Providence Hospitals Implementation Strategy

Community HealthNeeds Assessment

Columbia, South Carolina

2013

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TABLE OF CONTENTS

ABOUT PROVIDENCE HOSPITALS.............................................................2

PURPOSE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT................3

METHODOLOGY.......................................................................................4

EXECUTIVE SUMMARY OF THE 2013 COMMUNITY HEALTH NEEDS

ASSESSMENT............................................................................................5

IMPLEMENTATION STRATEGY..................................................................9

CREATING GREATER ACCESS TO CARE.....................................................9

STRATEGY 1: THE HEALTH CARE COLLABORATIVE ...........................10

STRATEGY 2: PROVIDENCE INTERNAL MEDICINE DOWNTOWN.......10

STRATEGY 3: HEALTHY OUTCOMES PLAN.........................................11

STRATEGY 4: EMERGENCY SERVICES REALIGNMENT AT

PROVIDENCE HOSPITALS NORTHEAST..........................................11

STRATEGY 5: CONTINUATION OF CHARITY CARE.............................12

TRIPLE AIM FOCUS IMPROVING POPULATION HEALTH.........................13

STRATEGY 1: PROVIDE HEALTH AND WELLNESS PROGRAMS..........13

AREA OF FOCUS 1: CORPORATE WELLNESS.........................13

AREA OF FOCUS 2: EMPLOYEE WELLNESS............................15

AREA OF FOCUS 3: COMMUNITY WELLNESS........................16

IDENTIFIED ISSUES NOT BEING ADDRESSED..........................................18

IN CONCLUSION.....................................................................................19

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PROVIDENCE HOSPITALS

2013 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA)

IMPLEMENTATION STRATEGY

ABOUT PROVIDENCE HOSPITALS

Providence Hospitals is the Midlands leading provider of cardiovascular and orthopedic

services. Providence is an accredited chest pain center and is composed of two hospitals,

thirteen physician practices, a network of rehabilitation centers, three sleep centers, and a

school of cardiac diagnostics. In total, Providence employs more than 2,000 dedicated staff.

Founded in 1938 by the Sisters of Charity of Saint Augustine, and a member of the Cleveland

based Sisters of Charity Health System, Providence is known state wide for outstanding clinical

quality and compassionate care. The Providence open heart surgery program has ranked

consistently in the top 15% of open heart programs for the past six and one-half years. Both the

orthopedic and cardiac services have previously received the South Carolina BlueCross

BlueShield centers of distinction designation.

Providence Hospitals is a Catholic faith-based ministry and our Mission: “In the spirit of the

Sisters of Charity of St. Augustine, Providence Hospitals will extend the healing ministry of

Jesus Christ to God’s people” is the foundation of what we do and who we are. Our strong Core

Values of RESPECT, COMPASSION, COLLABORATION, COURAGE, and JUSTICE are

driving forces that guide our behaviors and our choices.

RESPECT that values dignity and sacredness of life from conception to death.

COMPASSION that comes from the heart, is expressed in concern, empathy and

support, and leads us to respond to persons experiencing need, pain, suffering and

loss.

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COLLABORATION that fosters the sharing of gifts and talents, encourages interaction,

empowers others for service and facilitates networking with individuals and

organizations.

COURAGE that identifies need, explores options based on integrity, makes difficult

decisions wisely and takes risks in responding creatively to human needs.

JUSTICE that develops right relationships, seeks the common good, addresses needs

of the poor and vulnerable, and acts as responsible stewards of all resources.

Our Mission and our Core Values lead us to respond to the needs identified in our 2013

Community Health Needs Assessment (CHNA).

“In its efforts to strategically respond to and address the unmet needs of the communities

it serves, SCHS is committed to sustainable community benefit programming in support of

its Catholic mission and tax exempt status. Community benefits are programs that are

designed to address the needs of the overall community, low income and other

disadvantaged individuals and families who deserve special attention and priority.

Community benefits include charity care, unreimbursed cost of Medicaid and other

means-tested government-funded insurance programs for the underserved, health

professions education, research and costs associated with community outreach, as well

as programs to build community capacity.” (Sisters of Charity Health System Policy on

Community Benefits: Finance 4.5)

PURPOSE OF THE COMMUNITY NEEDS HEALTH ASSESSMENT

A provision of the Patient Protection and Affordable Care Act of 2010 requires all tax exempt

hospitals to conduct a community health needs assessment every three years. Palmetto Health

and Providence Hospitals complied with this new provision and conducted an initial assessment

in 2011 and updated the data in 2013. The results will be reported on the IRS Form 990,

Schedule H for tax year 2013 and posted on Providence Hospitals’ web page.

