Read the 2016 Community Health Needs Assessment (CHNA) about East Tennessee Children's Hospital's plans to serve the community. Learn more at https://www.etch.com/chna
Patients and their loved ones often hold critical knowledge that informs diagnosis. This toolkit from the Institute of Medicine offers patients, families and clinicians guidance on how they can collaborate to improve diagnosis.
Patient-centered medical homes (PCMHs) are intended to actively provide effective care by physician-led teams, Where patients take a leading role and responsibility. Objective: To determine whether the Walter Reed PCMH has reduced costs while at least maintaining if not improving access to and quality of care, and to determine
whether access, quality, and cost impacts differ by chronic condition status. Design, setting, and patients: This study
conducted a retrospective analysis using a patient-level utilization database to determine the impact of the Walter Reed PCMH on utilization and cost metrics, and a survey of enrollees in the Walter Reed PCMH to address access to care and quality of care. Outcome measures: Inpatient and outpatient utilization, per member per quarter costs, Healthcare Effectiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communication, and customer service are included. Results: Costs were 11% lower for those with chronic conditions compared to 7% lower for those without. Since treating patients with chronic conditions is 4 times more costly than treating patients without such conditions, the vast majority of dollar savings are attributable to chronic care.
The Patient-Centered Medical Home in the Transformation From Healthcare to He...Paul Grundy
Surgeon General of the Navy VADM Matthew L. Nathan, MC USN
Fortunately, we have a way to address this crisis—the
Patient-Centered Medical Home (PCMH) model launched at Naval Hospital Pensacola and Walter Reed National Military Medical Center, Bethesda, Maryland (formerly the National Naval Medical Center) in 2008. It is now being implemented throughout the Military Health System (MHS) and carries great promise. It provides the clinical framework we need to meet our strategic objectives in terms of quality of care, impact on costs, population health, and readiness. One of the most significant benefits of the team-based, collaborative approach is that it allows us to embed within a primary care environment the psychologists, nutritionists, tobacco cessation specialists, mind-body medicine therapists, and health educators our patients need in order to develop and maintain mindful, healthy behaviors—along with the “mental armor,” our active duty military personnel need to increase their operational effectiveness and their resiliency in bouncing back from stressful situations. As we move ahead with this more comprehensive approach to health, we can begin to better address so many of our patients for whom we can find no specific reason for pain and discomfort. The PCMH model also provides a positive impact on our costs. Early data reporting from the PCMH clinics at Bethesda show reduced visits to the emergency room, lowered pharmacy costs, and significant per beneficiary per year savings and improved Healthcare Effectiveness Data and Information Set metrics, access, and patient satisfaction and trust. These positive impacts on the bottom line can be applied directly to improved costs or toward the reallocation of resources from reimbursing those who are sick to the population health-based programs that can make and keep our patients healthy.More significant, however, the PCMH environment allows us to go beyond mere collaboration and to a much more proactive approach to managing our patient populations. It is within the context of the medical home that we can begin to surround our patients with the tools and resources they need to move them from health care to health.
Patients and their loved ones often hold critical knowledge that informs diagnosis. This toolkit from the Institute of Medicine offers patients, families and clinicians guidance on how they can collaborate to improve diagnosis.
Patient-centered medical homes (PCMHs) are intended to actively provide effective care by physician-led teams, Where patients take a leading role and responsibility. Objective: To determine whether the Walter Reed PCMH has reduced costs while at least maintaining if not improving access to and quality of care, and to determine
whether access, quality, and cost impacts differ by chronic condition status. Design, setting, and patients: This study
conducted a retrospective analysis using a patient-level utilization database to determine the impact of the Walter Reed PCMH on utilization and cost metrics, and a survey of enrollees in the Walter Reed PCMH to address access to care and quality of care. Outcome measures: Inpatient and outpatient utilization, per member per quarter costs, Healthcare Effectiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communication, and customer service are included. Results: Costs were 11% lower for those with chronic conditions compared to 7% lower for those without. Since treating patients with chronic conditions is 4 times more costly than treating patients without such conditions, the vast majority of dollar savings are attributable to chronic care.
The Patient-Centered Medical Home in the Transformation From Healthcare to He...Paul Grundy
Surgeon General of the Navy VADM Matthew L. Nathan, MC USN
Fortunately, we have a way to address this crisis—the
Patient-Centered Medical Home (PCMH) model launched at Naval Hospital Pensacola and Walter Reed National Military Medical Center, Bethesda, Maryland (formerly the National Naval Medical Center) in 2008. It is now being implemented throughout the Military Health System (MHS) and carries great promise. It provides the clinical framework we need to meet our strategic objectives in terms of quality of care, impact on costs, population health, and readiness. One of the most significant benefits of the team-based, collaborative approach is that it allows us to embed within a primary care environment the psychologists, nutritionists, tobacco cessation specialists, mind-body medicine therapists, and health educators our patients need in order to develop and maintain mindful, healthy behaviors—along with the “mental armor,” our active duty military personnel need to increase their operational effectiveness and their resiliency in bouncing back from stressful situations. As we move ahead with this more comprehensive approach to health, we can begin to better address so many of our patients for whom we can find no specific reason for pain and discomfort. The PCMH model also provides a positive impact on our costs. Early data reporting from the PCMH clinics at Bethesda show reduced visits to the emergency room, lowered pharmacy costs, and significant per beneficiary per year savings and improved Healthcare Effectiveness Data and Information Set metrics, access, and patient satisfaction and trust. These positive impacts on the bottom line can be applied directly to improved costs or toward the reallocation of resources from reimbursing those who are sick to the population health-based programs that can make and keep our patients healthy.More significant, however, the PCMH environment allows us to go beyond mere collaboration and to a much more proactive approach to managing our patient populations. It is within the context of the medical home that we can begin to surround our patients with the tools and resources they need to move them from health care to health.
Safety is Personal: Partnering with Patients and Families for the Safest CareEngagingPatients
The work of NPSF"s Lucian Leape Institute's Roundtable on Consumer Engagement, "Safety Is Personal: Partnering with Patients and Families for the Safest Care" is a call to action for health leaders, clinicians, and policy makers to take the necessary steps to ensure patient and family engagement at all levels of health care.The report identifies specific action items for health leaders, clinicians, and policy makers to pursue in making patient and family engagement a core value in the provision of health. care.
June 27/2017 - SPOR-PIHCI Network presentations from the pre-CAHSPR conference day in Toronto, Ontario
Sharing Practical Advances in Research Knowledge-
Translating Findings to Action from PIHCIN Research
Partnering with Patients, Families and Communities for Health: A Global Imper...EngagingPatients
Engagement is an essential tool to improving global health. This report introduces a new framework for engagement to help countries assess current programs and think strategically about future engagement opportunities. It spotlights barriers to engagement and offers concrete examples of effective engagement from around the globe.
National Conference on Health and Domestic Violence. Plenary talk Paul Grundy
explaining how the Patient Centered Medical Home (PCMH) platform for healthcare deliver is more likely to support domestic violence prevention and creat a safer environment than the FFS episode of care system we are in now. The medical Home is a home for the data where the all the data goes and is held accountable this idea was first articulated by Dr. Calvin C.J. Sia, a Honolulu-based pediatrician in 1967.
This concept of the medical home was integrated with Ed Wagners Chronic disease Model and Thomas Bodenheimer Kevin Grumbach advanced/proactive primary care at the request of the Patient Centered Primary care Collaborative into a set of principles Know as the Joint principles of the Patient centered medical home.
The patient-centered medical home (PCMH), is a team based health care delivery set of principles led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults" The provision PCMH medical homes allow better access to health care, increase satisfaction with care, and improve health. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[10] Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage coordination.
PIHCI programmatic grants webinar (en) for circulationAlexandra Enns
These are the slides from CIHR’s webinar providing information for the upcoming PIHCI Network Programmatic Grant funding opportunity.
