with a focus on the importance of cancer screening and treatment. The overarching message will focus on how cancer is “preventable, treatable and beatable”! By partnering with community organizations and non-profit agencies, Park Ridge Health can increase the education awareness amongst the community. In addition, efforts will focus on distribution of information to the At-Risk Community.
The Park Ridge Health Cancer Committee will review and approve the Community Needs Assessment for implementation. Thereafter, the Community Needs Assessment will be presented to the Park Ridge Health Medical Executive Committee and Hospital Executive Leadership. For the next three years, Park Ridge Health will remain committed to improving delivery of comprehensive cancer care, sharing the importance of cancer screening, and aiding in the prevention of late-stage cancer instances across the community.
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