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Community Health Needs Assessment
Essentia Health, Fosston, Minnesota
June 27, 2013
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Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
TABLE OF CONTENTS
Executive Summary
1. Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Community Served by the Hospital Facility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.1. Description/Definition and Determination . . . . . . . . . . . . . . . . . . . . . . . . . .
2.2. Demographics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.3 More Demographics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Process and Methods Used to Conduct the Assessment. . . . . . . . . . . . . . . . . . . . . . . .
3.1. Sources and Dates of the Data and Other Information Used in the
Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.2. Analytical Methods Applied/Process Used to Identify Community Health
Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.3. Coordination with Other Hospitals and Collaboration with Other
Organizations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.5. Contracted Third Parties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Community Health Profile. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Input from Persons Who Represent the Broad Interests of the Community Served
by the Hospital Facility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.1. When and How These Persons Were Consulted. . . . . . . . . . . . . . . . . . . . . .
5.2. Organizations Consulted. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.3. Individuals with Special Knowledge of or Expertise in Public Health. . . . .
5.4. Federal, Tribal, Regional, State, or Local Health or Other Departments or
Agencies with Current Data or Other Information Relevant to the Health
Needs of the Community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.5. Individuals Who are Leaders, Representatives, or Members of Medically
Underserved, Low-Income, and Minority Populations and Populations with
Chronic Disease Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Community Health Needs Identified Through the CHNA . . . . . . . . . . . . . . . . . . . . . .
7. Existing Healthcare Facilities and Other Resources within the Community Available
to Meet the Community Health Needs Identified Through the CHNA . . . . . . . . . . . . . .
7.1. Process for Identifying and Prioritizing Resources/Services to Meet the
Community Health Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8. Making the CHNA Report Widely Available to the Public. . . . . . . . . . . . . . . . . . . . .
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Appendix A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Appendix B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Appendix C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Appendix D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Appendix E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Executive Summary
First Care Medical Services, doing business and hereafter referred to as Essentia Health-Fosston, is
required to conduct a Community Health Needs Assessment (CHNA) and adopt an implementation
strategy to meet the community health needs identified through the CHNA at least once every three
years. The following document and past and future activities described therein serve to meet that
requirement. The implementation strategy was approved by the Essentia Health-Fosston’s Board of
Directors on 27 August, 2012.
Essentia Health-Fosston is a 25-bed critical-access hospital in Fosston, Minn. It has served the people
of Polk County and surrounding communities for over a century, providing quality healthcare and
helping patients and their families lead active and fulfilling lives. The large geographical area the
hospital cares for covers northern Minnesota from Thief River Falls on the north to Mahnomen on the
south, and from west of Erskine to east of Bagley.
The majority of the hospital facility’s CHNA process occurred in 2012 and early 2013. Essentia
Health-Fosston hired a third party---the National Rural Health Resource Center located in Duluth, MN
to assist with their CHNA. In January 2012, the National Rural Health Resource Center conferred with
leaders from Essentia Health-Fosston to discuss the objectives of a regional community health needs
assessment survey. A survey instrument was developed to assess the health care needs and preferences
in the service area. In the winter of 2012, a random stratified sample within Fosston’s service area was
surveyed on the utilization and perception of local health care services. In response to the findings of
the survey two meetings were convened with relevant community partners. The three highest-priority
health needs for the community served by Essentia Health-Fosston are 1) Increase access to patientcentered health education (disease prevention and wellness), 2) Increase access to primary care, and 3)
Increase access to specialty care and coordination with community agencies. Each of these health
needs will be addressed by a variety of efforts.
We truly believe this CHNA and associated implementation strategy will benefit community health,
thus supporting Essentia Health’s mission to make a healthy difference in people’s lives.
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Community Health Needs Assessment
1. Introduction
This Community Health Needs Assessment (CHNA) was conducted in response to the enactment
through The Patient Protection and Affordable Care Act, Public Law 111-148 (124 Stat. 119 (2010)),
of section 501(r) of the Internal Revenue Code.1 According to REG-106499-12, “Section 501(r)(3)
requires a hospital organization to conduct a CHNA at least once every three years and adopt an
implementation strategy to meet the community health needs identified through the CHNA.”1
In addition to the CHNA being a legal requirement, the CHNA and associated implementation strategy
support population health-related goals of Essentia Health. First and foremost, Essentia Health’s
mission is to make a healthy difference in people’s lives. As the CHNA is ultimately designed to
provide community benefit by improving community/population health, meeting CHNA requirements
helps Essentia Health pursue that mission. Second, Essentia Health is one of the first accredited
Accountable Care Organizations (ACOs) in the nation.2 This accreditation is part of Essentia Health’s
pursuit of the Triple Aim of “improving the individual experience of care; improving the health of
populations; and reducing the per capita costs of care for populations.”3 Finally, Essentia Health is
working on a Patient Centered Medical Home (PCMH) primary care delivery model project. As
described by the Agency for Healthcare Research and Quality, PCMHs coordinate care among
different parts of the healthcare system, such as hospitals and community services and supports, and
assure quality through activities such as population health management.4 Community/population
health consequently links several of Essentia Health’s goals (Figure 1).
