Sutter Health
Sutter Amador Hospital
2013 – 2015 Implementation Strategy
Responding to the 2013 Community Health Needs Assessment
Sutter Amador Hospital
200 Mission Blvd.
Jackson, CA 95642
http://www.sutteramador.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 ............................................................................... 8
Lack of or limited access to primary and preventative services ................................. 9
Lack of or limited access to health education .......................................................... 12
Limited Access to Dental Care ................................................................................ 13
Lack of Opportunity for Physical Activity ................................................................. 14
Needs Sutter Amador Hospital Plans Not to Address ................................................... 15
Approval by Governing Board ........................................................................................ 16
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Sutter Amador Hospital, Implementation Strategy 2013 - 2015
Introduction
This implementation strategy describes how Sutter Amador Hospital, a Sutter Health affiliate, plans to
address significant needs identified in the Community Health Needs Assessment (CHNA) published by
the hospital on October 5, 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 Amador 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 health and well-being of people in the communities we serve,
through a not-for-profit commitment to compassion and excellence in health care services.
Vision
Sutter Health leads the transformation of health care to achieve the highest levels of quality, access and
affordability.
Values
Excellence and Quality
Caring and Compassion
Honesty and Integrity
Teamwork
Community
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 Amador Hospital, please visit http://www.sutteramador.org/
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Sutter Amador Hospital, Implementation Strategy 2013 - 2015
2013 Community Health Needs Assessment Summary
Every three years nonprofit hospitals are required to conduct community health needs assessments
(CHNA) and use the results of these to develop community health improvement implementation plans.
These assessments are required of virtually all nonprofit hospitals by both state and federal laws.
Between early 2012 and February 2013, Valley Vision, Inc., conducted an assessment of the health
needs of residents living in the Sutter Amador 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 impact health.”
The objective of the CHNA was to provide necessary information for Sutter Amador Hospital’s community
health improvement plan, identify communities and specific groups within these communities which are
experiencing health disparities, especially as these disparities relate to chronic disease, and further
identify contributing factors that create both barriers and opportunities for these populations to live
healthier lives.
The full 2013 Community Health Needs Assessment report conducted by Sutter Amador Hospital is
available at http://www.sutterhealth.org/communitybenefit/community-needs-assessment.html
Definition of Community
Served by the Hospital
A community-based participatory research orientation was used to
conduct the assessment, which included both primary and secondary
data. Primary data collection included input from more than 50 members
of the HSA, expert interviews with 14 key informants, focus group
interviews with 39 community members, and input gathered at meetings
of the Sutter Amador Hospital community advisory board. In addition, a
community health assessment collected data on more than 40 assets in
the greater Amador County area. Secondary data included health
outcome data, socio-demographic 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, and safety and mental health conditions. Sociodemographic data included data on race and ethnicity, poverty (femaleheaded 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 study area of the assessment included the greater Amador County
region. A key focus was to show specific communities (defined
geographically) experiencing disparities as they relate to chronic disease
and mental health. To this end, ZIP code boundaries were selected as
the unit of analysis for most indicators. This level of analysis allowed for
examination of health outcomes at the community level that are often
hidden when data are aggregated at the county level. Some indicators
(demographic, behavioral, and environmental in nature) were included in
the assessment at the census tract, census block, or point prevalence
level, which allowed for deeper community level examination.
HSAs were determined by analyzing patient discharge data. The
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Sutter Amador Hospital, Implementation Strategy 2013 - 2015
primary geographic area served by the hospital was identified
through the collection and analysis of ZIP codes associated with
patients discharged from the hospital over a six-month period.
Analysis of both primary and secondary data revealed five specific
Communities of Concern living with a high burden of disease in Amador
County. These five Communities of Concern had consistently high rates
of negative health outcomes that frequently exceeded county, state, and
Healthy People 2020 benchmarks, and were confirmed by experts as
areas prone to experiencing poorer health outcomes relative to other
communities in the HSA.
The Sutter Amador HSA five Communities of Concern are home to
nearly 20,000 county residents. The areas consist of ZIP code
communities occupying the north, central, and western portions of the
Amador County area. Ione and Jackson are the most densely populated
ZIP codes and include both urban and rural areas. The rural
communities of Fiddletown, River Pines, and Amador City have
significantly lower populations.