The complete instructions are on ResearchNet: https://www.researchnet-recherchenet.ca/rnr16/vwOpprtntyDtls.do?prog=2734&view=currentOpps&org=CIHR&type=EXACT&resultCount=25&sort=program&next=1&all=1&masterList=true
Patient Engagement Presentation - MPN Network Forum April 18, 2017Alexandra Enns
April 18, 2017
In April we held a Network Forum on engaging policymakers and patients/public effectively and appropriately. We would like to give a warm thanks to both Carolyn Shimmin, Patient Engagement expert of CHI's Knowledge Translation team, and Marcia Thomson, Assistant Deputy Minister of Manitoba Health, Seniors and Active Living for their presentations. Below you can see Carolyn's presentation - to see more of her work on patient engagement and to learn more about knowledge translation at CHI, please check out the blog Knowledge Nudge here. If you would like more information, helpful tools or advice about patient/public engagement in research, please contact Carolyn Shimmin at cshimmin@exchange.hsc.mb.ca
The purpose of this Health Policy Study is to better understand adolescents’ views on what are considered core components of the medical home and identify barriers to promoting adolescent health in relation to the medical home.
In addition, this study sought to better understand the needs and challenges in providing adolescents with access to medical homes—from the perspective of both adolescents and experts in adolescent health and medical home policy. To accomplish these goals, researchers conducted focus groups with adolescents, presented these findings to experts, and gathered experts’ reactions to the adolescents’ perspectives. This report includes a detailed description of the methods used for this study, followed by a summary of key focus group findings and the expert reactions to these findings.
The 2019 Community Health Needs Assessment offers a comprehensive analysis of the health needs for children in the East Tennessee region. East Tennessee Children's Hospital partners with members of our community every three years to evaluate the top concerns, and to form an action plan which will take aim at combating these concerns to improve the health of children.
Safety is Personal: Partnering with Patients and Families for the Safest CareEngagingPatients
The work of NPSF"s Lucian Leape Institute's Roundtable on Consumer Engagement, "Safety Is Personal: Partnering with Patients and Families for the Safest Care" is a call to action for health leaders, clinicians, and policy makers to take the necessary steps to ensure patient and family engagement at all levels of health care.The report identifies specific action items for health leaders, clinicians, and policy makers to pursue in making patient and family engagement a core value in the provision of health. care.
June 27/2017 - SPOR-PIHCI Network presentations from the pre-CAHSPR conference day in Toronto, Ontario
Sharing Practical Advances in Research Knowledge-
Translating Findings to Action from PIHCIN Research
Partnering with Patients, Families and Communities for Health: A Global Imper...EngagingPatients
Engagement is an essential tool to improving global health. This report introduces a new framework for engagement to help countries assess current programs and think strategically about future engagement opportunities. It spotlights barriers to engagement and offers concrete examples of effective engagement from around the globe.
National Conference on Health and Domestic Violence. Plenary talk Paul Grundy
explaining how the Patient Centered Medical Home (PCMH) platform for healthcare deliver is more likely to support domestic violence prevention and creat a safer environment than the FFS episode of care system we are in now. The medical Home is a home for the data where the all the data goes and is held accountable this idea was first articulated by Dr. Calvin C.J. Sia, a Honolulu-based pediatrician in 1967.
This concept of the medical home was integrated with Ed Wagners Chronic disease Model and Thomas Bodenheimer Kevin Grumbach advanced/proactive primary care at the request of the Patient Centered Primary care Collaborative into a set of principles Know as the Joint principles of the Patient centered medical home.
The patient-centered medical home (PCMH), is a team based health care delivery set of principles led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults" The provision PCMH medical homes allow better access to health care, increase satisfaction with care, and improve health. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[10] Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage coordination.
PIHCI programmatic grants webinar (en) for circulationAlexandra Enns
These are the slides from CIHR’s webinar providing information for the upcoming PIHCI Network Programmatic Grant funding opportunity.
The complete instructions are on ResearchNet: https://www.researchnet-recherchenet.ca/rnr16/vwOpprtntyDtls.do?prog=2734&view=currentOpps&org=CIHR&type=EXACT&resultCount=25&sort=program&next=1&all=1&masterList=true
Patient Engagement Presentation - MPN Network Forum April 18, 2017Alexandra Enns
April 18, 2017
In April we held a Network Forum on engaging policymakers and patients/public effectively and appropriately. We would like to give a warm thanks to both Carolyn Shimmin, Patient Engagement expert of CHI's Knowledge Translation team, and Marcia Thomson, Assistant Deputy Minister of Manitoba Health, Seniors and Active Living for their presentations. Below you can see Carolyn's presentation - to see more of her work on patient engagement and to learn more about knowledge translation at CHI, please check out the blog Knowledge Nudge here. If you would like more information, helpful tools or advice about patient/public engagement in research, please contact Carolyn Shimmin at cshimmin@exchange.hsc.mb.ca
The purpose of this Health Policy Study is to better understand adolescents’ views on what are considered core components of the medical home and identify barriers to promoting adolescent health in relation to the medical home.
In addition, this study sought to better understand the needs and challenges in providing adolescents with access to medical homes—from the perspective of both adolescents and experts in adolescent health and medical home policy. To accomplish these goals, researchers conducted focus groups with adolescents, presented these findings to experts, and gathered experts’ reactions to the adolescents’ perspectives. This report includes a detailed description of the methods used for this study, followed by a summary of key focus group findings and the expert reactions to these findings.
The 2019 Community Health Needs Assessment offers a comprehensive analysis of the health needs for children in the East Tennessee region. East Tennessee Children's Hospital partners with members of our community every three years to evaluate the top concerns, and to form an action plan which will take aim at combating these concerns to improve the health of children.
Periodically, not-for-profit hospitals are required to conduct a Community Health Needs Assessment (CHNA) and develop an implementation plan to best serve the community's health needs. Read the latest East Tennessee Children's Hospital's CHNA reports at https://www.etch.com/chna
MHIN Special Report - Strategic Plan UpdateCaitlin Worm
In May 2016, MHIN created a new strategy to dramatically improve the health of our local community.
By leveraging 17+ years of Health Information Exchange data, we are working proactively to forge innovative solutions to our community’s most immediate health issues.
We’re one year into our plan and are on track to success.
How wise plan managers acted "outside-the industry box" to improve health whi...Dan Ross
Employer health plan sponsor invests in employee/member health in a manner opposite to high-deductible plan designs. Free primary care and generic drugs bring huge plan and employee savings! Spending $50 million funnels Pasco Schools (FL) to hire their own physicians!
Going Where the Kids Are: Starting, Growing, and Expanding School Based Healt...CHC Connecticut
Webinar broadcast on: June 28 | 3 P.M. EST
This webinar will address the benefits, challenges, and strategic advantages of a school based health center program from a clinical, data, quality, operational viewpoint, communications, and community engagement perspective. Experts will share the strategy for integrating oral health and behavioral health to ensure the best outcomes for patients.
Maximizing System-Level Data to Address Health and Social Complexity in ChildrenLucilePackardFoundation
An innovative methodology using system-level data to identify children with health complexity, that is based on medical and social complexity, is transforming how they consider improving quality of care in Oregon. Learn about this new standardized approach, developed by the Oregon Pediatric Improvement Partnership and Oregon Health Authority, and how it has helped inform priority areas, potential policy improvements, investments and partnerships in support of children with health complexity.
Effective care coordination ranks high on the priority list of families of children with special health care needs, yet it remains an elusive goal for most. This webinar featured a parent's perspective, along with real-life examples from a provider and a payer on how to develop effective local care coordination systems. The webinar, which drew close to 400 registrants from across the US, was designed as a first step in building a national movement to promote care coordination policies and payment options that better serve children, families, and care providers.
6 Pages references not includedTOPIC How Culture plays a role imilissaccm
6 Pages references not included
TOPIC: How Culture plays a role in ASD AUTISM Spectrum Disorder
References: 8 or more
THESE REFERENCES MUST BE IN APA FORMAT!!
Ascension St. Vincent's Foundation
09/18/2022
Ascension St. Vincent's Foundation
Background Information
Ascension St. Vincent's was founded in 1916 by the Daughters of Charity in response to a request made by Bishop James Michael Curley of St. Augustine. The Daughters of Charity arrived in Jacksonville in 1916. To meet the overwhelming demand for superior medical care in the Jacksonville area, four sisters responded by establishing our non-profit, faith-based hospital. Since the beginning of the twentieth century, many who work in the medical field have dedicated their lives to helping others who are ill or injured.
