2016
COMMUNITY HEALTH
NEEDS ASSESSMENT
Essentia Health
St. Joseph’s Medical Center
523 North Third Street, Brainerd, MN 56401
CENTRAL REGION
Overview
Essentia Health-St. Joseph’s Medical Center
523 North 3rd Street
Brainerd, MN 56401
Essentia Health-St. Joseph’s Medical Center is
part of Essentia Health, a nonprofit, integrated
health system caring for patients in Minnesota,
Wisconsin, North Dakota and Idaho.
Headquartered in Duluth, Minn., Essentia
Health combines the strengths and talents of
14,000 employees who serve our patients and
communities through the mission of being
called to make a healthy difference in people’s
lives.
St. Joseph’s Medical Center is a 162-bed
hospital that serves the Brainerd Lakes area
with 162 hospital beds and primary care clinics
in Baxter, Brainerd, Crosslake, Emily, Pequot
Lakes, Pierz, Pillager and Pine River as well as a
rehabilitation facility in Brainerd.
The Level 3 Trauma Center offers 24-hour
emergency care and an intensive care unit. It
has been designated as an Acute Stroke Ready
hospital and is working towards becoming a
Primary Stroke Center. The hospital also offers
24/7 surgical care as well as obstetrics and
birthing services.
Established in 1900 by the Benedictine Sister of
St. Scholastica Monastery, St. Joseph’s Medical
Center is a Catholic hospital.
In addition to the care provided at the hospital,
clinics and rehabilitation center, St. Joseph’s
Medical Center works to meet the community’s
healthcare needs in a variety of ways including:
•
•
•
Providing a free evidence-based
lifestyle change program for all
community members age 18 and older.
Leading a public/private partnership
with a local public health department to
create a community health and
wellness movement.
Helping to establish and provide
infrastructure for an aging coalition and
working with community partners and
stakeholders to come together to
support an aging population and their
families so they can “age in place.”
LEAD PARTIES ON THE ASSESSMENT
Cassie Carey, Health and Wellness Specialist,
Central Region
Kayla Keigley, Community Health Program
Manager, East Region
TABLE OF CONTENTS
Overview ....................................................................................................................................................... 1
Essentia Health: Here With You .................................................................................................................... 3
Caring for our Community ............................................................................................................................ 4
Progress to Date on 2013 Community Health Needs Assessment ............................................................... 4
2016 Community Health Needs Assessment ................................................................................................ 6
Objectives ..................................................................................................................................................... 6
Description of Community Served by Essentia Health – St. Joseph’s Medical Center ................................. 7
Process Overview .......................................................................................................................................... 8
Assessment Process .................................................................................................................................... 10
Phase 1: Assessment ................................................................................................................................... 10
Phase 2: Prioritization ................................................................................................................................. 12
Conclusion ................................................................................................................................................... 19
APPENDIX A - CWE Communications Plan .................................................................................................. 20
APPENDIX B - CWE Movement efforts ........................................................................................................ 25
APPENDIX C - Crow Wing County Demographics........................................................................................ 29
APPENDIX D - Survey Methodology ............................................................................................................ 34
APPENDIX E - Two-page Summary: Crow Wing County Community Health Survey Results ..................... 36
APPENDIX F - Crow Wing County vs State vs National ............................................................................... 39
APPENDIX G - Crow Wing County vs Region Five Counties ........................................................................ 42
APPENDIX H - Crow Wing County Cost of Living Analysis ........................................................................... 44
APPENDIX I - Central Region Body Mass Index Obesity and Overweight rates within Adults .................... 46
Appendix J - Central Region Body Mass Index Obesity and Overweight rates within Pediatrics ............... 48
2016 Community Health Needs Assessment
St. Joseph’s Medical Center
Essentia Health: Here With You
At Essentia, our mission and values guide us every day. Together, we deliver on our promise to be here
with our patients and members of our communities from the beginning to the end of life, both in our
facilities and where they live, work, and play. As a Catholic facility sponsored by the Benedictine Sisters
of the St. Scholastica Monastery, St. Joseph’s Medical Center promotes Christ’s ministry of holistic
healing for all human life with special concern for the poor and powerless.
Mission
We are called to make a healthy difference in people's lives.
Vision
Essentia Health will be a national leader in providing high quality, cost effective, integrated
health care services.
Values
•
•
•
•
•
•
Quality
Hospitality
Respect
Justice
Stewardship
Teamwork
Belief Statements
• Our highest priority is the people we serve.
• We believe that the highest quality health care requires a regard for both the soul and
science of healing and a focus on continuous improvement.
• We believe in the synergy of sponsorship among faith-based and secular organizations.
• We believe in the value of integrated health care services.
• We believe in having a meaningful presence in the communities we serve.
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Caring for our Community
Our commitment to community health and wellness goes well beyond the work of the Community
Health Needs Assessment. Through donations of funds, along with employees’ time and talents, Essentia
Health invests in a variety of programs and outreach efforts. Across the organization, we support
community coalitions, housing, food shelves, mental health, congregational outreach, community
infrastructure, public health, education, safety and other nonprofit organizations. These investments are
designed to promote better health, help lessen inequities in our communities, improve access to health
care and strengthen relationships with those we serve.
Progress to Date on 2013 Community Health Needs Assessment
The 2013 Community Health Needs Assessment for St. Joseph’s Medical Center identified the top 3
priorities to be:
1. Obesity, physical activity and poor nutrition as risk factors for chronic diseases such as Type 2
diabetes
2. Tobacco use, primary prevention/cessation
3. Reduction of excessive/binge drinking
PRIORITY 1: OBESITY, PHYSICAL INACTIVITY, POOR NUTRITION
St. Joseph’s Medical Center has partnered with Crow Wing Energized to offer the National Diabetes
Prevention Program (NDPP) in the community and the region served by the hospital.
The reach of the NDPP program has increased because a St. Joseph’s Medical Center employee
coordinates course offerings and its lifestyle coaches. Through a partnership with the Minnesota
Department of Health, an additional 80 community leaders have been trained as certified lifestyle
coaches under the Crow Wing Energized umbrella. Medical staffs at St. Joseph’s Medical Center and
area clinics refer patients who qualify for the program and meet Type 2 diabetes risk criteria.
Additional marketing and promotion is done through the Crow Wing Energized website
(www.crowwingenergized.org), the area’s newspaper and clinical brochures. A year-long communitywide program called “Your Energized Year” has been launched and focuses on supporting healthy
changes through workplace partnerships, faith communities, food-shelf participants and among rural
communities experiencing socioeconomic disparities. Additional information on the communications
plan within Crow Wing Energized and our partnership can be found in Appendix A.
Through Crow Wing Energized, the NDPP continues to see growth and success. More community
partners are offering the course to their own employees or volunteering to provide lifestyle coaches as
well as meeting locations including local food shelves, churches and locations that serve higher
populations of low-income individuals in our community. These individuals will continue to collaborate
with Essentia Health’s NDPP coordinator as well as the Crow Wing Energized coordinator in increasing
these efforts in the community. To build upon the work, a community-wide NDPP Lifestyle Coaches
Coalition meets monthly to promote additional training and classes throughout the community as well
as networking time to sustain the initiative.
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Patients and community members who participated in the NDPP saw profound change by meeting the
CDC-recommended goals of losing between 5 and 7 percent of their body weight. Promoting and
growing the program is a successful strategy for having a larger impact on the community’s health:
•
•
•
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2013 – 65 participants averaged 6.2% loss in body weight
2014 – 93 participants averaged 6.4% loss in body weight
2015 – 130 participants averaged 7.2% loss in body weight
2016 – More than 500 participants currently enrolled
In addition to NDPP, St. Joseph’s Medical Center has focused on addressing obesity in both adults and
youth through a variety of tactics in partnership with Crow Wing Energized. These include promotion of
active living, healthy eating and breastfeeding. For more details, see Appendix B.