Jackson (95642) is the largest city in Amador County and the location of
the majority of the region’s retail centers, government and social service
agencies, and health care providers. Sutter Amador Hospital is located in
Jackson.
Amador City (95601) is a small, rural community in the central part of
Amador County, 6.5 miles north of Jackson (95642). This community is
approximately eight miles or 15 minutes away from Sutter Amador
Hospital.
Fiddletown (95629) and River Pines (95675) are rural communities
located in the northeastern part of Amador County. Sutter Plymouth
Health Center is approximately eight miles from Fiddletown and 12 miles
from River Pines. Drive time to Sutter Amador Hospital from Fiddletown
is approximately 30 minutes.
Ione (95640) is located in a large ZIP code in western Amador County.
The ZIP code includes the town of Ione and adjacent rural areas. This
community is approximately 11 miles or 20 minutes away from Sutter
Amador Hospital.
Significant Health Needs
Identified
5
The following significant health needs were identified by the 2013 CHNA.
Sutter Amador Hospital, Implementation Strategy 2013 - 2015
Significant Community Health Need
Intends to
Address
Lack of or limited access to primary and preventative services
Cost of co-pays is prohibitive; Lack of providers who accept Medi-Cal patients;
Clinics struggle to meet demand for services; Clinics located mainly in population
centers, creating challenges for rural populations; Long wait times to secure
appointments or inability to be seen; People only seek treatment for acute
conditions or serious injuries; and Rural areas do not have urgent care facilities
Yes
Lack of or limited access to specialty care
Extreme difficulty getting referrals for specialty care; Specialists not located in rural
areas; Many travel out of area to Stockton, Sacramento, Lodi; Conditions requiring
specialty services (i.e. dialysis) may not be properly managed; and Lack of chronic
disease management support
No
Limited transportation options
Public transit routes not linked to healthcare or social service delivery points;
Reaching services may require all day travel, especially on public transit; Rural
areas may not have any public transit; cost of gas prohibitive to accessing
services; Elderly population becomes isolated when they can no longer drive; and
Roads can be unsafe due to weather conditions
No
Limited mental health services; lack of access to mental health services
Lack of available services in Amador County, especially in rural areas and for
uninsured; No services available for children and adolescents; Many programs
and services have been cut due to lack of funding; Many travel out of area to
Stockton, Sacramento, Lodi; and Prisoners leaving Mule Creek State prison lack
transitional support
Yes
Lack of substance abuse treatment and rehabilitation, both inpatient and
outpatient
Lack of available services; Behavioral health issues exacerbated by lack of
residential treatment options in Amador County; Youth and adults in residential
substance abuse programs are far from family; Prisoners leaving Mule Creek
State prison lack transitional support; and Homeless population cannot access
services if not sober
No
Limited access to dental care
No Medi-Cal coverage for adults, extraction often the only option; Long wait times
or travel out of area for pediatric dentists; Lack of providers in rural area; and
Demand exceeds number of providers
Yes
Limited access to prescription medications and medical equipment
Prohibitive cost of prescription medication and equipment to manage chronic
conditions; Individuals forced to choose between food, rent, or medication; and
Prescription costs are especially difficult for seniors on fixed incomes
No
Lack of or limited access to health education
Need for more education about maintaining health and/or managing chronic
health conditions; and Need for education around healthy lifestyle choices
Yes
Lack of opportunities for physical activity
Classes, gyms, and youth sports are too expensive; Community facilities limited
or have restricted hours due to budget cuts; and Cost of driving to activities is
prohibitive, especially in rural areas
Yes
Lack of or limited access to healthy food
No
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Sutter Amador Hospital, Implementation Strategy 2013 - 2015
Significant Community Health Need
Intends to
Address
Abundance of fast food in urban areas; Produce is often expensive or of poor
quality in rural areas; People in rural areas must travel several miles to grocery
stores; and Healthy foods are not always the most economical choice
Criteria were established to help identify and determine all data to be included for the study. Data were
included only if they met the following standards:
1. All data were to be sourced from credible and reputable sources
2. Data must be consistently collected and organized to allow for future trending
3. Data must be available at the ZIP code level or smaller
All indicators listed below were examined at the ZIP code level unless noted otherwise. County, state,
and Healthy People 2020 targets (when available) were used as benchmarks to determine severity. All
rates are reported as per 10,000 of population unless noted otherwise. Health outcome indicator data
were adjusted using Empirical Bayes Smoothing (where possible) to increase the stability of estimates
by reducing the impact of the small number problem. To provide relative comparison across ZIP codes,
rates of Emergency Department (ED) visits and hospitalizations for heart disease, diabetes, hypertension,
and stroke were adjusted to reduce the influence of age. Appendix I contains a detailed methodology of
all data processing and data sources.