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METHODOLOGY

Palmetto Health (PH) is a two hospital system consisting of Palmetto Richland and Palmetto

Baptist. Providence Hospitals, a Catholic hospital ministry, is a faith-based organization of the

Sisters of Charity Health System. Providence is located in downtown Columbia with a second

hospital in the northeast area of Columbia. Mr. Charles D. Beaman, Jr., CEO of Palmetto

Health, and Mr. George Zara, CEO of Providence Hospitals, discussed the possibility of jointly

conducting the Community Health Needs Assessment. Both systems serve the same population

and working collaboratively would conserve resources. Mr. Beaman and Mr. Zara agreed and

identified personnel in their respective organizations to work collaboratively to fulfill the

requirements of the Community Health Needs Assessment (CHNA). The population was

identified as Richland and Lexington Counties. These two counties are considered Palmetto

Health’s and Providence Hospitals’ primary service area. Primary Service Area (PSA) is defined

as 75% of in-patient discharges and the Secondary Service Area (SSA) is defined as the next

10%. This includes the counties of Richland, Lexington, Chester, Clarendon, Fairfield,

Kershaw, Newberry, Orangeburg, and Sumter.

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The process of gathering data/information incorporated both qualitative and quantitative

methods. Secondary research was used from community agencies. Primary research (both

qualitative and quantitative) was gathered through National Research Corporation’s (NRC)

Community Needs Assessment, Palmetto Health’s and Providence’s Emergency Room data,

Mission 2011 and 2012 data, Providence Hospitals’ and Palmetto Health’s survey via email,

town hall meetings and interviews with community stakeholders. The qualitative portion of the

CHNA consisted of interviews and town hall meetings of community leaders, elected officials

and stakeholders. These were done simultaneously to help form our questions and to confirm

what we were hearing from our interviews. Further in-depth details are contained in the

assessment itself.

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EXECUTIVE SUMMARY OF THE

2013 COMMUNITY HEALTH NEEDS ASSESSMENT

The collective data supports the top critical areas listed below as the most significant unmet

health needs in Richland and Lexington Counties, particularly with households making less than

$25,000 per year. These top critical areas were determined by considering the information in all

the data sources, looking at the top percentile rankings in community surveys conducted, the

frequency of issues mentioned in town hall meetings, service provider surveys, personal

interviews and other components of data collected as identified in the main body of the

assessment.

Access to Care 33%: In the 2013 Providence Hospitals’ survey, 33% of the respondents who

indicated they had difficulty receiving health care in the last 12 months were uninsured. The

Providence Hospitals and NRC 2012 survey, along with *Mission 2011 and 2012 data, provide

us with the underlying reasons responders in the various data points are uninsured,

underinsured or have had difficulty accessing health care. Identified barriers to health care,

which are understood as medical, dental and vision care, are:

Cost of coverage: 53%-64%

Employer does not offer coverage: 15%

Unemployed: 33%

Previous medical condition: 6%

Don’t understand plans: 10%

Insurance does not cover or is not accepted: 39%

Transportation: 4-7%

High Blood Pressure (29-39%) and High Cholesterol (23-28%) remain in the top 4 identified

issues as significantly high health risk when compared to NRC 2010 data. However 41% and

21% of the respondents respectively have also indicated in 2012 that they have engaged in

preventative behaviors but at a lower rate when compared to the NRC 2010 data.

*Mission 2011 & 2012 were events where service providers across the community gathered for two days

to provide free care to the underinsured or uninsured in our communities.

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Smoking: Thirty-six percent of respondents in the NRC data report this risk, and 27% of the

Providence survey responders also identify themselves as smokers. DHEC data indicates that

21.8% of Lexington County’s and 17.4% of Richland County’s residents are smokers.

Engagement in preventative behavior for this condition, however, remains in the bottom 4

categories.

Depression & Anxiety 30%: NRC data identifies depression and anxiety as a health risk and in

17% of the Providence survey responders as well. Additionally, 27% of the survey respondents

report feeling sad or worried. Service provider interviews support that mental health issues exist

as unmet needs in the community.

Obesity rate of 14-31%: The NRC assessment identifies obesity as a high health risk for

households with incomes of less than $25,000, but is slightly higher at 16% in higher income

levels. 22% of the Providence survey participants stated that a physician diagnosed them as

obese. DHEC data for Lexington and Richland Counties lists obesity at 31%. Provider surveys

support the conclusion that obesity is a high health risk and the LCHP survey indicates it as the

second highest need.

