Sutter Health
Sutter Coast Hospital
2013 – 2015 Implementation Strategy
Responding to the 2013 Community Health Needs Assessment
800 E. Washington Blvd, Crescent City, CA 95531
http://www.suttercoast.org
Table of Contents
Introduction ........................................................................................................................ 3
About Sutter Health ........................................................................................................... 3
2013 Community Health Needs Assessment Summary .................................................. 4
Definition of Community Served by the Hospital ....................................................... 4
Significant Health Needs Identified ........................................................................... 5
2013 – 2015 Implementation Strategy ............................................................................... 7
Lack of Access to Primary and Preventative Services .............................................. 8
Limited Access to Mental Health Services .............................................................. 10
Limited Health Literacy and Health Education Opportunities................................... 11
Needs Sutter Coast Hospital Plans Not to Address ...................................................... 12
Approval by Governing Board ........................................................................................ 14
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Sutter Coast Hospital, Implementation Strategy 2013 - 2015
Introduction
This implementation strategy describes how Sutter Coast Hospital, a Sutter Health affiliate, plans to
address significant needs identified in the Community Health Needs Assessment (CHNA) published by
the hospital on September 30, 2013. The document describes how the hospital plans to address
identified needs in calendar (tax) years 2013 through 2015.
The 2013 CHNA and this implementation strategy were undertaken by the hospital to understand and
address community health needs, and in accordance with proposed Internal Revenue Service (IRS)
regulations pursuant to the Patient Protection and Affordable Care Act of 2010.
This implementation strategy addresses the significant community health needs described in the CHNA
that the Hospital plans to address in whole or in part. The hospital reserves the right to amend this
implementation strategy as circumstances warrant. For example, certain needs may become more
pronounced and merit enhancements to the described strategic initiatives. Alternately, other
organizations in the community may decide to address certain community health needs, and the Hospital
may amend its strategies and refocus on other identified significant health needs. Beyond the initiatives
and programs described herein, the Hospital is addressing some of these needs simply by providing
health care to the community, regardless of ability to pay.
About Sutter Health
Sutter Coast Hospital is affiliated with Sutter Health, a not-for-profit network of hospitals, physicians,
employees and volunteers who care for more than 100 Northern California towns and cities. Together,
we’re creating a more integrated, seamless and affordable approach to caring for patients.
The Hospital’s mission is to enhance the well-being of people in the communities we serve through
compassion and excellence in health care services.
At Sutter Health, we believe there should be no barriers to receiving top-quality medical care. We strive
to provide access to excellent health care services for Northern Californians, regardless of ability to pay.
As part of our not-for-profit mission, Sutter Health invests millions of dollars back into the communities we
serve – and beyond. Through these investments and community partnerships, we’re providing and
preserving vital programs and services, thereby improving the health and well-being of the communities
we serve.
In 2012, our network of physician organizations, hospitals and other health care providers invested $795
million (compared to $756 million in 2011) in health care services for low-income people, community
health improvement services, and other community benefits.
For more facts and information about Sutter Coast Hospital, please visit http://www.suttercoast.org
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Sutter Coast Hospital, Implementation Strategy 2013 - 2015
2013 Community Health Needs Assessment Summary
Between January and August 2013, Valley Vision, Inc., conducted an assessment of the health needs of
residents living in the Sutter Coast Hospital Service Area (HSA). For the purposes of the assessment, a
health need was defined as “a poor health outcome and its associated driver.” A health driver was defined
as “a behavioral, environmental, and/or clinical factor, as well as more upstream social economic factors,
that impacts health.”
The objective of the CHNA was as follows:
To provide necessary information for Sutter Coast Hospital’s community benefit plan, to identify
communities and specific groups within these communities experiencing health disparities, especially as
these disparities relate to chronic disease, and to further identify contributing factors that contribute to the
creation of both barriers and pathways to living healthier lives within these communities.
A community-based participatory research orientation was used to conduct the assessment, which
included both primary and secondary data. Primary data collection involved gathering input from more
than 65 members of the HSA, including expert interviews with 11 key informants and focus group
interviews with 54 community members. In addition, a community health assets assessment collected
information about 68 assets in the greater hospital service area.
Secondary data used included health outcome data, sociodemographic data, and behavioral and
environmental data at the ZIP code or census tract level. Health outcome data included Emergency
Department (ED) visits, hospitalization, and mortality rates related to heart disease, diabetes, stroke,
hypertension, COPD, asthma, safety and mental health conditions. Sociodemographic data included data