In 1982, the Ascension St. Vincent's Organization came into being as a philanthropic foundation with the intention of catering to the requirements of our healthcare mission. Our kind donors contribute more than $6 million annually to assist in funding essential community outreach programs, capital upgrades, and cutting-edge medical technology at our Riverside, Southside, and Clay campuses. These programs and technologies are located throughout the United States.
Organizational Context
Ascension St. Vincent Hospital, which is sponsored by the charitable endeavors of Ascension St. Vincent Foundation, is dedicated to aiding all people with a specific focus on the weak and vulnerable. This commitment is rooted in the compassionate ministry of Jesus as a healer. The Catholic health ministry aims to provide care that prioritizes the spiritual well-being of patients and the communities in which they live. Our words and actions reflect our dedication to creating a more compassionate and egalitarian world.
Ascension St Vincent having to provide healthcare services is vital to society and the public. The organization getting into the private sector will mean a seek for profit, expensive services to the public, and a possible reduction in quality of service. People compete for jobs in the public sector like it is a marathon because of the attractive perks these companies offer to their employees. On the other hand, in the private sector, your work is never safe, even if you stay in one place for years; a single mistake might result in your dismissal at any time.
Analysis
Evansville, Indiana's St. Mary's Hospital merged with the more extensive Ascension St. Vincent healthcare system in 2012 to provide better medical services to the city's citizens. In its mission statement, the Catholic non-profit Ascension says it "is committed to providing humane, tailored care to all, with special attention to those living in poverty and even those most disadvantaged" (Ascension, About Our Organization). The Ascension St. Vincent hospital in Evansville, Indiana, has undergone several improvements in recent years, including expanding the main hospital's footprint and establishing ...
An East Tennessee Children's Hospital publication that spotlights the lifesaving work done at Children's Hospital and the latest advances in medical technology, treatment and research.
In this issue: A special safety update from Children's Hospital regarding the ongoing COVID-19 pandemic. Learn how our facility has implemented policies and procedures to help keep your family safe from coronavirus.
An East Tennessee Children's Hospital publication that spotlights the lifesaving work done at Children's Hospital and the latest advances in medical technology, treatment and research.
In this issue: Meet Allison, a neurosurgical patient, student, non-profit founder and advocate for kids like her. Plus, get the latest news about the hospital and its upcoming events.
An East Tennessee Children's Hospital publication that spotlights the lifesaving work done at Children's Hospital and the latest advances in medical technology, treatment and research.
In this issue: Meet Bryan, a Sickle Cell warrior who has been a part of our hospital family since he was 6 weeks old. Plus, get the latest news about the hospital and its upcoming events.
An East Tennessee Children's Hospital publication that spotlights the lifesaving work done at Children's Hospital and the latest advances in medical technology, treatment and research.
In this issue: Meet the Baer twins, two boys who are celebrating one year of life after a very rocky beginning. Plus, get the latest news about the hospital and its upcoming events.
This magazine provides patient families with need-to-know information about East Tennessee Children's Hospital. The resources featured here are available to every family that visits our facility.
It's About Children special issue, the 2017-2018 annual report. Take a look back on some of the organization's stats and accomplishments over the past year, plus meet Audrey, a special young lady who is celebrating ten years cancer-free.
This special issue of It's About Children features two sisters with similar scoliosis diagnoses, the latest news and fundraising efforts, plus East Tennessee Children's Hospital's 2016-2017 annual report.
The Clinical Excellence Annual Report highlights some of the programs and advancements East Tennessee Children's Hospital has implemented over the past year.
It's About Children, Issue 1, 2017
An East Tennessee Children's Hospital publication that spotlights the lifesaving work done at Children's Hospital and the latest advances in medical technology, treatment and research.
In this issue: Meet Jasmyne, the healthy teen who inspires others, and Fletcher, the little boy with a big smile. Plus, get the latest news about the hospital and its upcoming events.
AJ Cucksey was named the Children’s Miracle Network Hospitals (CMNH) Champion for the state of Tennessee. He and his family will spend the year sharing his journey with brain tumors and how East Tennessee Children’s Hospital, a CMNH affiliate, has helped him.
It’s About Children is a publication of the Marketing Department at East Tennessee Children’s Hospital.
Caring for a child with a tracheostomy (trach) can be challenging. East Tennessee Children's Hospital has created this booklet for you to learn as much as possible about your child's new device.
Meet Madeline, or Maddie, as her family and friends call her. She’s active, outgoing and full of life, and despite a diagnosis that often leads her to spend more time in the hospital than she’d like, she believes in herself.
It’s About Children is a publication of the Marketing Department at East Tennessee Children’s Hospital. Learn more at www.etch.com/ItsAboutChildren
This PowerPoint presentation shows school nurses how to understand and respond to a child's sudden cardiac arrest. Information provided by the Project ADAM program at East Tennessee Children's Hospital.
"The quality of patient care is directly correlated to the degree to which our nurses are active and empowered through the use of the professional practice model." Read the East Tennessee Children's Hospital 2015 Nursing Annual Report.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
1. EAST TENNESSEE CHILDREN’S HOSPITAL
WWW.ETCH.COM
Form No. 31607 (06/16)
Community
Health Needs
Assessment
2016
2. EAST TENNESSEE CHILDREN’S HOSPITAL
WWW.ETCH.COM2
Table of Contents
Introduction................................................................................................................................................................3
2016 executive summary.......................................................................................................................................4
Community served...................................................................................................................................................5
Service area defined
Demographic data
Review of 2013 implementation strategy, outcomes..................................................................................7
Methodology and process for 2016 CHNA....................................................................................................11
Planning
Gathering and analyzing information
Key informant interviews
Focus groups
Community survey and summary
Primary data summary..........................................................................................................................................12
Secondary data summary....................................................................................................................................12
Findings and conclusions.....................................................................................................................................13
Identifying health needs
Selecting priorities
Gathering, tracking and reporting community benefit efforts
Current resources
Implementation strategy 2016...........................................................................................................................14
Community needs not addressed.....................................................................................................................18
Request more information, written comments solicited..........................................................................18
Appendices
3. EAST TENNESSEE CHILDREN’S HOSPITAL
WWW.ETCH.COM3
Introduction
For 79 years, physicians, staff members and volunteers at East
Tennessee Children’s Hospital (ETCH) have provided the best
care to children from across our region. However, our dedication
to the community extends beyond medical care. An integral
part of our mission is to improve the health of children through
exceptional wellness and education. In East Tennessee, we
provide services, support and education to the community
through various projects and programs. These programs promote
safety, healthy lifestyles and specialized care beyond what
Children’s Hospital offers within its walls. We strive to ensure
that community health is more than just words in our mission
statement.
In a broad sense, Children’s Hospital strives to improve the
health status of the children in our region. To better understand their needs, we formally review
their health using information obtained through analysis and interview with both families and
community leadership. Children’s Hospital conducted our first formal Community Health Needs
Assessment (CHNA) in 2013. The analysis identified the need to address issues associated with
access to care, behavioral health, childhood obesity, parent education and dental care. The
findings of the assessment provided a direction for our community mission and helped develop
the scope of the work we do in the community. Importantly, this assessment provided an
opportunity for Children’s Hospital to partner with those in the community who shared a similar
concern and offered an opportunity to leverage partnerships effectively, promote communication
and to be efficient with resources.
The feedback we receive from key informants, focus groups, other stakeholders and research of
published data is critical to understanding the health needs and resources within our community.
As you read about our activities associated with the assessment conducted in 2013 as well as the
information we have gleaned as a result of our 2016 analysis, I think you will agree with me that
although we have accomplished a lot, there is still much more to do. If you have questions or
suggestions based on your review of this report, please feel free to contact the Children’s Hospital
Community Benefit Department at (865) 541-8532. We have an ongoing commitment to listen to
and work with community members, leaders and organizations to help improve the lives of the
children in our area.