PRIORITY 2: TOBACCO USE/PREVENTION/CESSATION
St. Joseph’s Medical Center has partnered with Crow Wing Energized to offer tobacco prevention and
cessation efforts surrounding policy, system and environmental changes that target tobacco-free
housing efforts. In a deeper partnership with “Crave the Change” through CentraCare, St. Joseph’s
Medical Center used the content expertise to:
•
•
•
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Send four direct-mail pieces on education and policy promotion to all Crow Wing County multiunit housing list residents.
Host “Lunch & Learn” sessions with a lawyer to provide free legal advice on tobacco policy
change and implementation.
Continue bimonthly follow-up to people who have expressed interest in policy change.
Engage with attendees who attended community-led event and have a vested interest.
St. Joseph’s Medical Center also partnered with Crow Wing County Public Health, Wadena County Public
Health, Crave the Change, Central Lakes College-Brainerd Campus, Central Lakes College-Staples Campus
to provide training assistance to college wellness champions for a policy change supporting tobacco-free
campuses.
PRIORITY 3: REDUCTION OF BINGE/EXCESSIVE DRINKING
St. Joseph’s Medical Center has not addressed this need within the community. The Community Health
Needs Assessment Implementation Strategy, Fiscal Year 2014 Progress Report and Fiscal Year 2015
Update, detailed the following: As described in the original implementation strategy, the hospital facility
will not directly address the seven other health needs identified system-wide due to resource
constraints and the pursuit of quality over quantity. The Crow Wing Energized movement, however, may
address some of these needs, particularly preventive care and access to mental health care.
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2016 Community Health Needs Assessment
Objectives
Essentia Health is called to make a healthy difference in people’s lives. To fulfill that mission, we seek
opportunities to both enhance the care we provide and improve the health of our communities. In
conducting the Community Health Needs Assessment, Essentia Health has collaborated with community
partners to embrace these guiding principles:
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•
•
Seek to create and sustain a united approach to improving health and wellness in our community
and surrounding area;
Seek collaboration towards solutions with multiple stakeholders (e.g. schools, work sites, medical
centers, public health) to improve engagement and commitment focused on improving
community health; and
Seek to prioritize evidence-based efforts around the greatest community good that can be
achieved through our available resources.
The goals of the 2016 Community Health Needs Assessment were to:
1. Assess the health needs, disparities, assets and forces of change in Essentia Health-St. Joseph’s
Medical Center service area;
2. Prioritize health needs based on community input and feedback;
3. Design an implementation strategy to reflect the optimal usage of resources in our community;
and
4. Engage our community partners and stakeholders in all aspects of the Community Health Needs
Assessment process.
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Description of Community Served by Essentia Health – St. Joseph’s Medical Center
Through the partnership with Crow Wing
County Public Health and collaborative efforts
within the SHIP Grant, a focus on Crow Wing
County was determined since 70 percent of
Essentia Health clinic encounters came from
this service area in 2015.
Even though Crow Wing County is a focus
area for Crow Wing Energized, many efforts
partner with portions of Cass and Morrison
counties, their public health staff and Essentia
Health clinics outside of the county to achieve
aligned goals.
Thanks to our mission and our Benedictine
roots, Essentia addresses the health needs of
the area’s most underserved populations.
Additional demographic information for Crow
Wing County collected from the U.S. Census
and the 2014 Crow Wing County Health
Survey can be found in Appendix C.
Essentia Health–St. Joseph’s Medical Center
defined our community as our primary and
secondary service area as where we are
physically located. Crow Wing County
Community Services has also been a strong
partner in health efforts targeted at
community need and readiness. Our
organization works with community partners
within the five-county region in many aspects
including planning, funding and collaborating efforts to support health and
wellness.
Barriers facing our population include income disparity and an aging
population. Data shows these two characteristics increase the risk for falls and for obesity related to
unhealthy eating and inactivity. Crow Wing County has nearly 21 percent of its population over the age
of 65, compared to 14 percent for the state of Minnesota.
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Population Characteristics
Crow Wing County
Minnesota
Population
63,428
5,489,594
Median Household Income
$49,186
$60,828
Household Income less than $10,000
10.90%
11.50%
Some High School, no diploma
7.40%
7.70%
High School Graduate (or GED)
92.60%
92.30%
% of Population over the age of 65
20.7%
14.3%
% of Population, white alone
96.6%
85.3%
Data Source: U.S. Census Quick Facts webpage.
Process Overview
Essentia’s Community Health Committee developed a shared plan for the 15 hospitals within the system
to conduct their 2016 Community Health Needs Assessments (CHNA). This plan was based on best
practices from the Catholic Health Association and lessons learned from the completion of Essentia’s
first CHNAs in 2013. This process was designed to:
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•
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Incorporate community surveys and existing public data
Directly engage community stakeholders
Collaborate with local public health and other healthcare providers
From there, each of Essentia’s three regions was responsible for adapting and carrying out the plan
within their communities and hospital service areas. The Essentia Health-St. Joseph’s Medical Center
assessment was conducted in four stages: assessment, prioritization, design and finalization. The
process began in August 2014 and was completed in April 2016 with the final presentation of the
Community Health Needs Assessment for Essentia Health-St. Joseph’s Medical Center being presented
to leadership and the Board of Directors on May 3, 2016. The following page describes the assessment
steps and timeline for this Community Health Needs Assessment.
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2016 Community Health Needs Assessment
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ASSESS
Define Service Area
Service Area
Demographics
Analyze Secondary
Data
Set Criteria for
Prioritized Needs
Choose Prioritization
Method
Choose Needs to
Address
(March - April
2016)
Goal Setting
Identify the "team"
for each strategy
Determine strategy
options
FINALIZE
Review with key
stakeholders for final
feedback
Present to Hospital
Board for Approval
(April - October
2015)
PRIORITIZE
(December 2015
- March 2016)
DESIGN
(May 2016)
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Gather Community
Input
Conduct Asset
Mapping of Available
Community
Resources
Evaluate Progress on
2013 CHNA Priorities
Choose
Strategies/Programs
Set SMART
Objectives
Design
Implementation Plan
and Evaluation
Framework
2016 Community Health Needs Assessment
St. Joseph’s Medical Center
Assessment Process
Phase 1: Assessment
In 2014, Essentia Health-St. Joseph’s Medical Center staff, Crow Wing County Community Services and CentraCare
Health Foundation developed the questions for a Crow Wing County Community Health Survey instrument with
technical assistance from the Minnesota Department of Health Center for Health Statistics. For survey methodology, see
Appendix D.
Survey results were presented to more than 120 community leaders and representatives at the Crow Wing Energized
Health and Wellness Summit in January 2015. To review a two-page easy-to-read summary of the result, see Appendix E.
Key findings from the survey and other supporting data included:
• 65% of adults in Crow Wing County are overweight or obese
• 2 of 3 adults do not eat the recommended five or more fruits and vegetables a day
• 2 of 3 adults do not meet recommendations for moderate or vigorous physical activity
•
According to a March 2016 Minnesota Department of Health report: “Adult Minnesotans living in households
earning less than $35,000 per year are nearly two and a half times more likely to have diabetes than
Minnesotans living in households with annual incomes more than $35,000.”
•
The diabetes rate for working-age (18- to 64-year-olds) Minnesotans living in households with incomes less than
$35,000 is 12.5 percent, compared to a rate of 5 percent for working-age Minnesotans living in households with
incomes greater than $35,000. Additional outreach efforts related to diabetes and prediabetes should be
focused on our population impacted by lower annual incomes.
•
1 of 4 adults in Crow Wing County are dealing with some form of a mental health condition, such as depression
or anxiety
•
Based on the U.S. Census, Crow Wing County has a higher percentage of adults age 65 and older compared to
the rest of the state. This was considered in developing the hospital’s community health implementation plan.
•
Based on the size of Crow Wing County and data that shows its population to be greater than 97% Caucasian, as
well as limitations in conducting a mail survey, additional data based on race, ethnicity and health outcomes
specific to Crow Wing County, is unavailable. However, the hospital still considered the impact of race and
ethnicity on health outcomes when implementing the strategies.