Figure 1. Population Health Links ACOs, PCMHs, and Community Benefit (CHNA)
Essentia Health-Fosston hired a third party---the National Rural Health Resource Center located in
Duluth, MN to assist with their CHNA. In January 2012, the National Rural Health Resource Center
conferred with leaders from Essentia Health-Fosston to discuss the objectives of a regional community
health needs assessment survey. A survey instrument was developed to assess the health care needs
and preferences in the service area. In the winter of 2012, a random stratified sample within Fosston’s
service area was surveyed on the utilization and perception of local health care services.
A substantial portion of the CHNA process was completed prior to the April 5, 2013 release of
additional CHNA guidance via REG-106499-12.1 Consequently, the following CHNA report and
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Community Health Needs Assessment
accompanying implementation strategy conform to requirements outlined in Notice 2011-525 with one
exception and one addition resulting from guidance provided in REG-106499-12. In order to conform
to Notice 2011-52, names and titles of participants have been placed in the last appendix of this
document. The addition made to this CHNA based on guidance provided in REG-106499-12 is the
opportunity for public comment on the CHNA and implementation strategy. REG-106499-12 requires
a hospital facility to take into account input from “written comments received on the hospital facility’s
most recently conducted CHNA and most recently adopted implementation strategy.” Thus, comments
on this CHNA and accompanying implementation strategy can be emailed to Essentia Health in order
to meet this regulation for the next CHNA.
The following report is divided into sections and subsections as prescribed by Notice 2011-52.
2. Community Served by the Hospital Facility
2.1. Description/Definition and Determination
Essentia Health-Fosston is a 25-bed critical-access hospital in Fosston, Minn. It has served the people
of Polk County and surrounding communities for over a century, providing quality healthcare and
helping patients and their families lead active and fulfilling lives. The large geographical area the
hospital cares for covers northern Minnesota from Thief River Falls on the north to Mahnomen on the
south, and from west of Erskine to east of Bagley.
Figure 2. Hospital Location
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Community Health Needs Assessment
2.2. Demographics
Population demographics for the four states in which Essentia Health has a presence are displayed
below. As shown in
Table 1, compared to the other states, Minnesota has the highest percentage of individuals with annual
household income ≥ $35,000 and who are college graduates. These differences translate into
Minnesota having the highest proportion of individuals with high socioeconomic status (SES). Despite
the relatively high SES and although lower than the other three states, 42.8% of Minnesotans had at
least one health service deficit (HSD), defined as lacking health insurance, lacking a healthcare
provider, deferring medical care because of cost, or failing to obtain a routine medical exam, all within
the last twelve months.
Table 1. Population Demographics for States Where Essentia Health Has a Presence.
2009 BRFSS* Data (%)
Idaho Minnesota North Dakota Wisconsin
50.0
49.4
49.9
49.3
50.0
50.6
50.1
50.7
32.8
30.1
32.9
29.5
50.8
53.3
47.8
52.8
16.5
16.6
19.2
17.7
40.7
26.0
33.3
37.9
59.3
74.0
66.7
62.1
9.8
4.1
8.4
6.1
60.4
54.5
59.9
63.8
29.8
41.4
31.7
30.1
37.1
22.1
29.1
35.5
49.5
52.3
55.6
49.3
13.4
25.6
15.3
15.3
70.1
68.2
66.8
66.2
Measure
Male
Female
18-34 Years
Age Ranges
35-64 Years
>=65 Years
Annual
Household <$35,000
Income
>=$35,000
<High School
Educational
Completed High School
Attainment
College Graduate
Low SES
Socioeconomic
Middle SES
Status**
High SES
Married Or Living With Partner
Marital Status
Unmarried And Not Living With A
29.9
31.8
33.2
33.8
Partner
88.4
91.5
89.8
89.0
Caucasian
0.2
2.5
0.6
3.0
African American
Race/Ethnicity
6.7
1.9
2.0
3.1
Hispanic
4.7
4.1
7.6
4.9
Other/Multiracial
45.9
43.1
39.7
39.6
At Least 1 Child In Household
56.8
42.8
50.4
44.2
At Least 1 Health Service Deficit***
36.3
29.2
61.0
30.6
Population In State Rural
* Behavioral Risk Factor Surveillance System
** SES is a composite or computed variable comprised of two categorical variables: education and income.
*** Defined as lacking health insurance, lacking a healthcare provider, deferring medical care because of cost, or failing to
obtain a routine medical exam, all within the last twelve months.