Secondary quantitative data used in the assessment include those listed in Tables 1 (Health outcome
data used in the CHNA reported as ED visits, hospitalization, and mortality) and Table 1 (Sociodemographic, behavioral, and environmental data profiles used in the CHNA) contained in the full CHNA
report.
Data on socio-demographics of residents of these communities, which included socio-economic status,
race and ethnicity, educational attainment, status as home owner or renter, employment status, and
health insurance status, were examined. Area health needs were determined via in depth analysis of
qualitative and quantitative data, and then confirmed by socio-demographic data. As noted earlier, a
health need was defined as a poor health outcome and its associated driver. A health need was included
as a priority if it was represented by rates exceeding established quantitative benchmarks or was
consistently mentioned in the qualitative data.
The health needs identified through analysis of both quantitative and qualitative data are listed above.
These were prioritized according to the degree of support in the findings. Each need is noted as a “health
driver,” or a condition or situation that contributed to a poor health outcome. Health outcome results follow
the list below.
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Sutter Amador Hospital, Implementation Strategy 2013 - 2015
2013 – 2015 Implementation Strategy
This implementation strategy describes how Sutter Amador 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 Amador Hospital, Implementation Strategy 2013 - 2015
Lack of or limited access to primary and preventative services
Name of Program, Initiative
or Activity
Free Mammogram Screening Program
Description
Throughout the month of October, Sutter Diagnostic Imaging centers
across the SHSSR Region provide free digital screening mammograms
to uninsured women in honor of National Breast Cancer Awareness
Month. The goal of this outreach effort was to not only provide free
screenings to underinsured women in our communities, but it also serves
as an opportunity to provide women with information on health and
insurance resources. Free mammograms are offered in various
locations, at various times, including in Amador County, to ensure as
many women as possible were able to take advantage of this effort. In
addition, a packet of follow up resources was created in the event that a
participant had an abnormal screening, as well as insurance enrollment
services. Sutter Diagnostic staff was also given resources to provide to
women who needed diagnostic follow up and/or treatment. In 2012, as a
result of all of the crucial Breast Cancer Awareness efforts, SHSSR
provided a total of 670 free and low-cost mammograms.
Our goal is not only to screen uninsured women, but we also use these
events as a connection point for the underserved members of our
community, to link them with a primary care provider and follow up
resources if needed, as well as insurance enrollment information. We
will have to examine the current model of this program in 2014, as under
the Affordable Care Act, all women (with the exception of undocumented
immigrants) will have insurance; therefore, we will reassess our process
moving forward, as these events have typically targeted the uninsured
only.
Anticipated Impact and Plan
to Evaluate
SAH will continue evaluate the impact of our Free Mammography
Screenings on an annual basis, by tracking the number of people served
and by assessing the community’s access to care needs in its next
Community Health Needs Assessment. We will also reexamine this
program with a critical eye in 2014, to ensure it evolves with the needs of
the community after the implementation of the ACA.
Name of Program, Initiative
or Activity
Insurance Outreach, Education and Enrollment
Description
Sutter Amador Hospital is working with the Amador-Tuolumne
Community Action Agency (ATCCA) to provide insurance outreach and
education to the underserved population in Amador County. With the
support of Sutter Amador Hospital and the help of a small federal grant,
the ATCCA will be doing major outreach to connect with the underserved
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Sutter Amador Hospital, Implementation Strategy 2013 - 2015
population in Amador County to educate them about insurance coverage
through Covered California. This effort by ATCAA and other community
partners throughout SHSSR program is vitally important, as Covered
California, the new health insurance exchange and a critical piece of the
Affordable Care Act, will launch October 1, 2013. As a result, enrolling
the un- and underinsured population will be a major component of our
CHNA implementation planning, as this is the first step to connecting
patients with primary care and medical homes. In addition to providing
funding to ATCAA, we will look for opportunities to link ATCAA with SAH
efforts and other community initiatives to reach as many underserved
residents as possible.