We would like to thank all individuals who participated in the needs assessment process.
Combining the assets of the local community we serve with the mission, dedication and vision
of Children’s Hospital, we have confidence that we will continue to address health priorities of
children in our communities.
Keith Goodwin, President/CEO
4. EAST TENNESSEE CHILDREN’S HOSPITAL
WWW.ETCH.COM4
2016 Executive Summary
The 2010 Patient Protection and Affordable Care Act introduced reporting requirements for
not-for-profit hospitals to maintain their 501 (c) (3) tax-exempt status. Effective for tax years
beginning after March 23, 2012, each hospital must:
1. Conduct a CHNA at least once every three years.
2. Develop an implementation strategy to address identified needs.
3. Report on outcomes of efforts from strategies implemented.
4. Report the results of each CHNA publicly.
At Children’s Hospital, children are our only concern, and that drives our mission to improve
their health though exceptional, comprehensive family-centered care, wellness and
education. It is a mission that centers on a profound and unchanging commitment to the
physical, educational and emotional needs of each child. The CHNA is the foundation for
improving and promoting the health status of our community’s children. The planning,
activities and data review necessary for the development of the most recent assessment took
place beginning December 2014 and extended through spring 2016 and includes state and
county-specific data collection and primary data obtained through surveys and interviews
with individuals from local communities.
Throughout the CHNA, high priority was given to determining the health status and available
resources within Knox, Anderson, Blount, Sevier and Jefferson counties. These counties were
identified as core counties based on patient population data.
After careful evaluation of all primary and secondary data, health priorities were identified.
The remainder of this assessment is dedicated to reviewing the outcomes of the 2013
implementation strategy, identifying our service area, reviewing demographic data through
primary and secondary resources, explaining our process and methods for the assessment,
identifying the health needs selected as priorities, evaluating current resources, identifying
our implementation strategy and reporting on community needs not addressed and why.
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Where and who we serve
Service area defined
Children’s Hospital is certified by the State of Tennessee as a Comprehensive Regional
Pediatric Center (CRPC). This certification acknowledges Children’s Hospital’s ability to provide
a wide range of specialized pediatric medical and surgical services to acutely ill and injured
children. An additional responsibility involves working with hospitals within our region to
ensure they have a basic capability to provide care to children who may present at their
facility. Emergency Department physicians and nurses provide onsite education to hospitals
and physician groups in the regions. Training includes advanced CPR techniques, line
insertion, trauma care, injury prevention programs and education.
Upon examination of patient admission data, Children’s Hospital identified five area counties
to focus on gathering information. Although Children’s Hospital serves the entire East
Tennessee region as a CRPC, nearly half (%) of Children’s Hospital’s total patient visits during
the 2015 fiscal year were from Knox County residents, making Knox County Children’s
Hospital’s primary service area. For purposes of this CHNA, Blount County, Sevier County,
Anderson County and Jefferson County were included as we gathered and analyzed
community health needs.
Patient demographic data
Children’s Hospital serves children and young adults, newborn to 21.
Age distribution for FY 2015 Race distribution for FY 2015
0-3 39% Asian – 1%
4-7 20% American Indian – less than 1%
8-11 16% Black – 9%
12-16 19% Black/Hispanic – less than 1%
17-19 5% Bi-racial – 5%
Above 19 2% Hispanic – 5%
Other – 3%
White – 77%
White/Hispanic – 1%
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Payer mixFinancial highlights
Primary service area
Cost to operate Children’s Hospital
$577,303 a day
$210,715,622 a year
71,974 unique patients
144,783 patient visits
142,332 patient visits from Tennessee
1,068 patient visits from Kentucky
547 patient visits from Virginia
836 patient visits from other states
Patient population
Statistics from Fiscal Year 2014-15
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2013 Implementation strategy review and
summarization
The 2013 CHNA conducted by Children’s Hospital revealed the following five health priorities
to address for a three-year period though a focused implementation strategy:
1. Access to care
2. Behavioral health
3. Childhood obesity
4. Parent education
5. Dental care
The Children’s Hospital Board of Directors approved for several existing programs to be
developed or enhanced in response to these priorities.
Children’s Hospital Childhood Obesity Coalition
(Formerly Knoxville Area Coalition on Childhood Obesity)
This program works to improve the health of children through a community-wide partnership.
The goal of the coalition is to reverse the incidence of childhood obesity. In 2013, Children’s
Hospital committed to continuing this program through financial support for both staffing
and program costs.
Programs have been strategically developed in areas of East Tennessee where obesity is more
common and healthy food options are less accessible. The data used to define greatest need
was generated through analysis of body mass index (BMI) readings provided through the
school systems. By developing and implementing these programs, children and families learn
to incorporate a healthy regimen into their daily routine. Community partners are essential to
successful programming. Key partners in program execution and expansion are Coordinated
School Health coordinators, school systems and preschools. These partners play a pivotal role
in the capacity to support the program development, positively impacting the sustainability
of life-long habits of healthy behaviors among children and families.
With increased funding, both hospital and grant-based, the Children’s Hospital Obesity
Coalition has been able to offer the following programs:
• Kids Can Bike: a seven-week program held twice a week that teaches the participants
about bike upkeep, bike safety and greenway etiquette. Kids Can Bike is partnership
with the City of Knoxville Parks and Recreation.
• Health Happens: a three-part program targeting preschoolers, their parents and their
teachers. The preschoolers participate in a 12-week program, receiving 30 minutes of
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nutrition education and 30 minutes of instructor led physical activity. The parents
are invited to participate in six classes that include nutrition and physical activity
information. The teachers participate in two meetings that encourage their center to
participate in the Let’s Move Childcare Initiative, a national program that encourages
and supports child care and early education to make positive changes. During these
meetings, the instructors lead the teachers in creating an action plan and support
them during the implementation process.
• Healthy Kids Club: a 12-week program that targets students from kindergarten
to fifth grade. Weekly, up to 50 children participate in physical activity, nutrition
education and taste tests. The goal of Healthy Kids Club is to familiarize children
with basic nutrition concepts, expand their knowledge and consumption of fruits
and vegetables, increase physical activity and learn a lasting, playful approach to a
healthy lifestyle.
• The Grub Club: promotes healthy lifestyles to area elementary school students
through education about real food–where it comes from, how it grows the
nutritional benefits and its variety of flavors while providing physical activity in the
garden.
The Children’s Hospital Obesity Coalition has educated more than 26,000 children about the
benefits of nutrition and physical activity since 2013, and evaluations show an increased
awareness about health issues among children reached. The Knox County Schools reports
annually on BMI scores and indicates a decline in BMI scores taken in school-age children.
The average BMI scores for a selected age group for the school year 2011-2012 was 33.78
percent and for the school year 2014-2015 was 29 percent. While some success has been
achieved, we recognize there is much more work to do.
Project ADAM Tennessee
Project ADAM Tennessee was launched by Children’s Hospital in 2011 with the mission of
placing Automated External Defibrillators (AEDs) in elementary and middle schools and
instructing school personnel in the proper use of CPR and AEDs in Knox County. The goal
is to make AEDs available to all area schools and work toward eliminating sudden cardiac
death in children and community members through education and prevention. Since
starting the program, the focus has expanded beyond Knox County and now includes
support to schools and programs throughout the state. To date, Project ADAM has helped
fund or co-fund 131 AEDs, trained 950 individuals to administer CPR in schools and
conducted 129 AED heart-safe drills in area schools.
Partnerships with Knox County Schools, the University of Tennessee and Coordinated School
Health help Project ADAM Tennessee continue to make a difference. Opportunities continue
to promote the program’s expansion. Recently, a new Tennessee State law known as
“Sudden Cardiac Arrest Prevention Act”has spurred a flurry of new interest in Project ADAM
that will set a course for this program for years to come.
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Children’s Hospital Injury Prevention (Safe Kids Coalition of the Greater Knox Area)
Children’s Hospital is the lead organization for Safe Kids of the Greater Knox Area, a local
chapter of the international non-profit Safe Kids Worldwide. This program is dedicated to
preventing injuries in children, which is the number one killer of children in the United
States. The injury prevention program concentrates on reducing injuries from motor vehicles,
sporting activities, drowning, falls, burns and poisonings.