Additional data can be found within these appendices:
Appendix F: Crow Wing County compared to the state and national data
Appendix G: Crow Wing County compared to Region Five data
Appendix H: Crow Wing County cost of living analysis
•
•
50% are not meeting the cost of living needs within our community
12% of our population is living in poverty, including 15% of children.
Appendix I: Central Region body mass index obesity and overweight rates within adults
Appendix J: Central Region body mass index obesity and overweight rates within pediatrics
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Limitations of Findings from Survey Data
There are several sources of bias that can affect data collected via survey, including non-response and factors related to
respondents.
Non-response refers to the fact that some selected respondents did not complete and return the survey. Additionally,
some respondents refused to answer specific questions on the survey. Bias can occur if those who did not respond are
somehow different than those who did respond.
Other potential sources of bias relate to differences amongst respondents in their interpretations of questions, honesty
in answering, accuracy of recall and willingness to disclose information.
Due to the response rate and size of Crow Wing County, data from the 2014 Community Health Survey was unable to be
stratified based on race or ethnicity, this provides a gap in addressing the health needs of subsets of the population of
Crow Wing County.
A community grassroots movement called Crow Wing Energized was formed in 2013 (See Appendix B). It is led by
Essentia Health-St. Joseph’s Medical Center and Crow Wing County Community Services, in collaboration with
Minnesota Department of Health’s (MDH) Statewide Health Improvement Program (SHIP). The goal is to improve health
and wellness in our community through collaborative solutions with multiple community stakeholders focused on
efforts that can create the greatest community good with our available resources. St. Joseph’s Medical Center CEO and
president is one of the co-chairs for this community leadership team with Crow Wing County’s Public Health Community
Services program manager. St. Joseph’s Medical Center also employs the coordinator for the Crow Wing Energized
health and wellness movement and the coordinator for the National Diabetes Prevention Program (NDPP). Crow Wing
Energized has grown to engage more than 120 community representatives and includes a community leadership team
representing the broad interests of the community; a complete list with names is available upon request.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Essentia Health Central Region president
Essentia Health St. Joseph’s Medical Center
Essentia Health – Brainerd Clinic
Crow Wing County Public Health
City of Brainerd
Crow Wing County (Adult Mental Health, Chemical Dependency and Adult Protection Teams)
Hallett Community Center, Crosby, MN – representing a low income community
Crow Wing and Southern Cass County United Way
Brainerd YMCA
Heartland Hospice – representing the aging population
Brainerd Lakes Area Chamber of Commerce
ISD 181 Brainerd Public School District
Brainerd Dispatch
The Good Samaritan Society
University of Minnesota Extension – representing under-served, low-income and rural residents
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In 2015, representatives from Crow Wing Energized presented the summary findings of the Crow Wing County
Community Health Survey to more than 20 targeted groups and engaged these audiences: government officials,
businesses, community members, school leaders, non-profits and faith communities.
Discussion and input followed each community presentation. Feedback was invited on areas of opportunity and
disparity, areas where others in the community may already be working and a prioritization of needs.
There were no written comments received on the 2013 Community Health Needs Assessment, any comments received
would have been integrated into this report.
Phase 2: Prioritization
Needs were prioritized based on the agreement of community stakeholders in 2014 and reinforced at annual health and
wellness summits in 2015 and 2016. The health opportunities would be addressed if these conditions could be met:
•
•
•
Create and sustain a united approach to improving health and wellness in our community and surrounding
areas, helping to make the healthy choice the easy choice.
Collaborate towards solutions with multiple stakeholders (e.g. schools, worksites, medical center) to improve
community engagement and commitment focused on improving community health.
Prioritize evidence-based efforts around greatest community good that can be achieved through our available
resources.
In 2016, these priorities were identified and affirmed by community stakeholders:
Priority 1: Crow Wing Energized
Priority 2: Obesity, physical inactivity, poor nutrition
Priority 3: Falls prevention
Priority 4: Build resiliency
Priority 5: Advanced care directives
Although data from our 2014 Community Health Survey indicates 31% of adults in Crow Wing County participate in
binge drinking, the hospital has elected not to address this as a priority during FY2017-2019 due to limited resources.
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Phase 3: Design of Strategy and Implementation Plan
All implementation strategies reflect partnerships with existing healthcare facilities and resources within the community
that respond to the health needs of the community. Each priority highlights the appropriate partners and stakeholders;
if additional resources become available, they will be incorporated. These partners and stakeholders represent the
existing healthcare facilities and resources available within the community that are available to respond to the health
needs of the community.
SUMMARY OF COMMUNITY-DEFINED PRIORITIES/STRATEGIES
PRIORITY AREA
GOALS
CROW WING ENERGIZED
Throughout FY 2017–FY 2019, SJMC will assist in
maintaining grassroots health and wellness movement in
partnership with Crow Wing County Community Services.
1.
2.
3.
4.
OBESITY, PHYSICAL INACTIVITY, POOR NUTRITION
Steering committee meetings, 10 per year
Goal group meetings, 10 per year
Host annual health and wellness event
Develop infrastructure for deeper community
partnerships for employers with 10 or fewer
employees.
By the end of FY 2019, SJMC will have 60% of NDPP
participants meet or exceed CDC recommendations on
weight loss (5% of body weight) and exercise during the
program duration (1 year).
In 2016, we will reach at least 500 community members,
with 15% annual growth in NDPP participation.
Begin to address childhood obesity through strategic
partnerships and programming.
FALLS PREVENTION
In FY 2017, SJMC will build infrastructure for “Matter of
Balance” community class opportunities.
In FY 2018, SJMC will reach 100 community participants
within approximately 10 “Matter of Balance” classes.
In FY 2019, SJMC will help to increase community
participation by 20%.
BUILD RESILIENCY
In FY 2017, SJMC will improve resilience for individuals in
our community most at risk and help develop skills to cope
with life’s stresses by increasing awareness of Adverse
Childhood Experiences (ACEs). We’ll reach 25% of Crow
Wing County residents through media partnerships to
raise awareness and connections to resources.
In FY 2017, SJMC will develop a measure on reach to
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PRIORITY AREA
GOALS
2016 Community Health Needs Assessment
St. Joseph’s Medical Center
specific audiences.
These tactics will increase resiliency within the community:
In FY 2017, SJMC will increase the reach of “Attitude of
Gratitude” (Resiliency Building Tool Kit) by 15%.
In FY 2018, SJMC will spread “Attitude of Gratitude” reach
and develop another evidence-based initiative supporting
resiliency.
In FY 2019, SJMC will increase the reach of “Attitude of
Gratitude” and second resiliency tool by 15% as well as
develop a third evidence-based initiative supporting
resiliency.
ADVANCED CARE DIRECTIVES
Increase the impact of individuals within the community
who have an advanced care directive on file with their
primary care provider.