Diabetes 8-23%: NRC data indicates that diabetes is 23% among households with < $25,000

income. DHEC data for Lexington and Richland Counties indicates 8-10% of the population, and

the Providence survey indicates diabetes is 13% among survey participants.

Dental Care 58%: Although dental care was not specifically considered in the surveys or DHEC

statistics, our local emergency room data and data from Mission 2011 and 2012 efforts reveal a

gap in dental care in the community. 58% of the population served at Mission 2012 presented

with dental needs. Providence Hospitals’ survey indicated that 32% of individuals having

difficulty receiving care identified dental care as the top issue.

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Emergency room data indicates that:

1. The number of dental cases has grown by an average of 21% each year since 2009.

2. The number of non-emergent cases, which can be seen in a dental office, to total cases has

grown from 62% in 2009 to 73% in 2012.

3. Eighty-one percent is unfunded or Medicaid at Palmetto Health Hospitals.

4. Providence Hospitals had 1245 cases presented in FY 2012 with 75% as Medicaid and self-

pay.

Other Information:

Participants were asked in the Providence-Palmetto survey for which health topics they wanted

more information. Heart related illnesses, such as blood pressure, cholesterol, heart disease,

heart attack, etc. had the highest percentage of responses at 15%. Diabetes had the second

highest percentage of responses at 14.55%. The topic of cancer in its various forms was third

on the list at 13.18%. The collective responses related to eating healthy, weight loss and obesity

were fourth on the list at 11.8%.

When participants were asked the question about health topics they thought their children

needed more information about the top three answers were:

Nutrition 27.14%

Dental Hygiene 18.6%

Drug Abuse 11.63%.

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IMPLEMENTATION STRATEGY

2014-2016

The Steering Committee for the CHNA gathered to view the data/results of the assessment

once it was completed. They reviewed the top health issues that were identified and began to

discuss an implementation strategy to address these issues. Identification of current strategies

and new strategies were discussed and chosen as ways to move forward to address the

identified needs. Subsequently, both the CHNA and implementation strategy were presented to

the Executive Committee of Providence Hospitals Board of Trustees and finally to the entire

Board of Trustees on December 3, 2013 and given final approval.

Providence Hospitals’ Implementation Strategy has two main areas of focus: CREATING

GREATER ACCESS TO CARE and IMPROVING POPULATION HEALTH, which is a

component of the Triple Aim Focus.

CREATING GREATER ACCESS TO CARE

Providence Hospitals has identified 5 different strategies to enhance the availability of health

care to the uninsured and underinsured population of individuals in our market area. We know

that, ’Richland County has 49,204 uninsured individuals and Lexington County contains 38,397

uninsured individuals’. **

In the 2013 Providence Hospitals survey, 33% of the respondents that indicated they had

difficulty receiving health care in the last 12 months were uninsured. The top barriers to health

care (understood as medical, dental and vision care), were identified in the executive summary

above.

Providence Hospitals’ data indicates that for the past three fiscal years, our own emergency

room experienced 49,188 uninsured patient visits, which further confirms that access to

appropriate care in the appropriate place is a high need/priority.

**Environmental Scan State Analysis, Dr. Ana Lòpez-De Fede, Institute for Families in Society, Division of

policy and research on Medicaid and Medicare, University of South Carolina, 1600 Hampton Street,

Suite 507, Columbia, SC 29208, Used with Permission

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STRATEGY 1: THE HEALTH CARE COLLABORATIVE

The Health Care Collaborative is a collaborative effort of 6 community organizations working

together to expand and enhance access to dental, vision and medical care, creating a medical

home for the poor and uninsured in one location. This will enable individuals to have access to

manage their health needs in the most appropriate and affordable setting.

The collaborating partners (not intended to be understood as business partners) are: Sisters of

Charity Providence Hospitals, Lexington Medical Center, Palmetto Health, SC Optometric

Physicians Association, The Free Medical Clinic, and United Way of the Midlands. This effort

arose out of our past collaborative efforts in conducting what we called Mission 2011, 2012, and

now mission 2013. This Mission collaborative effort provided dental, vision and medical care

each year to the poor, uninsured and underinsured for two full days from 6:00 a.m. -7:00 p.m. in

one location. The vast amounts of people coming to receive health care who have not been able

to get it any other way demonstrated to the partners that there is a significant need to find a way

to provide these services all year round and in one location. Thus, the Health Care Collaborative

group started a process to identify resources and space to provide the year round care. We are

currently in the midst of organizing this effort and have a plan to implement this effort in 2014.