With dedicated funding and increased resources from Children’s Hospital and support grants,
over the last two years the program distributed 3,920 helmets and 820 car seats, conducted
106 car seat inspection events and provided injury prevention education programs to more
than 30,000 participants. While it is difficult to evaluate the impact of programs of this
nature, there is an implied success with the continued pre-and post-program evaluation,
participation of coalition members and community interest.
Children’s Hospital Developmental Behavioral Center
The Developmental Behavioral Center opened in January 2014. The center diagnoses
conditions such as ADHD, autism, depression, anxiety, obsessive compulsive disorder and
tic disorder. It provides medical management for these conditions and serves to coordinate
other appropriate services such as counseling, speech or occupational therapies. The program
works in coordination with the patient’s primary care physicians and strives to help them
determine appropriate referrals.
Currently there is one physician and one nurse practitioner on staff. Also on the team are
three nurses who in addition to their nursing duties provide support to families about
parenting skills. Since opening, the center has a total of 5,198 patient visits; 866 of those visits
were new consultations. Of those new consultations, 76 were with autism spectrum disorder,
30 with development delay, 350 with ADHD, 101 anxiety and 20 with depression.
Though still in its infancy, it is clear that this program is beginning to make an impact on
children who have previously been underserved in our community.
Knox County School nurse program in Title 1 Schools
“Title 1”is a federal status applied to schools that operate in high poverty areas. Additional
funds are distributed to Title 1 schools to operate programs for children who need extra
educational assistance to perform at the appropriate level for his or her age and grade. The
school nurse is central to coordination of health care services, health screenings, health and
dental hygiene promotion and education. School nurses have a broad knowledge base and
use their expertise to assist students and families in developing healthy lifestyle choices,
health care referrals, assistance in obtaining medical insurance and case management for
the chronically and acutely ill. The school nurse is one of the main collaborative partners in
a school; therefore, having a full-time registered nurse in each Title 1 elementary school is
paramount to student academic achievement, health and wellness.
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In the 2013-14 school year, Children’s Hospital provided a three-year grant to fund 10
registered nurses in 13 Title 1 schools at an average cost of $500,000 annually. Knox County
Schools reported that during the first two years of this program, educational outcomes were
increased and health outcomes were improved.
Students assessed by school nurses:
2012/13: 5,401
2013/14: 32,284
2014/15: 34,949
Attendance:
2013/14: .024 increase in attendance
2014/15: .037 decrease in attendance
Fluoride varnish:
60 students received fluoride varnish during the 2014/15 school year.
Fluoride varnish is a protective coating painted on a child’s teeth to help prevent
cavities.
Children screened for obesity:
76.1% increase in BMI screenings from previous year
Increase in children with an identified health care home:
2013/14: a baseline was established
2014/15: 6% increase (557 students) in the number of children having a
primary health care provider
Breathe Easy (asthma screening program):
Screenings at 8 schools
112 identified with abnormal lung function
This program provides free asthma screenings, assessments, asthma education and follow-up
phone calls to event participants. Goals are reached through a team approach comprised of
physicians, nurse practitioners, nurses, respiratory therapists, student nurses and community
volunteers. Screenings are provided for children 5 years or older, and in addition, some adult
screenings are performed, particularly at community venues.
From June 2013 to July 2015, the Breathe Easy team conducted 20 events, screened 1,526
individuals and identified 155 participants as having a significantly abnormal screening.
Identifying such a large number of children and adults with increased risk for asthma further
supports the utilization of this program in Knoxville and the surrounding communities.
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Methodology and process for 2016 CHNA
Planning
The planning process for the 2016 CHNA began in December 2014. An internal team was formed
to identify and approve resources and timelines for conducting the necessary steps for formation
of the needs assessment.
A schedule was established to allow sufficient time and resources to indentify and engage
community partners in key informant interviews and focus groups. The internal team used
a modified version of the Mobilizing for Action through Planning and Partnerships (MAPP)
process. This process is commonly used to assist community health organizations during the
needs assessment process. The MAPP process provided the framework for Children’s Hospital to
organize, visualize, assess, strategize, formulate goals and take action.
Gathering and analyzing information
Key informant interview
Key informants were identified in five counties (see Appendix A) and by using the following
criteria.
1. Those with special knowledge of or expertise in public health;
2. At least one state, local, tribal, or regional government public health department
(or equivalent department or agency) or State Office of Rural Health with knowledge,
information, or expertise relevant to the health needs of that community;
3. Members of medically underserved, low-income, and minority populations in the
community served by the hospital facility, or individual or organizations serving or
representing the interest of such populations;
4. Members of medically underserved populations include populations experiencing
health disparities or at risk of not receiving adequate medical care as a result of being
uninsured or underinsured or due to geographic, language, financial or other barriers.
Each interviewer was contacted using a uniform script (Appendix B). These face-to-face
interviews were conducted by Children’s Hospital Community Benefit staff at scheduled times.
Summary findings of the key informant interviews can be found in Appendix C.
Focus Groups
Children’s Hospital conducted five focus groups, enlisting the service of expert facilitators. The
demographics and findings of this process are included in Appendix D. The groups identified
meeting specific criteria were:
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1. Children’s Hospital’s Family Advisory Council
2. Emerald Youth Foundation Parent Group
3. Children’s Hospital’s Board of Directors
4. Primary care physicians
5. Knox County school nurses
Community survey
A survey for the general population was created to gain input from community residents and
key stakeholders about the top health needs and priorities of children. We promoted the survey
on the Children’s Hospital website and social media to encourage people to complete an online,
confidential survey (Appendix E). Results are indicated in Appendix E.
Primary data summary
The gathering and analyzing phase of the CHNA includes interviewing key informants,
conducting focus groups and collecting information through an online survey.
During the key informant interviews, feedback was sought on the perceived health needs of
children in our community. Childhood obesity, access to care, wellness and injury prevention,
mental health, dental care, asthma and allergies ranked the highest for seriousness and potential
needs to be addressed.
The five focus group sessions revealed detailed and knowledgeable conversations regarding
identifying the most critical needs of children in our community. The groups indicated access
to care, childhood obesity, outpatient mental health, parental substance abuse, neonatal
abstinence syndrome and injury prevention were needs that need to be addressed. A
comprehensive report and summary are available upon request by utilizing the contact
information available on page 13.
Summary results of the online survey indicate the largest health care issues in our area including
parental substance abuse, obesity, allergies and asthma, smoking and access to primary care.
Other issues indicated were behavioral health, health education, dental care and teen pregnancy.
Secondary data summary
In addition to engaging community members and soliciting information , Children’s Hospital
also reviewed and compiled qualitative data to explore core health indicators in effort to
recognize the current needs of our community. Sources used included the Knox County Health
Department Community Health Needs Assessment; County Health Rankings 2015; Tennessee,
Robert Wood Johnson Foundation; 2013/2014 State and County QuickFacts, U.S. Census Bureau;
and Kidscount Data Center 2014 Tennessee Commission on Children and Youth.
See Appendix F for 2014 Key Statistics.
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Findings and conclusions
Identifying health needs
Children’s Hospital analyzed all of the quantitative and qualitative data described above
and in the appendices hereafter. In general, the input received from community members
and those who participate more in the delivery of health care services varied slightly. The
health needs identified through the information process are indicated in Appendix C: Key
informant interview summary, Appendix D: Focus group listing and findings and Appendix E:
Community survey and summary.
Selecting priorities for guidance with the implementation strategy
The purpose of an implementation plan is to identify the activities and responsible parties
required to work toward making a positive impact towards improving the health needs of
children in our communities. This allows for proper allocation of staff and financial resources.
Children’s Hospital developed the implementation strategy based on the findings of the
current assessment on rankings of health needs from primary and secondary data in
conjunction with identifying other resources available in the community. These collaborative
efforts help key partners stay focused on critical issues working towards healthy futures for
our children.
