Introduction
Columbus Regional Hospital (CRH) is a community health system located in Columbus, Indiana whose mission is to improve the health and well-being of the people we serve and whose vision is to be, for all those we serve, their health and wellness partner for life.
For over 20 years, CRH has conducted Community Health Needs Assessments periodically to guide its community health promotion activities. CRH’s CHNA studies--conducted in 1996, 2000, 2003, 2006,
2009, 2012, 2015, and 2018 – employ a systematic, data-driven approach to determining the health status, behaviors, and needs of residents in the primary service area of Columbus Regional Hospital. This information is used to inform and determine CRH’s CHNA Implementation Strategies.
CRH addresses community health needs primarily through its Healthy Communities Initiative (HCI) organization. Healthy Communities’ mission is to achieve radical improvement in our community members’ long-term quality of life through local action. HCI accomplishes this by collaborating with a diverse network of partners to develop and respond to data-driven community health priorities.
HCI deploys Action Teams, comprised of paid staff and community volunteers, to address the most urgent community health issues. Healthy Communities’ Action Teams address community health issues in three general priority areas: Access to Health Care for All; Promoting Healthy Lifestyles; and Promoting Healthy Relationships. Most HCI Action Teams are standing committees, but from time-to- time, when new community health priorities arise and are identified by the CHNA, new Action Teams are deployed. Specific activities of the Action Teams are informed by a combination of the CHNA results and a Key Informant Survey and are prioritized by the Healthy Communities Council, a community collaborative comprised of health, civic, business, faith, social service, education, and other leaders from across the community.
CHNA Methodology
CRH’s CHNA incorporates data from both quantitative and qualitative sources. Quantitative data input
Includes primary research (a Community Health Survey) and secondary research (vital statistics and other existing health-related data); these quantitative components allow for trending and comparison to benchmark data at the state and national levels. Qualitative data input includes primary research gathered through an Online Key Informant Survey.
Survey
Survey Instrument
The survey instrument used for this study is based largely on the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS), as well as various other public health surveys and customized questions addressing gaps in indicator data relative to health promotion and disease prevention objectives and other recognized health issues. The final survey instrument was developed by the Columbus Regional Hospital and Professional Research Consultants, Inc. and is similar to the previous surveys used in the region, allowing for data trending.
Community as Defined for This Assessment
The study area for the survey effort (referred to as the “Columbus Regional Hospital Service Area” or “CRH Service Area” in this report) includes each of the residential ZIP Codes primarily associated with Bartholomew County, Indiana, as well as ZIP Codes 47274 in Jackson County and 47265 in Jennings County.
Online Key Informant Survey
To solicit input from key informants, those individuals who have a broad interest in the health of the community, an Online Key Informant Survey was also implemented as part of this process. A list of recommended participants was provided by Columbus Regional Hospital; this list included names and contact information for physicians, public health representatives, other health professionals, social service providers, and a variety of other community leaders. Potential participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall. Key informants were contacted by email, introducing the purpose of the survey and providing a link to take the survey online; reminder emails were sent as needed to increase participation. In all, 104 community stakeholders took part in the Online Key Informant Survey, as outlined in the following table:
| Key Informant Type | Number Invited | Number Participating |
| Community/Business | 124 | 77 |
| Leaders | | |
| Other Health | 82 | 52 |
| Physicians | 18 | 13 |
| Public Health | 42 | 28 |
| Social Services | 19 | 11 |
Information Gaps
While CRH’s CHNA assessment is quite comprehensive, it cannot measure all possible aspects of health in the community, nor can it adequately represent all possible populations of interest. It must be recognized that these information gaps might in some ways limit the ability to assess all of the community’s health needs.
For example, certain population groups — such as the homeless, institutionalized persons, or those who only speak a language other than English or Spanish — are not represented in the survey data. Other population groups — for example, pregnant women, lesbian/gay/bisexual/transgender residents, undocumented residents, and members of certain racial/ethnic or immigrant groups — might not be identifiable or might not be represented in numbers sufficient for independent analyses.