This effort will address both access to care and dental care. Both of these needs were identified

as the top two health issues in the CHNA.

STRATEGY 2: PROVIDENCE INTERNAL MEDICINE DOWNTOWN

Providence Internal Medicine Downtown is a Providence Hospitals’ owned physician practice

established a little over 2 years ago. This practice was intentionally set up to provide a medical

home to our in-patient population who were uninsured or underinsured. This physician-based

practice has become a medical home to over 350 uninsured or underinsured individuals in our

community. This practice is able to help individuals manage their health care needs, reduce re-

admissions to the in-patient setting, and reduce their need to manage their health in the ER

setting by giving them healthcare access at lower costs compared to a traditional hospital

setting or normal primary care setting. We are going to continue utilizing this practice as a

medical home for the uninsured and underinsured.

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STRATEGY 3: HEALTHY OUTCOMES PLAN

This is a South Carolina state initiative in which we have decided to participate. This is a new

strategy for Providence Hospitals and the intention of this initiative is to focus on uninsured

patients with chronic illnesses who frequently utilize the emergency department to manage their

illness. This program is an additional way to help patients get the right care they need in the

right place. This calls us to action to be intentional and develop a plan that identifies who these

patients are. As the plan is executed Providence Hospitals will assist patients with:

Finding quality care they can afford

Getting access to the medicines they need

Establishing a medical home for routine care and chronic illness management

Currently, our plans will utilize Providence Internal Medicine Downtown and the Free Medical

Clinic as medical homes. We will also assist those individuals who do qualify for insurance in

finding a medical home as we do not want them to be left unassisted in this effort and fall back

into a pattern of using the emergency room. This effort will also attempt to understand the

social/environmental barriers to accessing health care, such as transportation needs, and

partner with the patient where possible to break down these barriers.

STRATEGY 4: EMERGENCY SERVICES REALIGNMENT AT

PROVIDENCE HOSPITAL NORTHEAST

This is a new strategy which has a particular focus on Providence Hospitals’ Northeast facility.

We are aware that our Northeast hospital’s emergency room patients are mostly of a non-

emergent nature. Yet, the patients seek care in the emergency room, which is the most

expensive place for them to receive care. There are very few alternatives on this side of town.

This new strategy for Providence Hospital Northeast will transform a portion of the existing

emergency room into an Urgent Care Center. This will allow the uninsured or underinsured and

even the insured patients to receive the appropriate care needed in the most appropriate setting

for their needs and the more affordable setting to match their needs.

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STRATEGY 5: CONTINUATION of CHARITY CARE

Providence Hospitals’ core value of JUSTICE compels us to address the needs of the poor and

vulnerable. As part of its mission, the hospital provides care for those patients of the community

who do not have the ability to pay and for those whose care is under- funded. As part of the

annual budget process, Senior Management estimates the level of charity care expected for the

fiscal year.

Providence Hospitals charity care policy states:

Sisters of Charity Providence Hospitals shall have an organized charity

program designed to meet the needs of the community through an

expression of Christian concern and the continuance of Christ's

Healing Ministry for those in need of health services to the extent that

resources are available. Any patient may apply for charity care

assistance and all applications will be considered without regard to

race, creed, national origin, religious preference or disability. Sisters of

Charity Providence Hospitals will provide charity care to those patients

whom are determined to have insufficient financial means to pay for

their healthcare. Eligibility will be based on the hospital's eligibility

criteria, which will be indexed to the Federal Poverty Guidelines.

(Policy ID#338228)

Providence Hospitals’ core value of JUSTICE also compels us to be good stewards of its

resources and we desire to enable others to be partners with us in that stewardship.

Consequently, we will assist patients in exploring other resources that may be available to

them such as Medicare, Medicaid, public assistance, commercial or any other third party

coverage.

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TRIPLE AIM FOCUS

IMPROVING POPULATION HEALTH

As indicated above in the Executive Summary, the CHNA identified other health issues in the

community that are not necessarily about access to care, but about a prevalence of health

conditions. The top health issues identified were high blood pressure, high cholesterol, smoking,

obesity, and diabetes. This focus is not limited to the poor, uninsured, or underinsured, but

serves the community at large as well.