Gathering, tracking and reporting community benefit efforts
The Children’s Hospital Community Benefits Department provides oversight for more than
30 reporters who gather, track and record occurrences in the tracking and reporting program
called CBISA from Lyon Software.
Current resources (Appendix G)
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Implementation strategy 2016
The needs assessment process allows Children’s Hospital to identify the pediatric health care
needs in our region and direct our commitment to providing resources to help positively
impact child health. In addition to the many valuable, innovative programs and services
available at Children’s Hospital, there are five specific areas that will have a defined focus. In
May 2016, the Children’s Hospital Board of Directors unanimously approved the prioritized
focus areas described below to be the foundation of our implementation strategy.
Neonatal Abstinence Syndrome
Tennessee has seen dramatic growth in the number of newborns with Neonatal Abstinence
Syndrome (NAS). In 1999, less than 100 children were diagnosed with NAS according to the
Tennessee Department of Health. By 2010, more than 500 cases were reported, and in 2015,
the number of NAS births in Tennessee had risen to 986 with 32.7 percent (323 babies) being
treated at Children’s Hospital. Since 2010, the hospital has treated 1,354 infants with NAS.
Situated at the center of this epidemic, Children’s Hospital is a leader in establishing treatment
protocols of patients with NAS and in the training of their caregivers. However, there is a
gap in tracking, support and follow up for a significant number of these infants and their
caregivers after discharge. While some receive the support and care they need, others are lost
to follow up.
Children’s Hospital plans to research and develop a formal NAS care coordination service.
This strategy includes data collection, research and travel to established NAS programs across
the country. We plan to explore further collaborations that may include additional support.
Children’s Hospital embraces the broader scope of providing care coordination for patients
with NAS and is committed to supporting the service’s sustainability and expansion through
current operations and philanthropic support. Children’s Hospital has a long history of
successful fundraising. As the NAS care coordination service expands, it would be a priority for
philanthropic support.
Children’s Hospital’s goals for the first phase of program development include:
• Conducting two to three visits to NAS programs to evaluate best follow-up practices
• Developing collaborative partnerships with other programs working with NAS patient
families
• Researching former patients with a history of NAS to identify services being used after
discharge
• Developing a business plan for creating an NAS care coordination service. The business
plan developed during the first phase will be used to guide the implementation of the
NAS care coordination service in the second phase.
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The measurable impact will be demonstrated through:
• Identification and/or development of best practice models to assist children who were
born with NAS.
• Identification and engagement of community partners to ensure coordination of care
and family support
• Improved care efficiency for the child and increased family satisfaction with the care
provided
Project ADAM Tennessee
Project ADAM Tennessee provides schools with information, materials, training and support in
the management of Public Access to Defibrillation (PAD) programs. Supported by Children’s
Hospital since 2011, the placement of Automated External Defibrillators (AEDs) in area
schools is a priority. In addition to these life-saving devices, Project ADAM helps schools
coordinate and train emergency response teams, assist with practice drills and ensure staff
and community awareness.
Recent state legislation requires annual awareness training and practice drills for all schools in
Tennessee. In addition, the law requires coaches, athletes and parents/guardians of athletes
to be informed about the warning signs of sudden cardiac arrest and proper responses.
Schools must have emergency response plans in place, identify response teams trained
in CPR and perform CPR/AED drills when students are present. The law passed in 2016
recommending Project ADAM Tennessee as a resource for schools has created a dialogue
with school nurses and school health coordinators across the state that will continue to drive
the development of effective ways to provide materials, training and support to schools.
These new requirements will not only strengthen community responses to sudden cardiac
arrest, they will improve awareness about the importance of CPR and AED training and will
ultimately help Tennesseans have the best possible chance of surviving sudden cardiac arrest.
As AEDs become aged and as new school facilities are constructed, we will continue to
encourage schools to be properly equipped. We will focus on providing awareness training
for schools with our presence, consultation and materials. When possible, we will travel
to schools to personally demonstrate efficient and effective training and review individual
or system programs. For those outside our service area, we’ll continue to be available for
consultation and to develop accessible training materials. We continue to help evaluate AED
needs and help provide support where appropriate.
Project ADAM Tennessee continues to look for ways to expand our reach across the state and
country. We are currently in the process of assisting other hospitals across Tennessee with
implementation of a version of this program.
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Injury Prevention
According to the Centers for Disease Control and Prevention, accidental injury is the number
one cause of death among children ages 14 and under in the United States. Each year, one of
every four children requires medical attention for an accidental injury, and up to 90 percent of
these injuries can be prevented through education.
The Children’s Hospital’s injury prevention programs play a vital role in our community. These
programs are constantly evolving and include topics such as falls, water safety, fire safety and
child sleep safety.
Two valuable programs to our community are the Safe Travels program and our bike safety
program. The Safe Travels program is a child passenger safety program that focuses on
partnering with local agencies to conduct car seat inspections and to replace unsafe seats.
Our bike safety program is offered to local schools and at community events to encourage
the proper use of bike helmets. Helmets are many times provided at no cost to participants.
This program focuses on the ways to keep children safe while riding bikes or other wheeled
sports. The primary goal of the program is to reduce the occurrence of unintentional pediatric
injuries using evidence-based prevention techniques developed by Safe Kids Worldwide and
other proven injury prevention experts.
Children’s Hospital is a Comprehensive Regional Pediatric Center. We provide pediatric
education, training and networking services for pre-hospital professionals, hospitals and
health care providers in our designated region. We are committed to continuing these
programs to help keep children in our community safe.
Childhood Obesity
The Childhood Obesity Coalition’s vision is increase the health of the citizens in our area
and to help Knoxville become one of America’s fittest cities. According to the 2014-2015
Community Health Assessment, 17.4 percent of Knox County students were measured as
obese in the 2013-2014 school year. Programs are designed to prevent childhood obesity by
including both nutrition education and physical activity components. The overall goal for
obesity prevention programs is for children to develop and improve their social, physical,
emotional, cognitive and interactive skills to improve their health outcomes. Additionally, to
continue to improve the community, the coalition plans to actively show support for public
policy and advocacy around nutrition, increased physical activity and to build a community
where people are more active.
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Allergies and asthma
According to the World Health Organization, asthma is the most common childhood pediatric
disease. Knoxville has been consistently identified as one of the top 10 metropolitan areas in
the country where it is most challenging to live with asthma. As a key pediatric provider in
East Tennessee, one of our strategic goals is to create a virtual center for the care of a child with
asthma in our community.
For each child with asthma, we work towards providing the child and the caregiver the
most comprehensive care coordination of the disease process including education for self
management, proper medication regimen and follow-up care. We will continue to work with
primary care doctors to ensure they have the knowledge and resources to provide excellent“well
care”for children with asthma.
Our goals include:
• Providing access to appropriate and timely utilization of our asthma specialist
• Maximization of partnerships between school nurses and the health care providers
• Providing education on eliminating environmental triggers
• A focus on creating a best practice care map for patients who present to the Children’s
Hospital Emergency Department which will guide them through the inpatient setting to
discharge
• Form strategic alliances with asthma experts in the community and across the state to
improve and standardize care
• Continue to refine an asthma call process so that children with moderate to severe
persistent asthma or those that do not have a primary care provider can have access
to high quality follow-up care within 72 hours of presentation to the Children’s Hospital
Emergency Department. Key stakeholder relationships play an important role in the
success of this process
• Continue to collaborate with Children’s Hospital Alliance of Tennessee (CHAT) to
standardize and will be implement best practice asthma education
• Through our Breathe Easy program, perform screenings in high-risk schools and make
recommendations for follow-up and self care
• Work with our key stakeholders and the University of Tennessee at Knoxville to consider
novel ways to improve self management and potentially provide better school support
and/or care coordination
With our asthma experts and key stakeholders, we want to create or provide access to primary
care providers to the resources needed to provide excellent asthma well care. For the children
most at risk, we have set goals to pursue the viability of providing better community, school and
home support for these children.