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IMPLEMENTATION STRATEGY
Priority 1: CROW WING ENERGIZED
Partners: Crow Wing County Public Health, City of
Brainerd, Crow Wing County (Adult Mental Health,
Chemical Dependency and Adult Protection Teams),
Hallett Community Center (Crosby, MN), Crow Wing and
Southern Cass County United Way, Brainerd YMCA,
Heartland Hospice, Brainerd Lakes Area Chamber of
Commerce, Brainerd Public School District, Pequot Lakes
School District, Crosby Ironton School District, Crosslake
Community Charter School, Brainerd Dispatch, University
of Minnesota Extension SNAP ED Educators, U of M Master
Gardeners, St. Christopher’s Catholic Church, Lord of Life
Lutheran Church, Cuyuna Regional Medical Center, Mills
Ford Company, The Center (aging population), Nisswa
Lutheran Church of the Cross, Crow Wing County Land
Services, Brainerd Park United Methodist Church, Carefree
Living, Union United Church of Christ, Takedown Gym,
Salvation Army-Brainerd, Crosby High School, Trailside
Center, Pequot Tool & Equipment, Anytime Fitness Center,
Brainerd YMCA, Trinity Lutheran Church, Crosslake
Lutheran Church, CTC - Consolidated Telecommunications
Company, CLOW Stamping, Pine River Life Center, Pillager
Food Shelf, St. Croix Hospice, Lord of Life Lutheran Church,
Crow Wing County Victim Services Inc., Crosslake Lutheran
Church, Pointway Church, Good Samaritan Society, Senior
Linkage Line, Grandview Lodge, Central MN Council on
Aging, Breezy Point Police Department, Crow Wing County
Veteran’s Assistance Services, Happy Dancing Turtle &
Hunt Utilities Group, Nisswa Chamber of Commerce, Crow
Wing Power, City of Pequot Lakes, Hopkins Health and
Wellness, SNAP Fitness Center, Ultra Paws, Crow Wing
County Human Resources, Minnesota Teen Challenge –
MNTC, Northern Pines Mental Health, Community
Behavioral Health Hospital–Baxter, Wellness in the Woods,
NAMI – Crisis Line and Referral Services, Minnesota
Communities Caring for Children, MN Adult and Teen
Challenge, Nystrom & Associates, Pathways to Harmony,
Smile Again Ministries, Crisis Line and Referral Services,
Brainerd Lakes Early Childhood Coalition, Crow Wing
County Victim Services, University of Minnesota, Lakes
Area Restorative Justice Program, Brainerd Lakes Holistic
Community, Blue Cross Blue Shield, EssentiaCare, Health
Partners, Minnesota Department of Health, Statewide
Health Improvement Program (SHIP).
Strategy #1
Action(s)
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In FY2017-FY 2019, SJMC will help to maintain grassroots
health and wellness movement in partnership with Crow
Wing County Community Services as an ongoing
sustainable effort.
Steering committee meetings, 10 per year
Goal group meetings, 10 per year
Host annual health and wellness event
Develop infrastructure for deeper community partnerships
for employers with 10 or fewer employees. (Brainerd Lakes
Chamber of Commerce reports 75% of local businesses
have 10 or fewer employees)
Expected Short-Term Outcomes
Sources of Measuring Outcomes
Increased community participation and awareness in
community health activities.
Attendance rosters, registration for annual conference
Priority 2: OBESITY, PHYSICAL INACTIVITY, POOR NUTRITION
Partners: St. Christopher’s Catholic Church, Lord of Life
Lutheran Church, Cuyuna Regional Medical Center, Mills
Ford Company, Essentia Health-St. Joseph’s Hospital,
Essentia Health-Baxter Clinic, Essentia Health-Brainerd
Clinic, The Center (aging population), Nisswa Lutheran
Church of the Cross, Crow Wing County Land Services,
Crow Wing County Community Services, Brainerd Park
United Methodist Church, Carefree Living, The City of
Brainerd, Union United Church of Christ, Takedown Gym,
Salvation Army-Brainerd, Crosby High School, Trailside
Center, Pequot Tool & Equipment, Pequot Lakes High
School, Anytime Fitness Center, Brainerd YMCA, Trinity
Lutheran Church, Crosslake Lutheran Church, CTC, CLOW
Stamping, Pine River Life Center, Pillager Food Shelf, St.
Croix Hospice, community volunteers, Crow Wing
Energized, Lord of Life Lutheran Church, Crow Wing
County Victim Services Inc., Crosslake Lutheran Church
Strategy #1
Action(s)
By the end of FY 2019, SJMC will have 60% of NDPP
participants meet or exceed the CDC recommendations on
weight loss (5% of body weight) and exercise during the
program duration (1 year).
SJMC will host at least one NDPP training for community
leaders for further implementation efforts; special focus
will be on community partners who work with lowerincome and aging populations.
In 2016, we will reach at least 500 community members,
with 15% annual growth in NDPP participation.
Begin to address childhood obesity through strategic
partnerships and programming.
Expected Short-Term Outcomes
Sources of Measuring Outcomes
Increase the community’s capacity to address being
overweight, obese or having prediabetes by training
lifestyle coaches and improving access to class offerings.
Health coaches’ data
Attendance records from lifestyle coach trainings
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Specific focus will be on community partners who work
with lower-income and aging populations.
Expected Long-Term Outcomes
Sources of Measuring Outcomes
In FY 2018 and FY 2019, SJMC will increase community
reach with 15% annual growth (from 500 participants) in
participation.
Health coaches’ data
Priority 3: FALLS PREVENTION
Partners: Good Samaritan Society-Bethany, Good
Samaritan Home Care, parish nurses, Crow Wing County
Public Health, community volunteers, Brainerd Family
YMCA, Minnesota State Services for the Blind, Carefree
Living-Brainerd, Riverside Assisted Living, Pillager, Comfort
Keepers, Northern Lakes Senior Living, Central Minnesota
Council on Aging, Todd County Public Health, Morrison
County Public Health, Cass County Public Health.
Strategy #1
Action(s)
In FY 2017, SJMC will build infrastructure for “Matter of
Balance” community class opportunities.
Host at least one “Matter of Balance” training in
partnership with Minnesota Council on Aging each year.
In FY 2018 – SJMC will reach 100 community participants
in approximately 10 “Matter of Balance” classes.
Collaborate with existing community partners and those
being developed to mainstream a referral process from
Essentia Health providers to these community assets.
In FY 2019, SJMC will help to increase community
participation by 20%.
Class hosts to be determined. Specific focus will be placed
on community partners working with lower-income
populations.
Expected Short-Term Outcomes
Sources of Measuring Outcomes
Increase the community capacity to address falls
prevention by training “Matter of Balance” coaches.
Attendance records from “Matter of Balance” coach
training
Expected Long-Term Outcomes
Sources of Measuring Outcomes
Reduce falls and associated healthcare costs.
Minnesota Council on Aging and American Hospital
Association data related to falls in Crow Wing County
Priority 4: BUILD RESILIENCY
Partners: Community volunteers, Northern Pines Mental
Health, Community Behavioral Health Hospital–Baxter,
Crow Wing County Community Services, faith
communities, Wellness in the Woods, NAMI, Minnesota
Communities Caring for Children, local school districts,
local businesses, Chamber of Commerce, Brainerd
Dispatch newspaper, MN Adult and Teen Challenge,
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St. Joseph’s Medical Center
Nystrom & Associates, Pathways to Harmony, Smile Again
Ministries, Crisis Line and Referral Services, Brainerd Lakes
Early Childhood Coalition, Crow Wing County Victim
Services, University of Minnesota, Lakes Area Restorative
Justice Program.
Strategy #1
Action(s)
In FY 2017, SJMC will improve resilience for individuals in
our community most at risk and help develop skills to cope
with life’s stresses by increasing the awareness of Adverse
Childhood Experiences (ACE’s). We’ll reach 25% of Crow
Wing County’s population through media partnerships to
raise awareness and connections to resources.
Continue collaborating with local newspaper to educate
and promote resiliency-building skills.
Specific focus will be placed on community partners who
work with lower-income and aging populations.
Improve resilience to help community cope with life’s
stresses through prevention methods.
Expected Short-Term Outcomes
Sources of Measuring Outcomes
In FY 2017, SJMC will develop a measure on reach to
specific audiences.
Community partners will report to Essentia Health staff on
the population, reach and impact that the tool kit provides
in their workplace, community setting, service group etc.
In FY 2017 – SJMC will increase the reach of “Attitude of
Gratitude” (Resiliency Building Tool Kit) by 15%.
Pre- and post-questionnaires will be used by community
partners to measure resiliency based research by Dr. Bryan
Sexton.
Expected Long-Term Outcomes
Sources of Measuring Outcomes
In FY 2018, SJMC will spread the reach of “Attitude of
Gratitude” (Resiliency Building Tool Kit) and develop
another evidence-based initiative supporting resiliency.
Community partners will report to Essentia Health staff on
the population, reach and impact that the tool kit provides
in their workplace, community setting, service group etc.
In FY 2019, SJMC will increase the reach of “Attitude of
Gratitude” and the second tool by 15% as well as develop
a third evidence-based initiative supporting resiliency.