Sex
Table 2, there is a higher percentage of females in rural Minnesota compared to non-rural Minnesota.
All four states have a higher percentage of individuals ≥ 65 years of age in rural versus non-rural areas,
but the difference across rurality is more pronounced in Minnesota. All four states also have a lower
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Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
percentage of college graduates in rural areas compared to non-rural areas; this difference across
rurality is larger in Minnesota than the other three states. A higher percentage of individuals in rural
versus non-rural areas in all states have an annual household income < $35,000. Approximately 96%
of rural Minnesotans are Caucasian.
Table 2. Population Demographics for States Where Essentia Health Has a Presence Stratified
by Geographic Locale (Rural/Non-Rural)
% Idaho
NonRural
49.7
Sex
Male
50.3
Female
15.8
>=65 Years
36.9
Household Income <$35,000
8.5
Education
<High School
58.5
High School or GED
33.1
College Graduate
30.4
Unmarried and Not Living With A
Partner
88.9
Race/Ethnicity Caucasian
0.2
African American
5.8
Hispanic
5.1
Other/Multiracial
47.2
At Least 1 Child In Household
Measure
% Minnesota
% North Dakota % Wisconsin
NonNonNonRural
Rural
Rural
Rural
Rural
Rural
Rural
50.5
50.0
47.8
50.2
49.8
49.2
49.4
49.5
50.0
52.2
49.8
50.2
50.8
50.6
17.7
14.5
21.7
17.9
20.0
16.7
20.2
47.4
22.7
34.4
27.7
37.0
35.3
43.8
12.2
3.6
5.3
5.9
10.1
5.9
6.6
63.8
50.2
65.0
55.9
62.4
59.5
73.3
24.0
46.2
29.7
38.2
27.5
34.5
20.1
29.0
32.4
30.4
33.9
32.7
33.9
33.5
87.6
0.1
8.3
4.0
43.5
6
89.6
3.5
2.2
4.8
44.8
96.1
0.2
1.2
2.6
39.2
93.8
1.1
0.9
4.2
41.1
87.2
0.3
2.8
9.8
38.9
86.8
4.4
3.9
4.9
40.3
94.2
0.0
1.2
4.7
37.9
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Stratification by race/ethnicity, as shown in Table 3, highlights other demographic factors in the four
states. There is a sharply decreasing gradient across age in the percentage of Minnesotans who are
non-Caucasian in that 53.9% are 18-34 years of age compared to the 27.9% of Caucasians in that age
range. In all states, a higher percentage of non-Caucasians earn <$35,000 annually and a lower
percentage are college graduates compared to Caucasians. These racial/ethnic differences in indicators
of SES, however, are less pronounced in Minnesota versus the other three states.
Table 3. Population Demographics for States Where Essentia Health Has a Presence Stratified
by Race/Ethnicity
% Idaho
Measure
Male
Female
18-34
Years
Age
35-64
Ranges
Years
>=65
Years
Household Income
<$35,000
<High
School
Completed
Education High
School
College
Graduate
Unmarried and Not
Living With A Partner
At Least 1 Child In
Household
NonRural
Rurality
Rural
Sex
% Minnesota
% North Dakota
% Wisconsin
NonNonNonNonCaucasian
Caucasian
Caucasian
Caucasian
Caucasian
Caucasian
Caucasian
Caucasian
49.1
56.5
49.2
51.2
50.2
48.0
49.5
47.4
50.9
43.5
50.8
48.8
49.8
52.0
50.5
52.6
31.1
45.5
27.9
53.9
30.4
55.6
27.4
46.3
51.7
43.2
54.6
39.3
49.3
34.5
54.3
40.6
17.1
11.3
17.5
6.8
20.3
9.9
18.3
13.1
37.3
67.9
24.4
43.7
30.5
60.0
34.9
62.4
7.2
30.3
3.8
6.9
7.2
19.7
5.1
14.6
61.6
51.1
54.7
52.4
59.7
61.0
63.7
64.0
31.2
18.6
41.5
40.7
33.1
19.3
31.1
21.5
28.8
38.3
30.3
48.4
30.6
55.7
32.3
46.2
44.7
55.2
41.1
64.7
37.3
61.4
38.4
49.6
64.0
61.1
69.4
86.6
40.8
23.6
67.6
83.7
36.0
38.9
30.6
13.4
59.2
76.4
32.4
16.3
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Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
2.3. Additional Demographic Data on Polk, Clearwater, Mahnomen Counties, Minnesota
Estimated Population
Fosston
Polk
1,527
33,309
Source: US Census Bureau (2010)
Population Change 2000-2010
Fosston
Polk
-3.0%
+0.7%
Clearwater
8,695
Mahnomen
5,413
Clearwater
+3.2%
Mahnomen
+4.3%
Minnesota
5,303,925
Minnesota
+7.8%
Source: US Census Bureau (2010)
County Population Projections
Polk
Clearwater
2015
32,610
9,060
2020
33,370
9,270
2025
34,060
9,410
Source: Minnesota State Demographic Center (June 2007)
Mahnomen
5,110
5,100
5,110
Minnesota
5,709,700
5,943,240
6,135,060
Population by Age Group
Polk
Persons under 18 years old
Persons 65 years old and over
Clearwater Mahnomen Minnesota Persons under 5 years old
6.6%
7.0%
8.9%
6.7%
23.8%
25.0%
29.3%
24.2%
16.5%
18.6%
15.8%
12.9%
Source: US Census Bureau (2010)
Population Estimates by Race
Polk
White persons