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Community needs not addressed
Additional topic areas were identified during the CHNA process including teen pregnancy,
teen substance abuse, parental substance abuse and dental care. While Children’s Hospital
will continue to focus on the majority of efforts outlined in our implementation strategy, all
needs identified will be reviewed for future consideration and collaboration. These areas,
while still important to the health of children in the community, will be met through other
health care organizations with assistance from Children’s Hospital as needed. The community
needs not addressed by Children’s Hospital will continue to be addressed by governmental
agencies and existing community-based organizations.
Request for more information, written comments solicited
In addition to this CHNA being publicly available on our website, other reports relevant to this
process can be made available by request to:
East Tennessee Children’s Hospital
Community Benefits Department
2018 Clinch Avenue
Knoxville, TN 37916
Phone: 865-541-8532
Email: lcoxcollier@etch.com
Children’s Hospital solicits written comments on each CHNA. This is indicated on the
Children’s Hospital website at https://www.etch.com/community/chna/. As of 1-8-2016, there
have been no written comments regarding the 2013 CHNA.
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County Name Title Organization
Anderson VickiViolette, P.h.D. Director of Schools Clinton City Schools
Jamie Jordan Coordinator Clinton City Schools
Art Miller Director Anderson County Health Department
Anna Hurt Director, Anderson County Schools
Coordinated School Health
Rick Meredith President Anderson County Chamber
of Commerce
Blount Heather Ledbetter Coordinated School Health Coordinator Maryville City Schools
Kelly Gallemore Coordinated School Health Coordinator Alcoa City Schools
Mary Beth Blevins Coordinated School Health Coordinator Blount County Schools
Kelly Roberts Director Family Resource Center
Jane Andrews Director Blount Memorial Foundation
& Community Outreach
Tabitha Damron Executive Director New Hope Children’s Advocacy Center
Jefferson Sue McBee, R.N. Associate Professor Carson Newman University
MichelleWeatherbee, R.N. Nurse Jefferson County Health Department
Ronda Click Coordinated School Health Coordinator Jefferson County
Knox Tim Irwin Judge Knox County Juvenile Court
Kathy Brown Associate Professor University ofTennessee Department
and MPH Program Director of Public Health
LisaWagoner Coordinated School Knox County Schools
Health Coordinator
Nan Gaylord, P.h.D., Associate Professor, Vine Street School Health Center
P.N.P., R.N. University ofTennessee
Marcus Jackson Director Boys and Girls Club
Steve Diggs Director EmeraldYouth Foundation
Mark Field Vice President of Membership Knoxville Chamber Partnership
Elaine Streno Executive Director Second Harvest
Charlayne Frazier TENNderCARE Program Manager Knox County Health Department
Juanita Boring, R.N. Nurse Richard Bean Juvenile Detention Center
Ryan Redman, M.D. Director of Emergency Services EastTennessee Children’s Hospital
Lise Christensen, M.D. Chief of Medical Staff EastTennessee Children’s Hospital
Joe Childs, M.D. Vice President for Medical Services EastTennessee Children’s Hospital
Martha Buchanan, M.D. Director and Public Health Officer Knox County Health Department
Sevier Don Best Coordinated School Health Coordinator Sevier County Schools
Jana Chambers Director Sevier County Health Department
Garnet Southerland Wellness and Community Health Supervisor LeConte Medical Center
MaryVance Director Mountain Good Hope Sheppard
Linda Hyder Extension Agent University ofTennessee Extension
Appendix A: Key informants identified
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Appendix B: Key informant interview uniform script
Key informants will be interviewed as part of the Children’s Hospital qualitative data collection
process. These informants will represent a variety of governmental, social, and religious
organizations within five key counties in the Children’s Hospital service area. We want to
acknowledge all of the informants for their participation; however, all informants will not be
identified in order to protect confidentiality. In order to meet IRS requirements, we will ask
informants to agree to be identified as informants who meet some of the criteria as required
by the IRS:
1. Those with special knowledge of or expertise in public health;
2. At least one state, local, tribal, or regional government public health department
(or equivalent department or agency) or State Office of Rural Health with
knowledge, information, or expertise relevant to the health needs of that
community;
3. Members of medically underserved, low-income, and minority populations in
the community served by the hospital facility, or individual or organizations serving
or representing the interest of such populations;
4. Members of medically underserved populations include populations experiencing
health disparities or at risk of not receiving adequate medical care as a result of
being uninsured or underinsured or due to geographic, language, financial or other
barriers.
Hello, may I please speak with [NAME]?
My name is [INTERVIEWER’S NAME] and I am calling from East Tennessee Children’s Hospital.
________ from __________ gave me your information in order to participate in the 2016
Children’s Hospital Community Health Needs Assessment.
The purpose of this assessment is for the hospital to gain an understanding of the current
health status of their target area, learn about the top health needs and priorities, and to
develop an action plan to address some of those health needs when possible. Part of the
assessment is gathering quantitative data on health indicators from secondary analysis and
the other part of the assessment process includes getting input from community residents
and key stakeholders, which is why I am calling to ask to meet with you for a brief interview.
Your input will be used to inform the health needs assessment and potential future action by
Children’s Hospital in our community.
The interview will take 30 minutes to one hour. Can we schedule a meeting in the next week or
two?
21. EAST TENNESSEE CHILDREN’S HOSPITAL
WWW.ETCH.COM21
Needs identified Number of responses
Access to care (Cost, availability and transportation..................................................................................21
Asthma/allergies......................................................................................................................................................14
Childhood obesity/nutrition/physical activity.............................................................................................24
Clinical preventive services/wellness initiatives/injury and violence..................................................18
Dental care.................................................................................................................................................................15
Education health literacy........................................................................................................................................3
Neonatal abstinence syndrome.........................................................................................................................13
Outpatient mental health/autism spectrum/behavioral disorders......................................................24
Parent education.......................................................................................................................................................8
Parental substance abuse (alcohol and drug)...............................................................................................11
Pediatric inpatient psychiatric health................................................................................................................0
Teen pregnancy and sexually transmitted diseases.....................................................................................2
Tobacco/alcohol/drug abuse (children and adolescents)..........................................................................5
Type 1 diabetes..........................................................................................................................................................2
Quotes from interviews
On parenting:
“I think schools do a fantastic job, but there’s a limit to what you’re capable of doing, so I
think it’s empowering and educating parents to help their kids make better choices and
consequently help them make better choices.”
On transportation pertaining to specialty clinics for obesity/behavioral health:
“You can offer the best service in the world, but if it’s hard to get to it or it takes a great deal of
effort, if there’s a lot of transportation involved, especially for the economically disadvantaged
group, then they probably won’t go. … transportation is a barrier to accessing health services
for our economically disadvantaged families.”
On nutrition and obesity:
“I think Children’s Hospital can support parks and activities and school recreational programs,
and I think some of the nutrition programs through school that Second Harvest and others do
to try to – food that kids are actually taking home and having access to that’s healthy. …I think
just promoting ways for kids to be active. …I like trying to work through the schools. I think
there are a lot of resources for before school starts, but I think that the schools need our help,
school-age kids need our help.”
Appendix C: Key informant interview summary
22. EAST TENNESSEE CHILDREN’S HOSPITAL
WWW.ETCH.COM22
On mental health and psych patients:
“Number one, we need to have increased funding from the state. …The state absolutely has
to reimburse for psychiatric care, and we don’t have any child psychiatrists on staff, but we
have one, so they obviously are not getting reimbursed, so we have to find a way to reimburse
child psychiatrists so they’d be willing to be on our staff. …Second is do we need to add child
psychiatric services to our hospital or find a way to provide that kind of care? …Maybe going
back to the local leaders and asking how we can better serve this population of kids, because
it’s just a travesty for these families that these kids are in our ER for two to three days.”
On mental health, injury prevention and trauma:
“Give us more funding. …We just see a continued need within our community to continue to
educate people on (injury prevention).”
On meeting needs for preventative care and mental health:
“We have all these services that are available, but there’s a disconnect between the service
and getting it to the people in a relational way. …So I would just respond I think we need
more organizations, whether that be the church or other groups, that can engage relationally
with the families and make the connection to the services that are available, sort of reconcile
all of that.”