STRATEGY 1: PROVIDE HEALTH and WELLNESS PROGRAMS

Providence Hospitals has one main strategy with three different focuses to impact the overall

health of our community. We believe this strategy is complementary to the strategy of creating

greater access to health care.

Area of Focus 1: CORPORATE WELLNESS

We will work with other corporations and other employers to keep their work force healthy.

Providence Health & Wellness can provide an organization with health, wellness and

educational services. These services consist of wellness screenings, one-on-one consultation,

health educational programs, health and wellness challenges as well as other health-related

services as needed – all focusing on the total health and wellness of the participants. We will

expand these services to more organizations as one strategy of impacting and improving

population health.

One-on-One Lifestyle Coaching is designed for those employees who participate in the initial

Wellness Screening and Consultation and are termed “high risk”. One-on-One Lifestyle

Coaching will continue until the employees have reached a maintenance level. These Lifestyle

Coaching sessions will include a Personal Wellness Profile, weight, blood pressure, pulse, etc.

High risk status is assigned to those employees who have two or more major health risk factors.

These risk factors include:

BMI > 30

HDL Cholesterol < 35

LDL Cholesterol > 130

Blood Pressure > 140/90

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Fasting Glucose > 115

Health Score < 25

Lifestyle Coaching will occur twice during the year. New goals will be set each time and

progress will be recorded. Once employees are no longer termed “high risk,” they will move out

of this program and into the general maintenance program.

Group and executive report results will determine health education programs selected for

employee groups. These programs, delivered on-site, will be tailored to the company’s specific

needs and based on outcomes of the company’s wellness profile.

Examples of possible programs offered on site:

Nutrition 101

Healthy Choices: From the Store to the Restaurant

Cholesterol Connections

Oh, the (Blood) Pressure

Control Your Diabetes Instead of it Controlling You

Weight Management and Fad Dieting

Stress Busters

Physical Activity

Smoking Cessation

Each employee will be given the option to meet with a registered and licensed dietitian for

education and guidance concerning his/her nutritional needs. These one-on-one sessions are

optional and are open to all employees, regardless of risk status.

Health & Wellness Challenges are also available for corporations. The program is designed to

emphasize the total health and wellness of employees as well as foster an environment of

wellness. The program extends over a three month period and encourages competition as well

as team work. Employers are encouraged to offer incentives for the winning team of three.

Teams of three individuals will work together to try to earn the most points. Points are based on

exercise, weight loss, dietary habits and drinking water. Different activities equate to different

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point levels. Teams will turn in weekly exercise logs for tracking points. Point updates will be

given weekly so that teams can see how they match up to the rest of the competition.

Area of Focus 2: EMPLOPYEE WELLNESS

This area of focus is on our own employees. They are also our community members and have

the same illnesses and chronic diseases as any other members of the community. Providence

Hospitals’ wellness program focuses on health status outcomes. Employees must show proof of

positive health status outcomes at the end of the year (12/31/14) to receive their 2015 benefits

at a reduced rate.

Requirements for joining the Program:

Completion of lab work. Lab draws will be done in- house during the month of January

2014.

Completion of the online Personal Wellness Profile (PWP) in February.

Program Completion Requirements

In addition to the Personal Wellness Profile and lab work, program participants will be required

to collect points using a pre-determined point system. Participants must amass twelve points

annually to receive the program benefits.

Based on the results of the PWP and lab work, he/she will be placed into one of four categories:

Elevated Blood Sugar

Elevated Blood Pressure

Weight Management

Health Maintenance

Completion of the 2014 program will be results based:

Completion of the base educational classes required by the identified health status

category and outlined in the ‘2014 Wellness Points Guide’

Elevated Blood Sugar path must show management of blood sugar levels and increased

physical activity and/or weight reduction. A1-C Levels below 5.7 for non-diabetic

employee and A1-C levels below 6.5 for diabetic employee is considered successful

control of blood sugar. To complete 2014 wellness requirements, employees in the

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category must show either control or 1-2% reduction in A1-C level over the course of the

year.

Elevated Blood Pressure path must show a reduction and management of HTN and

increased physical activity and/or weight reduction. Blood pressure levels must be

below 140/90 or show a 5-10% reduction in weight over the course of the year.

Weight Management path must show a weight reduction and increased physical activity.

5-10% reduction in weight is considered successful completion.

Health Maintenance must show continuation of physical activity levels and overall

healthy lifestyle.

Area of Focus 3: COMMUNITY WELLNESS

This area of focus will be the community at large.