American Indian/Alaska Native
Black persons
Asian persons
Native Hawaiian/Pacific Islander
Hispanic or Latino origin
Persons reporting two or more races
Clearwater
93.3%
1.4%
0.9%
0.7%
0.0%
5.4%
3.0%
Mahnomen
87.2%
9.0%
0.3%
0.2%
0.0%
1.4%
8.6%
Source: US Census Bureau (2010)
Number of Live Births
Polk
Clearwater
Mahnomen
375
108
89
Source: Minnesota Department of Health (2009)
Number of Deaths
Polk
Clearwater
Mahnomen
349
87
67
Source: Minnesota Department of Health (2009)
50.1%
40.9%
0.2%
0.1%
0.0%
1.8%
2.4%
Minnesota
70,617
Minnesota
37,801
8
Minnesota
85.3%
1.1%
5.2%
4.0%
0.0%
4.7%
2.1%
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Education and Workforce
High School Graduates (percent of persons age 25+ that has a high school education)
Polk
Clearwater
Mahnomen
Minnesota
86.8%
84.4%
83.6%
91.3%
Nation
84.6%
Source: US Census Bureau (2010)
Bachelor’s Degree Graduates (percent of persons age 25+ that has a college education)
Polk
Clearwater
Mahnomen
Minnesota
20.6%
14.5%
13.5%
31.4%
Nation
27.5%
Source: US Census Bureau (2010)
Veterans 2005-2009
Polk
Clearwater
Mahnomen
Minnesota
2,672
958
480
395,262
Source: US Census Bureau (2010)
Primary Care Physicians (all currently licensed): population per 1 provider
Polk
Clearwater
Mahnomen
Minnesota
1,273:1
1,178:1
844:1
636:1
Range in Minnesota: 9,312:1 - 205:1
Source: County Health Rankings (2011)
Nation
2,894,578
Health Professional Shortage Areas (HPSA): shortage of primary, dental or mental health providers in a
county or service area
Polk
Clearwater
Mahnomen
Mental health
Mental health
Mental health
Source: Health Resources and Services Administration (2011)
Medically Underserved Area (MUA): shortage of providers with high poverty or elderly population on a scale of 0
– 100; score of >62 qualifies as a MUA
Polk
Clearwater
Mahnomen
59.90
55.90
59.40
Source: Health Resource and Services Administration (2011)
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Community Health Needs Assessment
Income Rates
Median Household Income 2009
Polk
Clearwater
Mahnomen
Minnesota
$47,233
$39,310
$38,523
$57,243
Source: US Census Bureau (2010)
Unemployment Rates
Polk
Clearwater
Mahnomen
Minnesota
6.1%
12.2%
7.4%
6.4%
Source: Bureau of Labor Statistics (2011)
Persons below Poverty Level
Polk
Clearwater
Mahnomen
Minnesota
13.0%
15.5%
23.6%
10.6%
Source: US Census Bureau (2010)
Uninsured: Percent of population under age 65 with no health insurance coverage
Polk
Clearwater
Mahnomen
Minnesota
11%
16%
14%
10%
Range in Minnesota: 7-16%
Source: County Health Rankings (2011), US Census Bureau (2010)*
Nation
$50,221
Nation
9.0%
Nation
14.3%
Nation
16%*
3. Process and Methods Used to Conduct the Assessment
3.1. Sources and Dates of the Data and Other Information Used in the Assessment
A community health profile consisting of state and county service area demographic, health-related
behaviors, health services, and health outcomes data was compiled for the hospital facility and is
included in Subsection 2.2 and Section 4. Data for the community health profile were obtained from
multiple sources including : the US Census Bureau, the UWPHI County Health Rankings7 and the
Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System
(BRFSS).8
Primary and chronic disease needs of minority groups were assessed through stratification of BRFSS
data on race/ethnicity. Primary and chronic disease needs and other health issues of uninsured persons
and low-income persons were assessed through stratification of BFRSS data on rurality, a factor that is
highly relevant to the rural area composing Essentia Health Fosston’s service area. The following
excerpt9 authored by researchers at EIRH describes the health disparities experienced by rural
populations:
“In addition to being a medically underserved population, U.S. rural residents experience more disease
and greater health and healthcare disparities than urban residents.10,11 Specifically, compared to the
urban population, rural populations have higher prevalence of uninsured adults, adults with chronic
conditions such as diabetes and cardiovascular disease, adolescent and adult smoking, and belowguideline consumption of fruits and vegetables.10-17 Other important disparities in social determinants
of health have also been detected for rural U.S. residents including higher poverty levels and lower
levels of attained education.”