on race and ethnicity, poverty (female-headed households, families with children, people over 65 years of
age), educational attainment, health insurance status, and housing arrangement (own or rent). Further,
behavioral and environmental data helped describe general living conditions of the HSA, such as crime
rates, access to parks, availability of healthy food, and leading causes of death.
The full 2013 Community Health Needs Assessment report conducted by Sutter Coast Hospital is
available at http://www.suttercoast.org/about/community_needs_assessment.pdf.
Definition of Community
Served by the Hospital
The Sutter Coast Hospital service area (HSA) was identified through the
collection and analysis of ZIP codes associated with patients discharged
from the hospital over a six-month period. Through this analysis, it was
determined that approximately 90% of all patients resided in five ZIP
codes split between two counties and two states. With the exception of
ZIP code 97415 (Brookings, OR) all of the ZIP codes in the HSA are
located in Del Norte County.
Sutter Coast Hospital is located in Del Norte County, along the Northern
Coast of California. The HSA is home to more than 42,000 residents.
Crescent City (95531) and Brookings (97415) are the most populated
areas in the HSA, while Gasquet (95543), Klamath (95548) and Smith
River (95567) are smaller, more rural communities. Highway 101 links
most of the communities in the HSA and serves as its major
transportation corridor.
The Sutter Coast HSA is bounded by redwood forests to the east and
the Pacific Ocean to the west, and also contains large sections of tribal
land. National parks and beaches attract tourists during the summer
months, although the area is prone to fog and rain during several months
of the year.
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Sutter Coast Hospital, Implementation Strategy 2013 - 2015
Significant Health Needs
Identified
The following significant health needs were identified by the 2013 CHNA.
Significant Community Health Need
Lack of access to primary and preventative services
Contributing Factors:
 Lack of providers who accept publically insured or uninsured patients
 Clinics located mainly in cities and are difficult for rural population to reach
 Patients must wait for a long time or are unable to secure appointments
 People only seek treatment for acute conditions or serious injuries
 The demand for services exceeds capacity
Limited access to mental health services
Contributing Factors:
 Limited mental health services available, especially for the uninsured and
youth
 Stigmas around seeking care, especially in small communities
 Existing programs and services have been cut due to lack of funding
 People have difficulty building trusting relationships with providers due to
high turn over
Limited health literacy and health education opportunities
Contributing Factors:
 People do not make the connection between behavior, lifestyle choices
and their health
 Many people do not understand how to care for themselves or manage
chronic conditions
 Cultural beliefs and diets may not support positive health outcomes
 People do not know how to read food labels or use fresh foods to prepare
healthy meals
 People have difficulty understanding and following written instructions
 Fees associated with available classes are cost prohibitive
 Classes are offered sporadically or at times that are not convenient, low
attendance is an issue
 People are often unaware of existing educational resources
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Intends to
Address
Yes
Yes
Yes
Sutter Coast Hospital, Implementation Strategy 2013 - 2015
Significant Community Health Need
Inability to fulfill basic needs, including food and shelter
Contributing Factors:
 Low income families cannot afford to move from housing that is poorly
maintained
 Some housing has mold, poor interior air quality and inefficient
weatherization
 Very limited emergency transitional housing is available
 There is a fixed homeless population in the area that resides in
campgrounds and on beaches and lack access to sanitation
 Many small communities do not have grocery stores, residents rely on gas
stations for food
 Produce is often expensive or of poor quality in rural areas
 People with special dietary needs (diabetic, cultural) have difficulty getting
necessary food
Limited access to safe and affordable places to exercise
Contributing Factors:
 Classes, gyms and youth sports are too expensive for many low income
families
 People in rural areas must drive elsewhere to access sports and
recreation activities and costs may be prohibitive
 Many areas lack sidewalks and adequate lighting or lanes for bicycles;
pedestrians do not feel safe walking in high traffic areas
 Inclement weather deters people from exercising outdoors
 People do not feel safe walking alone or allowing children to play outside
in some areas
Limited access to reliable transportation
Contributing Factors:
 Public transit runs infrequently or does not stop near delivery points for
health care services
 Rural areas may not have any public transit options, and people in rural
areas become isolated if they cannot drive
 Cost of gas prohibitive to accessing services, especially specialty care that
requires long distance travel
 Poor weather and limitations of available equipment create challenges
with patient transport
Lack of access to dental care
Contributing Factors:
 For uninsured adults, extraction is often the only option and dental
conditions go untreated
 People experience long wait times for dental appointments
 Children are presenting severe dental problems at very young ages
 People must travel out of the area for specialty services
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Intends to
Address
No
No
No
No
Sutter Coast Hospital, Implementation Strategy 2013 - 2015
2013 – 2015 Implementation Strategy
This implementation strategy describes how Sutter Coast Hospital plans to address significant health
needs identified in its 2013 Community Health Needs Assessment and consistent with its charitable
mission. The strategy describes:



Actions the Hospital intends to take, including programs and resources it plans to commit;
Anticipated impacts of these actions and a plan to evaluate impact; and
Any planned collaboration between the Hospital and other organizations.
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Sutter Coast Hospital, Implementation Strategy 2013 - 2015
Lack of Access to Primary and Preventative Services
Name of Program, Initiative
or Activity
Retention
Description
Retention is often the biggest issue faced when thinking in terms of
access to primary and preventative services. The local team is
committed to enhancing retention efforts. Some of the ideas include:
increasing connection of the school district for providers with children;
connecting new providers (and current) with the Chamber/Visitors
Bureau to get more ingrained into the community; looking at social
capital and the opportunities for spouses of providers to have enhanced
opportunities in the local job market. Plan to review exit surveys of
providers leaving the community to develop an appropriate retention
plan. Work with current providers and local community groups to develop
strong physician/provider networks. Identify a lead liaison between the
physicians and the community.
Anticipated Impact and Plan
to Evaluate
Retaining providers to our community is anticipated to improve access to
primary and preventative services. The Hospital will evaluate the
success of the program by tracking exits from the community. The
Hospital will continue to address total numbers of providers needed in
the community and will revisit this significant health need in its next
Implementation Plan.
Name of Program, Initiative
or Activity
Recruitment
Description
Sutter Coast Hospital (SCH) and Open Door Community Health Center
are the two main constituents who recruit new providers into the service
area. SCH is currently contracted with two outside physician recruiting
firms with the goal of finding one or more family practice physicians and
one or more pediatricians. SCH just successfully recruited two new
OB/GYN physicians who start in December of 2013 and February of
2014. Our internal team will continue to recruit and work with the
external team to bring providers to this area. SCH partners with Open
Door and United Health Indian Services as possible to assist with
recruitment efforts.
Further the goal is to determine what exists in the current recruitment
fund that was created some years ago as a partnership with several
groups, including the Del Norte Health Care District, Sutter Coast
Hospital and the California Endowment. Plan to put a task force together
to put this back at the forefront. The fund currently has $250k in it to aid
in the recruitment efforts.
Work to help develop a task force to determine what new guidelines
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Sutter Coast Hospital, Implementation Strategy 2013 - 2015
need to be developed to use and grow this fund. Consider any special
perks for private practice providers.
Look at recruitment in colleges and emphasis of the HPSA and National
Health Scholars opportunities for new graduates with student loan debt.
Teams to first identify all barriers to recruitment and retention and then to
work to develop and implement a mitigation plan when it comes to new
providers – and saving current providers.
Anticipated Impact and Plan
to Evaluate
Recruiting new providers to our community is anticipated to improve
access to primary and preventative services. The Hospital will evaluate
the success of the program by annually tracking the number of new
providers brought in to the community, as well as any providers leaving
the community. An anticipated task force will work on not only identifying
why those have chosen to leave, but also why the ones who remain,
choose to stay. Begin a process of evaluation, which includes midevaluation.
The Hospital will continue to address total numbers of providers needed
in the community and will revisit this significant health need in its next
Implementation Plan.
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Sutter Coast Hospital, Implementation Strategy 2013 - 2015
Limited Access to Mental Health Services
Name of Program, Initiative
or Activity
Partnership Development
Description
In addition of the Hospital/Del Norte Community Health Center
partnership to recruit a new psychiatrist to town, work with the current
providers of mental health services to develop a more detailed
partnership.
Plan will be drafted of new collegial group focused on the mental health
needs of this community. Goal will be to have five or more local groups
participate with measureable plans and outcomes.
Anticipated Impact and Plan
to Evaluate
Identified members of the partnership include: Sutter Coast Hospital,