Priority 5: ADVANCED CARE DIRECTIVES
Partners: Crow Wing County Public Health, Carefree Living,
Heartland Hospice, Comfort Keepers, Northern Lakes
Senior Living, Riverside Assisted Living-Pillager, Minnesota
State Services for the Blind, Good Samaritan SocietyWoodland, Bethany, home care, parish nurses, community
volunteers, Central Minnesota Council on Aging, Wellness
in the Woods, Cass County Public Health,
Todd/Morrison/Wadena County Public Health
Strategy #1
Action(s)
Increase the impact of individuals within the community
Specific focus will be placed on populations age 65 and
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who have an advanced care directive on file with their
primary care provider.
older.
Expected Short-Term Outcomes
Sources of Measuring Outcomes
In FY 2017, SJMC will measure to establish a baseline on
the number of people who have an advanced care
directive on file with their primary care provider.
Primary care records within Essentia Health’s Central
Region show baseline measure of 17.7% of patients age 65
and older who have an advanced care directive on file.
Raise awareness and education surrounding “aging in
place” and advanced care directive planning.
Registration reach for “Got Plans” aging conference and
other ongoing efforts.
Expected Long-Term Outcomes
Sources of Measuring Outcomes
In FY 2018 and FY 2019, SJMC will have an annual increase
of 10 percent in patients age of 65 and older who have an
advanced care directive on file with their primary care
provider.
Primary care records showing advanced care directives on
file.
Conclusion
As part of a nonprofit health system, Essentia Health-St. Joseph’s Medical Center is called to make a healthy difference
in people’s lives. This needs assessment and implementation plan illustrates the importance of collaboration between
our hospital and its community partners. By working collaboratively, we can have a positive impact on the identified
health needs of our community during Fiscal Years 2017-2019. There are other ways in which Essentia Health-St.
Joseph’s Medical Center has and will continue to indirectly address local health needs; including the provision of charity
care, the support of Medicare and Medicaid programs, discounts to the uninsured and others. Over the next three years,
Essentia Health-St. Joseph’s Medical Center will continue to work with the community to ensure that this
implementation plan is relevant and effective and to make modifications as needed.
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APPENDIX A
CWE Communications Plan
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Strategic Communications Plan – 2015
Template Resource Provided By The Statewide Health Improvement Program (SHIP)
Initiative Goal:
Crow Wing Energized is a united approach to improve health and wellness in our community by making healthy choices essential. We are looking for
collaborative solutions with multiple community stakeholders focused on efforts that can create the greatest community good with our available resources.
Communications Objective(s):
•
•
•
•
Crow Wing Energized webpage
Construct an online repository of health and wellness services
Monday/Monthly Motivator in area newspapers
Other communications techniques per the ongoing communications plan.
Audience:
•
Crow Wing Energized is a movement to serve the 62,000 residents of Crow Wing County
Key Values Messages:
Crow Wing Energized is a health and wellness grassroots movement to improve the overall health of the 62,000 residents in Crow Wing County over a sustained
period of time. This initiative is being co-lead by Crow Wing County Community Services and Essentia Health. Guiding principles of the movement are:
•
We seek to create and sustain a united approach to improving health and wellness in our community and surrounding area.
•
We seek collaboration towards solutions with multiple stakeholders (e.g. schools, worksites, medical center) to improve community engagement and
commitment focused on improving community health.
•
We seek to prioritize evidence based efforts around greatest community good that can be achieved through our available resources.
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S C A N
Strengths, Weaknesses, Opportunities, Threats(SWOT) that influence what communications tactics are achievable on
time/budget and how they will be percieved within the larger community conversation
Strengths
Weaknesses
Opportunities
Threats
• Engaged a large amount of
influencers and decision makers
• Broad audience to reach
• Engaged community, as
demonstrated by early interest in
this movement
• Private businesses may be in
competition
• Strong media relationships
• Challenges with breaking through
the media clutter
• Organizational infrastructure
• Beginning brand recognition
• Staffing plan built into the structure
to support communications
• Budget support of communications
strategies
• Community is ready for change
• Building off successes of Crow Wing
Energized movement and SHIP3
efforts
• Public private relationship
championing this effort to help
increase sustainability
• Re-education as additional people
engage
• Cross-generational stakeholders
engaged
• Balance between SHIP strategies
and community needs
• Gap with connection to faith
communities
• Numerous community events
established to use as venues for
community education and
engagement
22
• Disengaged community members
• Longevity is needed for success
• Culture currently often times makes
the unhealthy choice the easy
choice so this movement is counter
cultural
• Healthy choices are often perceived
as more expensive
S U S T A I N I N G
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T A C T I C S
Core communications tactics used to maintain support and information flow with key audiences
Tactic
Audience
Timing
Responsible
The Healthy Choice Blog
Community members and
influencers
Weekly
Authored by an initiative point person and submitted to CWE
Community Connections Goal Group for review, editing and posting.
Must contain links to supporting organizations or content specific to
Crow Wing County.
Crow Wing Energized Library Resources
Library patrons and
community members
Monthly
Initiative point person will provide a list of 2-5 articles or books that a
community member may reference supporting the specific healthy
initiative. Recommend readings for both children and adults are
encouraged. The titles and topic will be listed/linked to from
CrowWingEnergized.com and showcased in local libraries with a table
dedicated to the CWE movement.
Crow Wing Energized newsletter
Businesses, Influencers and
community members
Monthly
Push content from Blog and Monthly/Monday Motivators,
engagement opportunities, upcoming events and trainings, and Goal
Group meeting times in both print and electronic format
Life Unlimited column
Senior population in Crow
Wing County
Quarterly
Submit article and visuals to the senior population for feature in this
quarterly printed publication targeted at the senior population
Crow Wing Energized Calendar of Events
Businesses, Influencers and
community members
Daily
Community members may submit events to CWE Community
Connections Goal Group for review and posting on the CWE.com
website to serve as a repository of healthy events and educational
opportunities in Crow Wing County. Additionally, the events
repository will push CWE events to key community event calendars.
Community Awareness Campaign
Businesses, Influencers and
community members
Ongoing
Raise awareness of CWE and generate enthusiasm for specific
initiatives
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T A C T I C S
One-time events that can be leveraged to communicate the Initaitive’s value with multiple audiences to generate
momentum for change. Consider developing a specific plan for each “event”as they arise. Aim for at least 5 to 6
throughout the year.
Event
Tactics
Audience
“Headline” Message
Messenger
Timing
Annual Crow Wing Energized Health &
Wellness Summit
Personal invitations to
decision makers and
influencers w/ follow-up
letter and materials to
those who were unable to
attend
Key leaders and
influencers in Crow
Wing County
Review progress and
goals of Crow Wing
Energized. Receive
feedback on
priorities areas
This event will be led
by the Crow Wing
Energized co-chairs
with content highlights
from Goal Group
leaders or Community
Leadership Team (CLT)
members
Annually in midwinter
Crow Wing County Fair
Personal engagement with
community members on
how to engage in specific
initiatives
Community
members
How is the healthy
choice the easy
choice for me in the
community
Booth at the Crow
Wing County Fair
Annually in
August
Community Presentations
Personal connection with
established groups in Crow
Wing County
Key leaders and
influencers in Crow
Wing County as well
as community
members
CWE movement, is
making progress in
key initiatives, and
how to engage
CWE coordinator and
volunteers
Ongoing, as
needed
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APPENDIX B
CWE Movement efforts
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2016 Community Health Needs Assessment
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Crow Wing Energized Health and Wellness Movement
Crow Wing Energized is a united approach to improve health and wellness in our community by making healthy choices
essential. We are looking for collaborative solutions with multiple community stakeholders focused on efforts that can
create the greatest community good with our available resources.
The Crow Wing Energized Steering Committee meets monthly along with four goal groups - Healthy Choices, Mental
Fitness, Workplace Wellness and Community Connections - for a total of 60 engaged community partners. The total
effort, including outside meetings, exceeds 120 community volunteer partners. Expected outcomes and guiding
principles were established for the steering committee as well as the goal groups.