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Community Health Needs Assessment
UWPHI County Health Rankings7 data from 2011 were utilized in this assessment. These data are
compiled by the County Health Rankings team from a variety of sources including, but not limited to,
BFRSS, The Dartmouth Institute, the National Center for Health Statistics, the United States Census,
and the United States Department of Agriculture. For this assessment, both the county rankings and
the data underlying the rankings were utilized from the full County Health Rankings Model (Figure 3).
Figure 3. UWPHI County Health Rankings Model
As the County Health Rankings used years of data ranging from 2002 to 2011, with several measures,
such as diet and exercise, using 2009 data,7 BRFSS data from 2009 were utilized for congruency.
These data were also the most recently available BRFSS data during the initial stages of the CHNA.
BRFSS is the largest surveillance system in the world. BRFSS data are collected using a random-digit
dial telephone survey targeting adults 18 through 99 years of age. These data are collected under the
aegis of the CDC in collaboration with all US states and most US territories. Once collected, BRFSS
data are weighted by state or territory to represent the non-institutionalized US adult population.
BRFSS data are cross-sectional and are focused on health risk factors and behaviors, as well as chronic
11
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
diseases. All analyses were performed on weighted data as is recommended by the CDC. The
weighting, calculated by the CDC, uses the most recently available census data to provide a stratified
representation of the nation’s non-institutionalized population.
BRFSS data collected in 2009 and made available in 2010 were analyzed for this CHNA. These data
were the most recently available BRFSS data during the initial stages of the CHNA and correspond to
the County Health Rankings data. In the analyses presented here, a number of variables were either recoded or computed. All re-coding entailed collapsing categories and removing the responses don’t
know and refused. The following variables were computed: health service deficits (HSD), socioeconomic status (SES), and race/ethnicity. HSD was computed from the response categories of four
different variables (health insurance status, personal healthcare provider, deferment of medical care
because of cost, and routine medical exam). These variables were chosen because they all impact how
individuals interact with and access the health care system. The specific response categories were: did
not have health insurance, did not have a healthcare provider, deferred medical care because of cost,
and did not have a routine medical exam, all within the last 12 months. Having one or more of these
constituted having a HSD.
SES is comprised of two categorical variables: education and income. In keeping with convention,
data categories from each of these individual variables were coded as low, mid-range, or high and
numbered 1, 2, or 3, respectively. The variables with numbered factors or categories were then added
together to create the composite variable of SES. Categories for education included: low = less than
high school (coded as 1), mid-range = high school graduate (coded as 2), and high = at least some
college (coded as 3). Categories for income were: low = <$25,000 (coded as 1), mid-range = $25,000
- <$50,000 (coded as 2), and high = > $50,000 (coded as 3). The possible range for the SES variable
was 2 – 6 points. Subsequently, these points were indexed in the following manner: low = 2-3 points,
mid-range = 4-5 points, and high = 6 points. These cut-points were purposive. For the lowest range of
the index, 2 points was the floor (smallest possible point assignment). For the mid-range of the index,
4 points was the floor, and for the high range of the index, 6 points was the floor. Any points below
the floor for the mid-range were assigned to the lowest index category just as any points below the
floor for the highest index category were assigned to the mid-range index category.
The race/ethnicity variable was calculated from participant responses to two separate survey
questions—one regarding race and the other regarding Latino/Hispanic ethnicity. Caucasian, nonHispanic was coded as Caucasian, and all other racial/ethnic categories were coded as non-Caucasian.
The Metropolitan Statistical Area (MSA) variable included in BRFSS was used to define geographic
locale. MSA was re-coded by collapsing categories into those of rural and non-rural. Rural residents
were defined as persons living either within an MSA that had no city center or outside an MSA. Nonrural residents included all respondents living in a city center of an MSA, outside the city center of an
MSA but inside the county containing the city center, or inside a suburban county of the MSA.