Anticipated Impact and Plan
to Evaluate
SAH will evaluate the impact the Amador-Tuolumne Community Action
Agency’s insurance education and enrollment efforts, by tracking the
number of un- and under-insured people the ATCAA is able to reach,
and by assessing the community’s access to care needs in its next
Community Health Needs Assessment.
Name of Program, Initiative
or Activity
Expanded Partnerships with Rural Health Clinics/FQHCs
Description
Over the long-term, SAH plans to explore the possibility of expanding
partnerships with rural health clinics and FQHCs. We would look at
creative ways to strengthen the relationship between SAH and FQHC’s
like WellSpace Health, as building both the capacity and sustainability of
FQHC’s continues to be of critical importance not only to Sutter, but is
vital to the overall health and wellbeing of the community.
Our 2013 CHNA reports show that lack of access to care is one of the
most dire health related challenges facing our region. If we don’t make
strategic investments in our rural health clinics and FQHC's, we are
going to be left with thousands of newly insured Medi-Cal patients in
2014, with no medical home. Therefore, it is our goal to tighten the
partnership with these important health clinics, to provide a linkage to
primary and mental health services to those who need it the most.
In addition to addressing the lack of access to primary and
preventative services, expanded partnerships with rural health
clinics and FQHCs would also tackle lack of access to mental
health services.
Anticipated Impact and Plan
to Evaluate
10
SMF will continue along the path of recruiting more physicians for the
rural health clinics in Amador and will review the impact (number of
patients seen, etc) on a yearly basis. We predict this effort will help
increase access to primary and mental health services for the
Sutter Amador Hospital, Implementation Strategy 2013 - 2015
underinsured residents in the SAH HSA. If we need to move into phase
two down the line, where we look at partnership with an FQHC, we
would project the number of patients that could be served each year and
determine the impact on the community’s access to care needs in its
next CHNA, to measure effectiveness.
Name of Program, Initiative
or Activity
Other investments
Description
SAH will continue to invest in many of the organizations and events it’s
historically supported, and recommend expanding the scope of the key
community benefits initiatives that have become so important to the
underserved community and directly address the top health needs
identified by the CHNA in the Sutter Amador Hospital HSA.
We recognize that we can’t address all of the health needs in our
community alone, we also provide funding and support to various
organizations throughout the community to help us meet the needs of
patients as it relates to all of the priority needs outlined in the full CHNA.
We will continue to explore new partners, examine existing programs
and look for ways to form innovative partnerships, to collaboratively meet
the needs of the underserved in Amador County, especially around
issues like access to care, dental and other priority needs that have
been identified.
Anticipated Impact and Plan
to Evaluate
11
We will review these investments on a yearly basis and evaluate their
impact on the needs identified in the CHNA and measurable outcomes.
Sutter Amador Hospital, Implementation Strategy 2013 - 2015
Lack of or limited access to health education
Name of Program, Initiative
or Activity
Diabetes Education
Description
Led by a nationally recognized diabetes educator and specially trained
staff of nutritionists, Sutter Amador Hospital's (SAH) Outpatient Diabetes
Education and Clinical Nutrition Center helps people with diabetes and
their families understand and manage this life-threatening disease.
Services include training in the use of blood sugar testing equipment,
diet and exercise, food shopping and symptom control. The program
also offers Sweet Success, a program with special education and
counseling for pregnant women.
The Outpatient Diabetes Education and Clinical Nutrition Center also
hosts a Diabetes Fair that offers free blood-glucose and hemoglobin AIC
testing for more than 200 participants each year. The fair provides an
opportunity for local residents to talk to vendors about personal blood
sugar testing equipment, insulin pumps, dietary supplements and other
products.
In addition, the Diabetic Youth Summer Camp Program is funded by
vendors of the Diabetes Fair and gifts from the community. This program
pays for young people with diabetes to attend summer camps designed
for their special needs and provides an opportunity for them to meet
others dealing with the challenges of living with diabetes.