Steering Committee Charge:
Enhance health and wellness through the development and implementation of a county-wide strategic plan.
Steering Committee Guiding Principles:
1. We seek to create and sustain a united approach to improving health and wellness in our community and
surrounding area.
2. We seek collaboration towards solutions with multiple stakeholders (e.g. schools, worksites, medical center) to
improve community engagement and commitment focused on improving community health.
3. We seek to prioritize evidence-based efforts around greatest community good that can be achieved through our
available resources.
Healthy Choices
Purpose:
To develop sustainable strategies that encourages the population of Crow Wing County to make healthy choices.
General Desired Outcomes:
1. Increase access to healthy food choices.
2. Increase active living opportunities and active lifestyles.
3. Promote and support healthy environments.
Mental Fitness
Purpose:
To encourage and equip citizens in achieving and maintaining mental fitness.
General Desired Outcomes:
1. Build networks throughout the county to equip citizens in achieving resilience.
2. Increase the practice of intentional choices to reduce stress and anxiety.
3. Educate to increase the community knowledge on mental fitness so individuals can make positive choices regarding
their overall health.
Workplace Wellness
Purpose:
To create a healthy and energized workforce.
General Desired Outcomes:
1. Achieve employee satisfaction.
2. To maximize productivity.
3. To minimize absenteeism.
4. Reduce healthcare costs.
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Community Connections
Purpose:
To connect Crow Wing County citizens to services, events, organizations, and resources which promote healthy living.
General Desired Outcomes:
1. Increase awareness of available services, programs, and events promoting health in Crow Wing County.
2. Promote Crow Wing Energized health and wellness movement and the citizen-inspired programs and events
throughout the county.
Supporting Community Health Development
Crow Wing Energized was able to support more than 40 Healthy Community grants ranging from $500 to $5,000 each
for a total more than $70,000 given back to the community, and more than $300,000 leveraged from the multiple
stakeholders.
These partners and areas of health and wellness were impacted in a positive manner through the process:
1. Northern Pines Mental Health to implement “Active Living, Tobacco, and You” an evidence-based curriculum
that promotes tobacco cessation, healthy eating and physical activity to those struggling with chronic mental
health concerns.
2. Northland Arboretum for a handicapped-accessible fitness trail, as well as a deeper community partnership with
the local school district and its community garden.
3. Forestview Middle School for a “Little Diggers School Garden” in partnership with the Northland Arboretum;
promoting Gardening 101 classes in partnership with Master Gardeners and University of Minnesota Extension
workers in the community.
4. Local public library to promote healthy eating, gardening and active living for the youth.
5. Local city government for way-finding signs, bike racks and active living promotion.
6. Local community center to promote active living and education on health and wellness.
7. Local public and charter school districts to promote farm-to-school foods; healthy eating and snacks during the
school day; school gardens; active recess; and staff trainings on safe and productive recess time.
8. Local food shelf coalition: Food shelf partner started a community garden and implemented healthy choices in
the food shelf. We have established other community partnerships for education on healthy eating, including
choice model shopping, which promotes choosing produce and other fresh, healthier versions of food as well as
education on how to make healthier donations to food shelves.
9. Local food co-op was established in a food desert. It incorporates a farmers’ market start-up with EBT readers to
help provide healthy food options for low-income families.
10. Through community connections established within the Workplace Wellness Goal Group and a partnership with
the local Chamber of Commerce, 10 local businesses implemented policy, systems and environmental changes
to support active living, healthy eating (including breastfeeding support), and tobacco cessation best practices.
11. More than 30 local child-care facilities and home day-care partners have been trained to promote healthy foods
and physical activity, including less screen time for children.
12. Local youth center increased physical activity in the daily routines of at-risk youth, including a policy on less
screen time.
13. Local college was supported through tobacco policy changes and cessation efforts.
14. Local housing authorities and its partners were supported in policy, system and environmental changes on
tobacco-free housing efforts.
15. Local aging coalition began, which in encompasses more 25 community partners working on:
27
a.
b.
c.
d.
e.
f.
g.
Fall awareness and prevention
Advanced care planning (health care directives)
Healthy eating and exercise
Care transitions
Active lifestyle and socialization
Companionship and respite
Caregiver resources
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Crow Wing Energized has hosted numerous health- and wellness-related events on which a variety of topics.
1. Annual Health and Wellness Summits
a. February 2014
i. 60 attendees
ii. Announced Essentia Health and Crow Wing county partnership
iii. Identified focus areas (goal groups)
iv. Named movement to solidify ownership/engagement
b. January 2015
i. 120 attendees
ii. Shared county-specific health survey results
iii. Identified future priorities
iv. Provided opportunities for engagement
c. January 2016
i. 270 attendees
ii. Provided education and networking for communities to celebrate past successes and rally
around future efforts
iii. Launched community-wide lifestyle change program
2. April 2015 – Business After Hours Workplace Wellness Promotion
a. 150 attendees
b. Promoted education and support surrounding best practices in the workplace for active living, healthy
eating, tobacco support and breastfeeding support
3. Resiliency – Three Good Things Launch (See Appendix for resiliency tool kit)
a. August 2015 – Crow Wing County Fair (2,000 participants) (appendix tree data)
b. August 2015 – April 2016 (2,500 participants) (appendix tree data)
i. Partnered with numerous local businesses, school districts, mental health facilities, faith
communities, local jail and youth centers to promote “three good things” in their realm of
influence.
4. September 2015 – Dr. Bryan Sexton, The Science of Resiliency (appendix tree data)
a. 220 attendees
b. Provided evidence-based information on resiliency and further promoted our “Three Good Things”
campaign.
5. April 2016 – Got Plans?
a. Number of attendees to be determined
b. Topics: Aging in Place, Health Care Directives, Falls Prevention, Financial Planning, Difficult
Conversations
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APPENDIX C
Crow Wing County Demographics
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Crow Wing County Community Health 2014 Adult Survey
Demographic
Characteristic
Crow Wing
County
Minnesota
n=757
Percent
Percent
Male
49.4
Female
50.6
49.6*
50.4*
18-34
24.6
35-44
14.5
45-54
19.1
55-64
17.8
65-74
13.2
75+
10.8
White
96.5
Not white
3.5
Gender
Age Group
62.2*
14.3*
White/Of
color
81.4
18.6
5.1
Hispanic/Latino
Somali
Other ethnicity
17.4
1.3
5.9
4.8
American Indian or Alaska Native
Black, African or African American
Asian or Pacific Islander
Other race
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2016 Community Health Needs Assessment
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Education
Less than HS
3.1
High school/GED
19.4
Some college/vocational school
31.7
Associate’s degree
13.3
Bachelor's degree
22.4
Graduate/professional degree
10
Less than $10,000
6.2
$10,000-$14,999
5.8
$15,000-$24,999
12.4
$25,000-$34,999
11
$35,000-$49,999
15.3
$50,000-$74,999
21.8
$75,000-$99,999
12.2
$100,000+
15.3
5.5
4.4
9.1
9.1
13
18.9
14.1
25.8
Employed
57.8
65.7
Self-employed/farmer
11.2
Unemployed
1.1
Homemaker/stay-at-home parent
5.2
Student
1.5
Retired
26.2
Unable to work
6.3
91.8
31.8
Income
Employment
status
(These do not
add up to 100%
because
respondents
could choose
more than one
status)
^Data from U.S. Census QuickFacts web page.
*Data from Minnesota Compass
**Include people whose highest degree was a high school diploma or its equivalent, people who attended college
but did not receive a degree and people who received an associate's, bachelor's, master's, or professional or
doctorate degree.