In terms of content, the CHNA assessment was designed to provide a comprehensive and broad picture of the health of the overall community. However, there are certainly a great number of medical conditions that are not specifically addressed.
2020-2022 Implementation Plan
Among 14 “Areas of Opportunity” identified by the 2018 CHNA results, wherein local results differed significantly from state and/or national benchmarks, CRH has prioritized 13 areas of opportunity for the 2020-2022 period. The area not addressed in the implementation strategy, Sexually Transmitted Diseases, is being addressed by the Bartholomew County Health Department.
Areas of Opportunity
1. Access to Healthcare Services (primary care)
2. Cancer (deaths, incidence, screenings)
3. Tobacco Use (cigarette smoking & smokeless tobacco use prevalence)
4 & 5. Diabetes & Kidney Disease (prevalence, kidney disease deaths)
6 & 7. Heart Disease & Stroke (stroke deaths, high blood pressure prevalence, overall CV risk)
8. Injury & Violence (unintentional injury deaths, bike helmet usage, firearm deaths, firearm prevalence in homes with children)
9. Nutrition, Physical Activity & Weight
10. Respiratory Diseases (CLRD, COPD & Asthma prevalence)
11 & 12. Substance Abuse (disease- and drug-induced deaths) & Mental Health (depression prevalence, suicide deaths)
13. Infant Mortality
CHNA Implementation Plan Approach
Recognizing that population health outcomes are inter-related and that efforts to improve outcomes in one area also have the potential to improve outcomes in another, our 2020-2022 CHNA Strategy combines and attacks the 13 Areas of Opportunity into Four Priority Strategies:
PRIORITY STRATEGIES:
- Increase Access to Primary Care
- Prevent Disease & Injury
- Reduce Substance Abuse
- Reduce Infant Mortality
The goals for each Area of Opportunity are outlined in the following 2020-2022 Strategy.
PRIORITY STRATEGY I: INCREASE ACCESS TO PRIMARY CARE
Opportunity 1: Primary Care Access
Goal 1: Increase access to primary health care.
a) Increase number of Medicaid and uninsured patients using VIMCare
Clinic as their medical home.
b) Increase net number of primary care physicians in CRH primary and secondary service areas by 22.
c) Continue support for combined Medication Assistance Program
(community and VIMCare Clinic patients) at VIMCare.
d) Evaluate options for community-based primary dental care services.
e) Continue support for United Way’s Premium Link HIP 2.0 and marketplace health insurance subsidy program for low-income people in Bartholomew County.
f) Continue support for health insurance navigators in the community.
g) Develop and implement a community-wide Medicaid enrollment and retention strategy to respond to new work requirement/Gateway to Work .
PRIORITY STRATEGY II: PREVENT DISEASE & INJURY
Opportunities 2 & 3: Cancer and Tobacco Use
Goal 1: Increase local cancer treatment options to lower cancer deaths.
a) Expand access to local oncology providers and state-of-the-art treatments.
Goal 2: Increase screening for skin and lung cancer.
Goal 3: Accelerate tobacco & e-cigarette control efforts to prevent youth initiation.
a) Lead and re-invigorate efforts to prevent youth initiation.
b) Continue High School Heroes program at local high schools.
d) Lead advocacy and education efforts to lower e cigarette initiation.
Goal 4: Increase referrals to Indiana Quitline.
- Leverage EHR across CRH Physician practices.
- Coordinate efforts with inSpire network tobacco quality goals.
Goal 5: Increase adult participation in tobacco cessation courses.
a) Fully implement US Public Health Service clinical practice guidelines for treating Tobacco Use and Dependence at VIMCare Clinic.
b) Expand adoption of tobacco USPHS clinical practices inSPIRE practices.
Opportunities 4 & 5: Diabetes & Kidney Disease
Goal 1: Increase prevention behaviors in persons who are at high risk for diabetes or have been diagnosed with pre-diabetes.
- In 2020, evaluate regional adoption of Blue Zones.
- In 2021-2022, begin implementation of Blue Zones.