Additionally, Essentia Health-Fosston chose to contract with a third party to conduct a community
health needs survey. In the winter of 2012, a random stratified sample within Fosston’ s service area
was surveyed on the utilization and perception of local health care services. The results of the survey in
12
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
both narrative and chart formats, as well as a summary report of focus groups are presented in section
4. A copy of the survey instrument is included at the end of the report (Appendix A).
3.2. Analytical Methods Applied/Process Used to Identify Community Health Needs
The National Rural Health Resource Center developed and administered a survey to a random sample
of community members in the Essentia-Fosston service area. In order to construct the survey,
The Center conferred with leaders from Essentia Health-Fosston to discuss the objectives of a regional
community health needs assessment survey. The survey instrument was designed to be easily
completed by respondents. Responses were electronically scanned to maximize accuracy. The survey
was designed to assemble information from local residents regarding:
•
Demographics of respondents
•
Utilization and perception of local health services
•
Perception of community health
Essentia Health Fosston provided The Center with a list of inpatient hospital admissions. Zip codes
with the greatest number of admissions were stratified in the initial sample selection. Each area would
be represented in the sampling proportionately to both the overall served population and the number of
past admissions. Eight hundred residents were selected randomly from Prime Net Data Source, a
marketing organization. Although the survey samples were proportionately selected, actual surveys
returned from each population area varied. This may result in slightly less proportional results.
In April 2012, the community health needs assessment, a cover letter on Essentia Health-Fosston’s
letterhead, and a postage paid reply envelope were mailed first class to 800 randomly selected residents
in the targeted region. A press release was sent to local newspapers prior to the survey distribution
announcing that Fosston would conduct a community health needs assessment throughout the region in
cooperation with The Center.
Two hundred sixteen of the mailed surveys were returned providing a 28% response rate. Based on the
sample size, surveyors are 95% confident that the responses are representative of the service area
population, with a margin of error of 4.95%. Note that 40 of the original 800 surveys sent were
returned by the U.S. Postal Service as undeliverable.
FOCUS GROUPS
The National Rural Health Resource Center was contracted by Essentia Health Fosston (Essentia) to
conduct focus groups to provide qualitative data as a supplement to the community survey. The
purpose of the focus groups was to hear directly from local residents on the strengths and needs of
health services in Fosston.
3.3. Coordination with Other Hospitals and Collaboration with Other Organizations
Polk County Public Health, service area clergy, Polk County Social Services all participated in this
CHNA process. Additionally, local business owners, education and local civic organization
participated.
13
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
3.5. Contracted Third Parties
The hospital facility contracted with the National Rural Health Resource Center, located in Duluth
MN, to assist with conducting of the CHNA.
4. Community Health Profile
The following is a community health profile developed by the National Rural Health Resource Center
for Essentia Health-Fosston.
Sampling
Essentia Health Fosston provided The Center with a list of inpatient hospital admissions. Zip codes
with the greatest number of admissions were stratified in the initial sample selection. Each area
would be represented in the sampling proportionately to both the overall served population and the
number of past admissions. Eight hundred residents were selected randomly from Prime Net Data
Source, a marketing organization. Although the survey samples were proportionately selected, actual
surveys returned from each population area varied. This may result in slightly less proportional
results.
Survey Respondent Demographics
The following tables indicate the demographic characteristics of survey respondents. Information
on place of residency, gender, age, and employment status is included. Percentages indicated in the
tables and graphs are based upon the total number of responses for each individual question, as
some respondents did not answer all questions.
Place of Residence (Question 34)
Zip codes with the greatest number of admissions were stratified in the initial sample selection so that
each area would be represented in proportion to both the overall served population and the proportion
of past admissions. Based on this selection, 42% (n=91) of respondents reside in Fosston, Minnesota.