31
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2016 Community Health Needs Assessment
St. Joseph’s Medical Center
Population 25 years and over
EDUCATIONAL ATTAINMENT
Crow Wing County**
Number
%
2,640
3
Less than 9th grade
9th to 12th grade, no diploma
High school graduate (includes equivalency)
Some college, no degree
Associate’s degree
Bachelor’s degree
Graduate or professional degree
Doctoral degree
Percent high school graduate or higher
Percent bachelor’s degree or higher
5,539
27,043
19,810
8,903
11,033
7
34
25
11
14
Minnesota *
Number
%
158,858
5
222,487
7
912,672
29
759,153
24
243,093
8
605,210
19
3,945
295
4
1
262,872
N/A
89
19
32
8
N/A
87.9
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2016 Community Health Needs Assessment
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2012 Estimated Households by Household
Income
Crow Wing
County**
Number %
Minnesota *
Number %
9610
8
6252
5
6929
6
7273
6
Less than $10,000
3,188
7
$10,000 to $14,999
2,784
6
$15,000 to $19,999
3,026
6
$20,000 to $24,999
3,217
7
$25,000 to $29,999
2,739
6
$30,000 to $34,999
3,026
6
$35,000 to $39,999
2,879
6
$40,000 to $44,999
2,821
6
$45,000 to $49,999
2,405
5
$50,000 to $54,999
2,270
5
$55,000 to $59,999
2,187
5
$60,000 to $64,999
2,013
4
$65,000 to $69,999
1,796
4
$70,000 to $74,999
1,599
3
$75,000 to $79,999
1,301
3
$80,000 to $84,999
1,204
3
$85,000 to $89,999
1,113
2
$90,000 to $94,999
1,013
2
$95,000 to $99,999
934
2
$100,000 to $124,999
2,676
6
$125,000 to $149,999
1,129
2
$150,000 to $174,999
627
1
$175,000 to $199,999
328
1
$200,000 to $249,999
280
1
$250,000 to $499,999
381
1
$500,000 or more
38
0
Total:
46974
117538
$44,657
$46,081
Median Household Income
*Based on 2009 data
33
7117
7047
6871
6416
5724
5500
5137
4561
4078
3784
3460
3145
2919
2529
2306
16880
N/A
N/A
N/A
N/A
N/A
N/A
6
6
6
5
5
5
4
4
3
3
3
3
2
2
2
14
N/A
N/A
N/A
N/A
N/A
N/A
2016 Community Health Needs Assessment
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APPENDIX D
Survey Methodology
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2016 Community Health Needs Assessment
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Survey Methodology
Survey Instrument
Staff from Crow Wing Energized, Essentia Health, Crow Wing County Community Health and CentraCare Health
Foundation developed the questions for the survey instrument with technical assistance from the Minnesota
Department of Health Center for Health Statistics. Existing items from the Behavioral Risk Factor Surveillance System
(BRFSS) survey and from recent county-level surveys in Minnesota were used to design some of the items on the survey
instrument. The survey was formatted by the survey vendor, Survey Systems, Inc. of New Brighton, MN, as a scannable,
self-administered English-language questionnaire.
Sample
A two-stage sampling strategy was used for obtaining a probability sample of adults living in Crow Wing County. For the
first stage of sampling, a random sample of Crow Wing County residential addresses was purchased from a national
sampling vendor (Marketing Systems Group of Horsham, PA). Address-based sampling was used so that all households
would have an equal chance of being sampled for the survey. Marketing Systems Group obtained the list of addresses
from the U.S. Postal Service. For the second stage of sampling, the “most recent birthday” method of within-household
respondent selection was used to specify one adult from each selected household to complete the survey.
Survey Administration
An initial survey packet was mailed to 2,400 sampled households in Crow Wing County on October 7, 2014, that included
a cover letter, the survey instrument, and a postage-paid return envelope. About two weeks after the first survey
packets were mailed (October 21), a postcard was sent to all sampled households, reminding those who had not yet
returned a survey to do so, and thanking those who had already responded. About 10 days after the reminder postcards
were mailed (October 30), another full survey packet was sent to all households that had still not returned the survey.
The remaining completed surveys were received over the next four weeks, with the final date for the receipt of surveys
being December 3, 2014.
Completed Surveys and Response Rate
During the survey administration, 100 sampled addresses were replaced by other eligible addresses due to these
addresses being vacant. Completed surveys were received from 758 adult residents of Crow Wing County for an overall
response rate of 31.8% (764/2400).
Data Entry and Weighting
The responses from the completed surveys were scanned into an electronic file by Survey Systems, Inc.
To ensure that the county level survey results are representative of the adult population Crow Wing County, the data
were weighted when analyzed. The weighting accounts for the sample design by adjusting for the number of adults
living in each sampled household. The weighting also includes a post-stratification adjustment so that the gender and
age distribution of the survey respondents mirrors the gender and age distribution of the adult population in Crow Wing
County according to U.S. Census Bureau 2010 estimates.
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2016 Community Health Needs Assessment
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APPENDIX E
Two-page Summary: Crow Wing County Community Health Survey Results
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2016 Community Health Needs Assessment
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2016 Community Health Needs Assessment
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APPENDIX F
Crow Wing County vs State vs National
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2016 Community Health Needs Assessment
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Number
Age
group
1
Condition or
outcome
Obesity
2
3
Tobacco use
4
5
Adults
aged
18+
6
Physical
activity
Diet
7
Mental
health
8
9
Physical
health
10
Alcohol use
11
Premature
Mortality
Indicator
CWC Health
Survey 2014
results
CWC
27.1
27(2015)
% obese according to BMI
from self-reported height and
1
weight
% reported smoking ≥ 100
cigarettes and are current
1
smokers
% of the population who are
current smokers
% of adults who used ecigarettes at least once in the
past 30 days
% that meet either moderate
or vigorous physical activity
guidelines of ≥ 5 days/week
of ≥ 30 min. moderate OR ≥ 3
days/week of ≥ 20 min.
1,2
vigorous
Average number of mentally
unhealthy days reported in
past 30 days
% reporting diagnosis of
anxiety or panic attacks,
depression, OR other mental
health problems
% reporting fair OR poor
health
21
16 (2006-2012)
11.8
17(2015)
8,28
14.4 (2015)
3.8
N/A
3.2*
3.9(2015)
8
2.8 (2016)
8
19 (2006-2012)
13
N/A
2.9 (2012)
15
Obesity
16
Overweight
17
N/A
29
11
5.8(2015)
11.5 (2013)
8
14
6.38(2013)
16.14(2016)
14
13.32(2013)
13
n/a
13
28.6(2013)
n/a
27
8
8
unable to retrieve
data
29
13.14(2016)
n/a
8
5,100 (2016)
6 (2016)
25
11
8
13(2014)
25,26
19.3 (2014)
0.8 (20074,6
10)
18 (201023
2016)
16 (20068
2012)
7681 (20108
2012)
unable to
retrieve data
14.5 (2013)
11
8 (2006-2012)
9
18 (2012)
12
16
15 (2014)
15
21 (2013)
25
4
17 (20068
2012)
20(2015)
8
22
3.5 (20068
2012)
32.8
5,393(2015)
20
20.6 (2012)
8
11 (2016)
%of live births with low birth
weight
40
18
8
13
21 (20065,8
2012)
3.7 (2014)
16(2015)
n/a
8
17.3 (2015)
19
11.9
Maternal/
Child health
18
19
unable to retrieve
data
14
Tobacco use
5,8
unable to retrieve
data
29
11 (2014)
17
45.0 (2012)
N/A
% in poverty
Youth
29.30
33.9
SES
% obese according to BMI
compared to BMI for-age
percentiles
% overweight according to
BMI compared to BMI for-age
percentiles
% with frequent (20+ days)
use of any tobacco products
during the past 30 days
% of youth who used ecigarettes at least once in the
past 30 days
5.9 (2015)
N/A
n/a
13
29
National
(Years of
Data)
31 (2011)
8,28
Premature death rate
3
stratified by race/ethnicity
Adult
and
Youth
8
17(2015)
Inequality
12
26 (2011)
24.8
% reporting either binge OR
heavy drinking
Premature death rate
8
11.8
35.1
% consuming ≥ 5 servings/day
of fruits and vegetables
1
combined
State (Years of
Data)
10,24
18.1 (2011)
22
3.9 (2014)
12.9 (2015)
8
4,7
22
2016 Community Health Needs Assessment
St. Joseph’s Medical Center
*Includes those who had 0 mentally unhealthy days (63% of all adults). When only adults with at least 1 unhealthy day are examined, the average number of mentally unhealthy days is 8.6.)