Del Norte Community Health Center, DHHS and the Del Norte Health
Care District.
Looking for additional avenues – in addition to current recruitment efforts
for a psychiatrist – and the development of a plan following recruiting.
Also, better utilization of telemedicine in mental health services.
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Sutter Coast Hospital, Implementation Strategy 2013 - 2015
Limited Health Literacy and Health Education Opportunities
Name of Program, Initiative
or Activity
Education
Description
Sutter Coast Hospital currently offers a variety of health education
programs. There are programs on diabetes in both communities – Del
Norte County, California and Curry County, Oregon. There are
programs for healthy pregnancy, breast feeding, weight management,
childhood development and more.
Further, our education opportunities will include other items identified,
but not addressed in year 1 from our Community Health Needs
Assessment including, but not limited to: access to dental care, basic
needs and safe and affordable places to exercise. An additional
identified need – that being lack of transportation – will be taken into
consideration with any new education program development.
Anticipated Impact and Plan
to Evaluate
Work to better align programs offered with identified health needs of
community – including chronic conditions and heart disease. Measure
participation rates, numbers educated ability to integrate transportation
and addition of providers to serve as instructors.
Name of Program, Initiative
or Activity
Literacy
Description
We understand that literacy is a much bigger issue than simple health
education. Literacy encompasses the level of understanding of our
clients. This includes things as simple as do they understand and know
how to follow basic discharge instructions to as complex as how and
when to take which medications – for what, when, etc.
Literacy is looking at the “whys” in our community. With an approximate
eighth grade learning level, we have the promise of strong partners to
insure success.
Anticipated Impact and Plan
to Evaluate
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Identify the key partners to develop a plan for health literacy. This is no
small feat, but one in which this community has energy. The
measurements will be healthier citizens with less ER admissions for
misusing prescription medication, fewer re-admissions, measurable
results from home health and surgery follow up calls.
Sutter Coast Hospital, Implementation Strategy 2013 - 2015
Needs Sutter Coast Hospital Plans Not to Address
No hospital can address all of the health needs present in its community. Sutter Coast Hospital is
committed to serving the community by adhering to its mission, using its skills and capabilities, and
remaining a strong organization so that it can continue to provide a wide range of community benefits.
This implementation strategy does not include specific plans to address the following significant health
needs that were identified in the 2013 Community Health Needs Assessment:
1.
Inability to fulfill basic needs, including food and shelter

Need being addressed by many others in the community:
o
Building Healthy Communities
o
Community Assistance League
o
Local Ministries
o
DHHS
o
Sovereign Nations

Insufficient resources (financial, personnel and expertise) to address the need.

Need is not likely to be resolved as other problems.
2. Limited access to safe and affordable places to exercise

Implementation plan will address health literacy and education opportunities; and this topic will be
included within education.

Issue is not a priority for community members, and therefore, approach is unlikely to succeed.

Hospital does not have expertise to effectively address the need.
3. Limited access to reliable transportation

Need is not likely to be resolved as other problems.

Insufficient resources to address the need.

May be able to partially address this need through education and literacy focus.
4. Lack of access to dental care

Insufficient resources to address the need.
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Sutter Coast Hospital, Implementation Strategy 2013 - 2015

Hospital does not have expertise to effectively address the need.

Implementation plan will address health literacy and education opportunities; and this topic will be
included within education.
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Sutter Coast Hospital, Implementation Strategy 2013 - 2015
Approval by Governing Board
This implementation strategy was approved by the Governing Board of Sutter Coast Hospital on October
29, 2013.
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Sutter Coast Hospital, Implementation Strategy 2013 - 2015