On preventative services and mental health:
“Essentially, it’s just going to take a lot of resources. The problem with the primary care issue
is there’s just not enough primary care docs out there, where they can keep a reasonable
number of patients. …And then the psychiatric stuff is just going to take resources, and I don’t
know where that comes from. …We have a lot of resources here in this community, but that’s
one we just don’t have.”
23. EAST TENNESSEE CHILDREN’S HOSPITAL
WWW.ETCH.COM23
Appendix D: Focus group summary listing and findings
Children’s Hospital conducted five focus groups, enlisting the service of expert facilitators. The
demographics and findings of this process are included in Appendix D. The groups identified
meeting specific criteria were:
1. Children’s Hospital Family Advisory Council
2. Emerald Youth Foundation parent group
3. Children’s Hospital Board of Directors
4. Primary care physicians
5. Knox County school nurses
The five focus group sessions revealed detailed conversations between experts regarding
identifying the most critical needs of children in our community. In summary, the groups
indicated access to care, childhood obesity, outpatient mental health, parental substance
abuse, neonatal abstinence syndrome and injury prevention were needs that need to be
addressed. A comprehensive report and summary are available upon request by utilizing the
contact information available on page 13.
24. EAST TENNESSEE CHILDREN’S HOSPITAL
WWW.ETCH.COM24
Appendix E: Community survey and summary
East Tennessee Children’s Hospital wants to be sure that we are meeting the health care needs
of all children in our community. Please fill out this short survey to help us identify areas in
which we can better serve you.
What are the ages of the children in your home? *
Do you have difficulty finding healthcare for your child? * o Yes o No
Does your child have a chronic health care condition? * o Yes o No
If yes, what is the diagnosis?
Does your child have a primary care doctor? * o Yes o No
If yes, how often does your child see this doctor? Once a month or less?
More than once a month?
How would you rate your child’s Health? *
o Excellent o Good o Fair o Poor o Very Poor
Which health care issue (s) listed below do you feel are the largest problems in our area
(check all that apply)? *
o Access to Primary Care o Allergies and Asthma o Behavioral Health o Dental Care
o Diabetes o Diversity o Handicapped Access o Health Education in Schools
o Illegal Drug Use, Parental Illegal Drug Use o Child Immunizations o Injury Prevention
o Obesity o Parenting/Parent Education o Smoking o Teen Pregnancy
How often does your child go to a hospital emergency room? *
o Rarely o Once a month or less o At least twice a month
Does your child’s school nurse help meet the healthcare needs of your child? *
o Yes o No
What is your ethnicity? *
o African-American o American Indian or Alaska Native o Asian o Caucasian
o Hispanic Two or more races o Other___________________________________________
25. EAST TENNESSEE CHILDREN’S HOSPITAL
WWW.ETCH.COM25
Summary of survey results
Does your child have a primary care doctor?
Yes – 26 No – 2
Which health care issue(s) listed below do you feel are the largest problems in our area?
Please let us know any additional thoughts, ideas or concerns you may have about healthcare
needs and issues in our community.
Issue
Access to primary care
Allergies and asthma
Behavioral health
Diabetes
Illegal drug use, child
Illegal drug use, parental
Immunizations
Injury prevention
Obesity
Parenting/parent education
Smoking
Teen pregnancy
Dental care
Health education in schools
Handicapped access
Diversity
Number of responses
8
14
10
6
9
15
3
3
15
12
13
7
5
7
2
1
What is your ZIP code? *
What kind of insurance do you have for your child? *
o Commercial o Cover Kids o TENNcare o No Insurance
o Other ______________________________________________
Please let us know any additional thoughts, ideas or concerns you may have about
healthcare needs and issues in our community.
26. EAST TENNESSEE CHILDREN’S HOSPITAL
WWW.ETCH.COM26
Appendix F: 2014 Key statistics
Community health needs assessment
East Tennessee Children’s Hospital
for the fiscal year ending June 30, 2015
2014 Key Statistics1
Knox Blount Sevier Jefferson Anderson TN U.S.
Demographics
Population 448,644 126,339 95,110 52,677 75,528 6,549,352 0
% below 18 years of age 21.5% 21.4% 21.4% 21.1% 21.1% 23.0% 23.3%
HealthOutcomesRank2
15 8 22 51 41
Mortality
Infant mortality 32 10 3 5 5 562
Child mortality 16 4 2 0 5 217
Morbidity
Low Birthweight 8.8% 8.5% 8.9% 7.6% 9.1% 9.2%
HealthBehaviors
Teen births 34 42 55 47 43 47
Physical Inactivity 28% 32% 32% 33% 32% 30%
Adult Smoking 19% 21% 28% 26% 21% 23%
Healthcare
Unisured 15% 15% 22% 17% 14%
Social&EconomicFactors
Children in poverty 23.0% 21.8% 26.5% 25.6% 23.8% 25.9%
Children in single-parent households 29% 27% 31% 35% 33% 36%
Children participating in
free/reduced lunch
PhysicalEnvironment
Access to recreational facilities 78% 71% 82% 63% 76% 70%
Access to healthy foods 6.9 7.4 7.5 7.5 7.4
1
Sources: County Health Rankings 2015;Tennessee, RobertWood Johnson Foundation; 2013/2014 State and County QuickFacts, U.S. Census
Bureau; Kidscount Data Center 2014Tennessee Commission on Children andYouth.
2
The 2015 County Health Rankings reports ranksTennessee counties according to their summary measure of health outcomes and health
factors. Counties also receive a rank for mortality, morbidity, health behaviors, clinical care, social and economic factors and physical
environment. Access to healthy foods 1-10 scale where 10 is the best.
27. EAST TENNESSEE CHILDREN’S HOSPITAL
WWW.ETCH.COM27
Anderson County
• Allies for Substance Abuse Prevention (ASAP)
• Anderson County Coalition
• Civitan Club
• Clinton Drug Store
• Clinton Fire Department
• Clinton Lions Club
• Clinton Police Department
• Department of Health
• East Tennessee Children’s Hospital
• Health Advisory Council
• Helen Ross McNabb
• Local churches
• Optimist Club
• Rotary Club
• Second Harvest Food Bank
• State Department of Health
• University of Tennessee Agriculture Extension
• University of Tennessee Extension Program
• University of Tennessee Nursing
Blount County
• Blount County Chamber
• Blount County Community Health Initiative
– Blount Benefits
– Food Allergy Action Team (FACET)
– Mental Health Awareness and Suicide
Prevention Alliance (MHASPA)
– Safe Blount County
– Substance Abuse Prevention Group
– Teen Pregnancy Prevention
• Blount County School System
• East Tennessee Children’s Hospital
– Project Adam
– Safe Kids
• Fire Department
• Blount County Health Department
• New Hope Advocacy Center
• Police Department
• United Way
Jefferson County
• Boys and Girls Club
• Coordinated School Health
• Second Harvest
• Local churches
• Jefferson County Health Council
Knox County
Big Brothers Big Sisters
• Boys and Girls Club
• Catholic Charities
• Cherokee Health Systems
• City of Knoxville Parks and Recreation
• Columbus Home
• Community Action Committee (CAC)
• Compassion Coalition
• Department of Children’s Services
• East Tennessee Children’s Hospital
– Obesity Coalition
– Project Adam
• EmeraldYouth Foundation
• Emergency Shelters
• Fellowship of Christian Athletes
• Helen Ross McNabb
• Knox Area Rescue Ministries (KARM)
• Knox County Health Department
• Knox County Schools
• Leadership Knoxville
• Local Donors
• Mobile Crisis Unit
• Omni Vision
• Peninsula
• Public Health
• Salvation Army
• Second Harvest
• Smoky Mountain Children’s Home
• University of Tennessee College of Nursing
• Vine Health Center
• YMCA
• Youth Villages
Sevier County
• Cherokee Health Systems
• Community groups
• East Tennessee State University third-year
medical students
• HEAL and MOMS
• Sevier County Health Department
• Sevier County Health Improvement Council
• Sevier County Promise
• Sevier County school nurses
Appendix G: Current community resources