1
Minnesota Department of Health (MDH) Statewide Health Improvement Program (SHIP) core health measure
2
Ann Kinney from MDH is looking into other options that may be more relevant to future guidelines; waiting for follow-up
May not apply to all counties because of small numbers. Premature death rates by definition are always by age. Premature death rates can be stratified by race/ethnicity, but there will be
problems of small numbers by race/ethnicity by county by age.
3
4
Health People 2020
5
% of adults who are current smokers, no specific number of cigarettes reported
6
Mean daily intake of total vegetables (age adjusted, cup equivalents per 1,000 calories, 2+ years)
7
Adolescent cigarette smoking in past 30 days (grades 9-12)
8
County Health Rankings and Roadmaps 2015
9
Minnesota Student Survey
10
Smoked cigarettes in past 30 days
11
U.S. Census Bureau
12
CDC
13
Question not on local survey
14
Clarity 2007, Pediatric BMI -- Pediatric patients within this study were with 3-17years of age. (Feb. 2016)
15
MDH Overweight and Obesity Fact Sheet
16
MDH Children & Adolescent Overweight Fact Sheet
17
Cost of Living Analysis
18
CDC Minnesota State Nutrition, Physical Activity, and Obesity Profile
19
MDH Tobacco Prevention and Control: Data and Reports
20
ClearWay Minnesota: Minnesota Adult Tobacco Survey (MATS)
21
Life lost before age 75 per 100,000 population (age-adjusted)
22
Campaign for Tobacco-Free Kids: ELECTRONIC CIGARETTES: USE AMONG ADULTS AND YOUTH. This stat is defined as adults who currently still use e-cigarettes.
23
Anxiety and Depression Association of America & National Institute of Mental Health
24
Teens and Tobacco in Minnesota, 2014 Update
25
2013 Minnesota Student Survey
26
This is data that is based off of 8th grade, 9th grade, and 11th grade students who reported using tobacco "daily" from the 2013 Minnesota Student Survey.
27
Question not asked on the 2013 Minnesota Student Survey.
28
Data based off of tobacco use. There are no specific measures of frequency indicated within results.
29
Data not available within the County Health Rankings.
30
Data indicates 21% inactivity levels for those living within Crow Wing County.
41
2016 Community Health Needs Assessment
St. Joseph’s Medical Center
APPENDIX G
Crow Wing County vs Region Five Counties
42
2016 Community Health Needs Assessment
St. Joseph’s Medical Center
Age group
Overall
County
Health
Ranking
(Score
out of
87)
Adults aged
18+
Adult and
Youth
Youth
Condition or
Outcome
Crow Wing
Todd
Cass
Wadena
Morrison
Health Outcomes
59
50
85
74
65
Health Factors
62
79
84
75
74
Obesity3
66.0
63.0
69.0
64.0
65.0
Tobacco Use3
66.0
63.0
69.0
64.0
65.0
Physical Activity3
66.0
63.0
69.0
64.0
65.0
Diet3
66.0
63.0
69.0
64.0
65.0
Mental health2
50.0
43.0
86.0
81.0
58.0
Physical health2
50.0
43.0
86.0
81.0
58.0
Alcohol use3
66.0
63.0
69.0
64.0
65.0
Premature
Mortality 4
60.0
54.0
84.0
57.0
62.0
63.0
74.0
85.0
78.0
69.0
SES 5
Maternal/ Child
health 6
Obesity
63.0
74.0
85.0
78.0
69.0
45.0
86.0
87.0
54.0
55.0
n/a1
n/a1
n/a1
n/a1
n/a1
Overweight
n/a1
n/a1
n/a1
n/a1
n/a1
Tobacco use
n/a1
n/a1
n/a1
n/a1
n/a1
Inequality
5
^
Data from the County Health Rankings and Roadmaps 2015
Data not available within the County Health Rankings.
2
"Quality of Life" Ranking
3
"Health Behaviors" Ranking
4
"Length of Life" Ranking
5
"Social & Economic Factors" Ranking
6
"Clinical" Ranking
1
43
2016 Community Health Needs Assessment
St. Joseph’s Medical Center
APPENDIX H
Crow Wing County Cost of Living Analysis
44
2016 Community Health Needs Assessment
St. Joseph’s Medical Center
45
2016 Community Health Needs Assessment
St. Joseph’s Medical Center
APPENDIX I
Central Region Body Mass Index Obesity and Overweight rates within Adults
46
2016 Community Health Needs Assessment
St. Joseph’s Medical Center
Adult BMI Metric1
last updated
2/29/2016
Percentages for Essentia Health Central Region
Clinics*
Overall Central Region:
41.71%
Overweight
33.88%
Baxter Clinic3
42.12%
34.30%
Brainerd Medical Center
41.51%
34.04%
Crosslake Clinic
36.50%
36.06%
Pequot Lakes Clinic
40.44%
35.74%
Pierz Clinic
47.84%
28.93%
Pillager Clinic
42.13%
31.76%
Pine River Clinic
42.90%
32.66%
Hackensack Clinic
43.34%
Obese Percentages4
31.94%
*Data from Essentia Health Chronic Disease Reporting 2005- BMI for Patients by PCP and Home Location (March 19, 2016)-- DATA IS BOLDED
1
An adult for this study is classified as a patient who is 18 years of age or older.
2
Data not available from the EH Chronic Disease Reporting 2005- BMI for Patients by PCP and Home Location
3
Does not include Baxter Specialty Clinic data
4
Obesity was comprised of obese classes I (30 to 34.9), obese classes II (35 to 39.9), and extreme obesity (>=40) classes.
5
Data is pulled from Essentia Health Clarity 819-BMI Metric (March 2015-February 2016)
47
2016 Community Health Needs Assessment
St. Joseph’s Medical Center
Appendix J
Central Region Body Mass Index Obesity and Overweight rates within Pediatrics
48
2016 Community Health Needs Assessment
St. Joseph’s Medical Center
Pediatrics BMI Metric
Date: 3/12/16
Percentages for Central Region Clinics*
*Data is pulled from Clarity 2007,
Pediatric BMI (March 12, 2016)
Total patient pool
20
85-94% BMI (overweight)
10 % (2)
95% BMI (obese)
40 % (8)
Total %
Overweight or
Obese based up
on BMI
50%
Baxter Clinic
3678
16.37 % (602)
12.70 % (467)
29.07%
Brainerd Clinic
359
16.99 %(61)
12.81 % (46)
29.80%
Crosslake Clinic
78
10.26 % (8)
10.26 % (8)
20.52%
Emily Clinic
3
33 % (1)
0% (0)
33%
Pequot Lakes
106
18.8% (20)
12 % (13)
30.80%
Pierz Clinic
101
13.86 % (14)
20.76 % (21)
34.62%
Pillager Clinic
130
14.62 % (19)
18.46 % (24)
33.08%
Pine River Clinic
Central Region
178
4653
13.48 % (24)
16.14 % (751)
20.79 % (37)
13.14 % (624)
34.27%
29.28% (1,375)
13.32% (69.28)
6.38% (33.16)
19.7% (102.44)
13%
21%
34%
15%
18%
33%
Hackensack Clinic
Crow Wing County1,4
2
State
National
3
1
2013 Minnesota Student Survey County Tables- Fall 2013
2
MDH Children & Adolescent Overweight Fact Sheet & Minnesota Student Survey
3
MDH Overweight and Obesity Fact Sheet & CDC
4
Data is calculated based on a pool of 520 students in grades: 8th, 9th, and 11th.
49
Essentia Health
St. Joseph’s Medical Center
523 North Third Street, Brainerd, MN 56401
EssentiaHealth.org