Goal 2: Promote adoption of healthy lifestyle behaviors through efforts that make the healthy choice the easy choice in the workplace, at home, and throughout the community.
a) Adopt and implement policies and practices at CRH that promote healthy eating and beverage consumption among employees and visitors.
b) Continue Healthy Lifestyles Action Team leadership in creating a pedestrian and bicycle friendly built environment throughout Bartholomew County.
Opportunities 6 & 7: Heart Disease & Stroke
Goal 1: Increase prevention behaviors in persons who are at high risk for heart disease or stroke.
a) See Diabetes Goal 1 initiatives.
b) Conduct Cardiovascular and Stroke screening events in community.
Goal 2: Promote adoption of healthy lifestyle behaviors through efforts that make the healthy choice the easy choice in the workplace, at home, and throughout the community.
a) See efforts for Diabetes.
b) Add a Cardiovascular physician to the Healthy Communities Council.
Opportunity 8: Injury & Violence
Goal 1: Eliminate Shaken Baby Syndrome (unintentional infant injury and deaths to infants resulting from caregivers shaking them.)
a) Continue Crying Education to all delivering at the CRH Birthing Center.
b) Continue providing Period of Purple Crying DVD’s to all who give birth at CRH Birthing Center.
c) Continue cooperative efforts with Family Services in support of home visits to new moms in Bartholomew County.
Goal 2: Increase understanding of safe biking practices.
a) Support safety initiatives of the Columbus Bike Co-op.
Goal 3: Make Bartholomew County safer for pedestrians and bicyclists.
a) CRH HCI staff serves on City of Columbus Bike & Infrastructure Team & CAMPO Citizens Advisory Team.
b) CRH HCI staff serves on Bartholomew County Safe Routes to Schools Task Force.
CRH leadership serves on Columbus Planning Commission.CRH leadership serves on Columbus Park Board. Opportunity 9: Nutrition, Physical Activity & Weight
Goal 1: Increase access to and consumption of plant-based foods throughout the community.
a) Support efforts of Bartholomew County Hunger Coalition.
b) Implement Blue Zones strategy
c) Partner with Purdue Extension Service Local Food efforts.
d) See Diabetes, Heart Disease, and Stroke priority area efforts above.
Goal 2: Increase initiation and duration of breastfeeding.
a) Continue Nurse & Chat program
b) Educate moms on safe milk storage.
c) Provide Lactation Station at county fairs.
d) Sustain and expand access to Nurse Family Partnership services.
Goal 3: Increase use of bicycling and walking for recreation and routine transportation.
- See efforts above in Injury & Violence.
- Implement Blue Zones strategy in CRH service region.
Opportunity 10: Respiratory Diseases
Goal 1: Decrease prevalence and deaths related to CLRD, COPD, and asthma.
a) Increase pulmonary provider access.
b) Conduct screenings in 2020-2022.
c) See Cancer & Tobacco Use goals and strategies.
PRIORITY STRATEGY III: REDUCE SUBSTANCE ABUSE
Opportunities 11 & 12: Substance Use Disorder & Mental Health
Goal 1: Reduce suicide rate.
a) Promote universal screening for depression and suicide risk throughout the CRH health system.
b) Promote standard protocols in the health, school, and criminal justice systems for handling those at risk for suicide.
c) Support Counseling Counts efforts at local school corporations.
Goal 2: Increase local access to treatment for substance use disorder (SUD).
- Expand CRH Medication-Assisted treatment to 11 counties.
- Increase local access to medically-managed detox services.
- Integrate CRH’s Treatment and Support Center (TASC) with all local treatment providers.
- Create care continuum TASC with ASAP Hub and community corrections treatment services.
- Develop and implement SUD services for local employers.
- Pilot adolescent telehealth SUD with Riley Children’s Hospital.
Goal 3: Decrease stigma to increase help-seeking behaviors.
a) Lead and support ASAP Prevention Team efforts.
PRIORITY STRATEGY IV: REDUCE INFANT MORTALITY
Opportunity 8: Infant Mortality
Goal 1: Implement Infant Mortality work plan toward achieving the above targets.
Goal 2: Sustain and expand Nurse Family Partnership services.