The 2014 Community Calendar of events is currently under development. At minimum,

Providence will host two ‘Speaking of Your Health’ programs for our community each

month. These programs provide health education by physicians and clinicians to our

community at no charge.

2014 Speaking of Your Health program titles will include but are not limited to:

Sex After Heart Attack

Menopause & Heart Disease

Vitamin D and Your Heart

Weight Loss and Back Pain

Eating on The Road

Proper Shoes for Exercise

The New Normal –Life After Heart Attack

Osteoporosis

Allergies/Dry Eyes

GERD - Gastroesophageal reflux disease

ADD/ADHD

PVD – Peripheral Vascular Disease

Depression after Heart Attack

CHF – Congestive Heart Failure

Diabetic Neuropathy

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Your Heart and Your Genes

Surviving the Holidays - Stress

Providence will provide vascular screenings to the community. This quick and non-

invasive screening for men & women provided by the School of Cardiovascular

Diagnostics at Providence Hospital is designed to evaluate one’s vascular health and

has three components:

1. Echocardiogram: An ultrasound is taken of your heart. These images show

the structure and movement of the heart, along with blood flow through it with each

beat- allowing any abnormalities to be seen, measured, and identified.

2. Carotid ultrasound: An ultrasound is taken of the carotid arteries in your neck. These

images show the size and structure of the carotid arteries, along with the blood flow

through it- allowing any abnormalities to be seen, measured, and identified.

3. Ankle-Brachial Index: Blood pressures are taken on your arms and ankles to

measure any difference in blood pressures. These differences in pressures can

indicate the presence of peripheral artery disease (PAD).

Each case is individually reviewed and reported on by a board certified cardiologist

of Providence Heart & Vascular Institute. Results will be mailed following the

screening. This screening does not require a physician’s order or insurance.

Providence will also provide HOCM screenings. Hypertrophic Obstructive

Cardiomyopathy (HOCM) is the leading cause of sudden cardiac arrest in young

athletes. HOCM is responsible for 36% of deaths in young athletes, and 90% of these

deaths occur during athletic activities. This quick and non-invasive screening, provided

by the Providence School of Cardiovascular Diagnostics, is the gold standard in

detecting this deadly disease. No physicians order or insurance are required.

Work has also begun to develop community gardening projects in several communities

throughout Columbia. Through collaboration with other community members, we believe

we will have a positive impact on the long term health of our community through

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community-based gardening which gives access to fruits and vegetables. Cooking

classes and gardening classes will be a part of the overall strategy for this development.

Providence will host EMS education sessions, at a minimum of six times per year.

These programs will focus on educating EMS staff in our area on proper STEMI and

other Providence Hospitals’ protocols as well as general health education. The desired

outcome is that through sharing information and ideas we will have a greater impact on

the health of our community.

IDENTIFIED ISSUES NOT BEING ADDRESSED

MENTAL HEALTH: The third top issue identified in the CHNA is the area of mental health.

Providence Hospitals will not be directly addressing this significant need in the community as

Providence Hospitals possesses no expertise and has no services to offer in this area since our

hospitals service line focuses are cardiology and orthopedics. However, Providence Hospitals

will engage with elected officials and community leaders, our Board, and support Sisters of

Charity Health System mission-focused advocacy to increase health coverage, including

behavioral health coverage, through national, state and local public policy.

TOPICS of EDUCATION: The topic of cancer in its various forms will not be education that

Providence Hospitals will provide. While we do offer Palliative Care and or Hospice Care to

patients who are dying from cancer we do not offer oncology services. Consequently, we would

not be the providers of education in the field of cancer.

Participants indicated the top health topics they thought their children needed more information

about. These were nutrition, dental hygiene and drug abuse. We have no plans to address this

directly, as we are not the experts in dental hygiene, although it may ultimately be an outreach

effort of the Health Care Collaborative initiative identified earlier in this document. While we

bring expertise in nutrition, our expertise is with adults, and not children, as we do not provide

pediatric services. We also have no expertise regarding drug abuse. However, we will reach out

to other organizations that do have expertise in these areas and let them know the findings of

our CHNA and encourage them to provide the needed education.

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IN CONCLUSION

Providence Hospitals remains committed to identifying and addressing the health needs of

those in the communities we serve. While we cannot address all of the human needs that exist

in our surrounding communities, we will bring quality care to all those we serve regardless of

their ability to pay. We will continue to seek creative ways to address the needs that arise and

collaborate with others in the community whenever possible. Together we can make a positive

difference in the lives of those we serve.