(N=216)
Location
56542 Fosston
No Answer
56621 Bagley
56556 Mcintosh
56535 Erskine
56592 Winger
56651 Lengby
56742 Oklee
Count
91
20
19
19
18
14
10
8
Percent
42%
9%
9%
9%
8%
6%
5%
4%
14
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
56644 Gonvick
56646 Gully
56634 Clearbrook
56516 Bejou
56540 Fertile
5
5
4
2
1
2%
2%
2%
1%
0%
Gender of Respondents (Question 35)
Of the 216 surveys returned, 60% (n=130) of survey respondents were female, 36% (n=78) were
male and 4% (n=8) chose not to answer this question. The survey was distributed to a random
sample consisting of 50% women and 50% men. It is not unusual for survey respondents to be
predominantly female, particularly when the survey is health care oriented since women are
frequently the health care decision makers for families. (N=281)
No Answer, 4%
Male, 36%
Female, 60%
No Answer
Male
15
Female
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Age of Respondents (Question 36)
Twenty-eight percent (n=60) of respondents were between the ages of 66-75 years old and 21%
(n=45) were 76-85 years old. The population of respondents in this community is comparable to
other rural community health assessment demographics. The increasing percentage of elderly
residents in rural communities is a trend that is seen throughout rural Minnesota and will likely have
a significant impact on the need for health care services during the next 10-20 years. Older residents
are also more invested in health care decision making; therefore they are more likely to respond to
health care surveys, as reflected by the graph below. It is important to note that the survey was
targeted to adults and therefore no respondents are under age 18. (N=216)
30%
28%
25%
21%
Percentag
e
20%
15%
15%
15%
9%
10%
6%
5%
5%
1%
0%
0%
Age of Respondents
16
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Employment Status (Question 37)
Forty-three percent (n=93) of respondents indicate they are retired, which is consistent with the age
of respondents. Thirty percent (n=64) are employed full time and 9% (n=93) work part time. This
response is comparable to other rural communities surveyed by the National Rural Health Resource
Center. “Comments listed as “Other” are available in Appendix B. (N=216)
43%
45%
40%
35%
25%
20%
15%
Percentag
e
30%
30%
10%
9%
10%
4%
2%
5%
0%
Employment Status
17
1%
1%
0%
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Survey Findings
Perception of Community Health (Question 1)
Respondents were asked how they would rate their community as a healthy place to live. Thirty-six percent
of respondents (n=78) rated their community as “Healthy” while 50% (n=109) felt their community was
“Somewhat healthy.” This indicates an opportunity to improve Fosston residents’ perception of their
community’s health. (N=216)
50%
50%
45%
36%
40%
Percentag
e
35%
30%
25%
20%
15%
10%
5%
5%
4%
0%
5%
0%
Perception of Community Health
18
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Community Health Concerns (Question 2)
Respondents were asked to identify the three most serious health concerns in the community. The
number one health concern identified by respondents was “Cancer” (76%, n=163), followed by
“Heart disease” (57%, n=122) and “Diabetes” (46%, n=98). “Alcohol/substance abuse” is typically
the most frequent response from other rural community health needs assessments conducted by The
Center. Respondents were asked to pick their top three health concerns, so percentages do not total
to 100%. Comments listed as “Other” are available in Appendix B. (n= 213)
Health Concerns
Cancer
Heart disease
Diabetes
Obesity
Alcohol/substance abuse
Tobacco use
Other
Motor vehicle accidents
Lack of exercise
Stroke
Mental health issues
Underage alcohol use
Lack of dental care
Child abuse/neglect
Lack of access to health care
Domestic violence
Count
163
122
98
79
61
43
42
31
27
23
22
13
11
10
8
2
19
Percent
76%
57%
46%
37%
28%
20%
20%
14%
13%
11%
10%
6%
5%
5%
4%
1%
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Criteria for a Healthy Community (Question 3)
Respondents were asked to identify the three most important criteria to a healthy community. Sixtynine percent (n=146) of respondents indicated “Access to health care and other services” was
important for a healthy community and “Good jobs and a healthy economy” was the second most
indicated criteria to a healthy community (43%, n=91). These are generally the top 2 responses in
rural community health needs assessments conducted by The Center. The third most frequent
selection from this assessment was “Religious or spiritual values” (37%, n=79). Respondents were
asked to identify their top three choices thus the percentages do not total to 100%. Comments listed as
“Other” are available in Appendix B. (n= 213)
Important Criteria
Access to health care and other services
Good jobs and healthy economy
Religious or spiritual values
Healthy behaviors and lifestyles
Strong family life
Good schools
Low crime/ safe neighborhoods
Affordable housing
Clean environment
Low death and disease rates
Community involvement
Parks and recreation
Tolerance for diversity
Other
Arts and cultural events
Low level of domestic violence
Count
146
91
79
74
72
49
31
29
25
12
11
7
6
5
2
2
20
Percent
69%
43%
37%
35%
34%
23%
15%
14%
12%
6%
5%
3%
3%
2%
1%
1%
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Awareness of Services Available at Essentia Health Fosston (Question 4)
Respondents were asked to rate their knowledge of health services available at Essentia Health
Fosston. Slightly more than half of the respondents rate their knowledge of local health services
available at Essentia Health Fosston as good (53%, n=115). This is an opportunity for Essentia
Health Fosston to educate community members and staff about services available locally. (N=216)
60%
53%
50%
Percentag
e
40%
30%
21%
18%
20%
6%
10%
2%
0%
No Answer
Excellent
Good
Awareness of Services
21
Fair
Poor
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Average Length of Time to Schedule an Appointment (Question 5)
Respondents were asked to identify the average length of time it takes to schedule an appointment
with a primary care provider at Essentia Health Fosston. Thirty-five percent (n=75) of respondents
report that they are able to schedule an appointment between 1-3 days. Focus group participants
validated this figure as well, noting that they could typically get into see their primary care provider
the day they called. (N=216)
35%
35%
31%
30%
Percentag
e
25%
17%
20%
15%
9%
10%
4%
3%
5%
1%
0%
Number of Days
22
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
How Respondents Learn of Health Care Services (Question 6)
“Word of mouth/reputation” was the most frequently reported method respondents indicated in
learning about local health services (73%, n=152). Generally, word of mouth is the most common
response in community health needs assessments conducted by The Center. “Health care providers”
was the second most frequent response to how people learn of health care services available (45%,
n=94). Respondents could select more than one method so percentages do not total to 100%.