Anticipated Impact and Plan
to Evaluate
12
SAH will continue to evaluate the impact of the Diabetes Education
program, by examining how many people we reach and if it has a
positive effect on the overall health literacy in Amador County. We are
also looking at other possible education classes that we can bring to
SAH or provide funding to other organizations who are doing important
health literacy work, within the SAH HSA.
Sutter Amador Hospital, Implementation Strategy 2013 - 2015
Limited Access to Dental Care
Name of Program, Initiative
or Activity
Support of Dental Care in the SAH HSA
Description
Sutter Amador Hospital partnered with the Amador Oral Health Task
Force to help address one of the priority areas of focus in Amador:
providing underinsured children with dental care. This partnership
allowed the Oral Health Task Force to offer twice-yearly dental
screenings, dental education and fluoride varnish to
uninsured/underinsured children in Amador County. As a result of this
effort, 260 underinsured and uninsured kindergarteners received dental
screenings. Lack of adequate dental care was identified as a major
need in Amador County; therefore, support of the Amador Oral Health
Task Force and other dental related efforts, is vital in the quest to spread
oral health throughout the community.
In addition to past efforts that address the lack of access to dental care,
SAH will continue to look for new opportunities to engage various
organizations throughout the SAH HSA to provide preventative dental
care to the children and adults in the community.
Anticipated Impact and Plan
to Evaluate
13
Since the completion SAH will continue evaluate the impact of the
Diabetes Education program, by examining how many people we reach
and if it has a positive effect on the overall health literacy in Amador
County. We are also looking at other possible education classes that we
can bring to SAH or provide funding to other organizations who are doing
important health literacy work, within the SAH HSA.
Sutter Amador Hospital, Implementation Strategy 2013 - 2015
Lack of Opportunity for Physical Activity
Name of Program, Initiative
or Activity
Let’s Get Healthy Amador Campaign
Description
In partnership with public health and other community organizations,
Sutter Amador Health plans to take part in the “Let’s Get Healthy
Amador” campaign. This important public/private partnership will
actively work to encourage people throughout Amador County to
exercise and stress the importance of healthy living. Additionally,
walking groups and other group fitness activities will be created and
promoted to the greater Amador community as a part of this effort.
In addition serving on the “Let’s Get Healthy Amador” board and
providing other resources, Sutter Amador Hospital has a beautiful
walking trail on the campus of the hospital, which is open to not only
patients, but the entire community. Between the walking trail and
expanded effort to promote exercise through the healthy living campaign,
providing encouragement and opportunity for physical activity is going to
be a major focus in 2014.
Anticipated Impact and Plan
to Evaluate
14
Once the “Let’s Get Healthy” campaign is underway, SAH will evaluate
the impact of program by examining how many people are reached, the
number of participants in walking groups and other group fitness
opportunities, and if the overall effort has a positive effect in providing
healthier options and physical activity in Amador County and the SAH
HSA.
Sutter Amador Hospital, Implementation Strategy 2013 - 2015
Needs Sutter Amador Hospital Plans Not to Address
No hospital can address all of the health needs present in its community. Sutter Amador 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:
Lack of or limited access to specialty care: At this time, SAH does not have sufficient resources to
address this need.
Limited transportation options: At this time, SAH does not have sufficient resources to address this need.
Limited mental health services; lack of access to mental health services: In this first phase of addressing
priority needs; SAH is focusing on building capacity and connecting people with primary care. Hopefully
once we’ve made a dent in that priority need, we can then shift our focus to mental health.
Lack of substance abuse treatment and rehabilitation, both inpatient and outpatient: While SAH plans to
investigate bringing classes and other educational opportunities that address this need to Amador’s HSA,
at this time, lack of access to care remains the top priority.
Lack of or limited access to healthy food: Not only is there a lack of effective interventions to address this
need, this is not something that we are able to greatly affect through community benefit; therefore, we are
focusing our resources elsewhere.
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Sutter Amador Hospital, Implementation Strategy 2013 - 2015
Approval by Governing Board
This implementation strategy was approved by the Governing Board of Sutter Amador Hospital on
November 11, 2013.
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Sutter Amador Hospital, Implementation Strategy 2013 - 2015