Comments listed as “Other” are available in Appendix B. (n= 209)
Method
Word of mouth/reputation
Health care provider
Newspaper
Radio
Mailings
Yellow pages
Other
Public health
Church
Website/internet
Presentations
Count
152
94
68
61
43
17
13
8
7
4
2
Percent
73%
45%
33%
29%
21%
8%
6%
4%
3%
2%
1%
Community Health Resources Utilized in the Last Three Years (Question 7)
Respondents were asked to identify other community health resources they have utilized, other
than the hospital or clinic, in the last three years. The pharmacy was the most utilized community
health resource by 90% (n=189) of respondents, followed by the dentist at 61% (n=128).
Typically, the dentist and chiropractor are the most frequently cited community health resources
utilized outside of the hospital and clinic, based on other community health needs assessments
conducted by The Center. Respondents were asked to select all that applied so percentages do not
total to 100%. Comments listed as “Other” are available in Appendix B. (n=210)
Community Health Resources
Pharmacy
Dentist
Eye doctor
Chiropractor
VA
Community Health Center
Other
Public health
Count
189
128
120
76
20
15
13
12
23
Percentage
90%
61%
57%
36%
10%
7%
6%
6%
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Mental health
Council on Aging
7
2
3%
1%
Ideas for Improving Access to Health Care (Question 8)
Respondents were asked to identify methods for improving access to local health care services. “More
primary care providers” was the most frequently reported method indicated, followed by “More
specialists” (39%, n=68). These responses are common based on other community health needs
assessments offered by The Center. Respondents may select these options if they perceive that there is
a lengthy waiting time to see a physician or would like to spend more time with their physician.
Respondents could select more than one method so percentages do not total to 100%. Comments listed
as “Other” are available in Appendix B. (n= 175)
Method
More primary care providers
More specialists
Greater health education services
Improved quality of care
Outpatient services expanded hours
Transportation assistance
Other
Telemedicine
Cultural sensitivity
Interpreter services
Count
69
68
48
46
39
36
14
7
7
5
24
Percent
39%
39%
27%
26%
22%
21%
8%
4%
4%
3%
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Economic Importance of Local Health Care Services (Question 9)
The majority of respondents (76%, n=165) indicated that local health care services are very important
to the economic well-being of the area while 19% (n=42) indicated they are important. (N=216)
76%
80%
70%
50%
40%
30%
Percentag
e
60%
19%
20%
10%
0%
No Answer
important
1%
1%
Very
Important
important
Economic Importance of Local Health Care Services
25
Not
2%
Don't Know
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Delayed Receiving Health Care Services (Question 10)
Of the 216 surveys completed, 21% (n=45) reported they, or a member of their household,
thought they needed health care services but either did NOT get the service or experienced a
delay in receiving it. Seventy percent (n=152) of respondents felt they were able to get the
health care services they needed without delay. (N=216)
No Answer, 9%
Yes, 21%
No, 70%
No Answer
Yes
26
No
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Reasons for Delaying Health Care Services (Question 11)
The reasons most frequently cited for why respondents were not able to receive, or had a delay in receiving
health care services were: “It cost too much” (47%, n=22), “My insurance didn’t cover it” (36%, n=17) and
“Too long to wait for an appointment” (21%, n=10). Comments listed as “Other” are available in Appendix B.
Respondents were asked to select up to three applicable choices, therefore percentages do not total
100%. (n= 45)
Reason
It cost too much
My insurance didn't cover it
Too long to wait for an appointment
Other
Not treated with respect
Don't like doctors
Office wasn't open when I could go
Could not get an appointment
No insurance
Didn't know where to go
Unsure if services were available
Transportation problems
Distance too great
Too nervous or afraid
Language barrier
Had no one to care for my children
Could not get off work
Count
22
17
10
9
7
7
6
5
5
4
2
2
1
1
1
0
0
27
Percent
47%
36%
21%
19%
15%
15%
13%
11%
11%
9%
4%
4%
2%
2%
2%
0%
0%
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Preventive Services Used in the Last Year (Question 12)
Respondents were asked to identify which of the following preventative test and early diagnostic services
they have received in the past year. Of the preventative services listed, “Routine blood pressure checks”
was the most frequent response by 62% (n=128) of respondents. Fifty-seven percent (n=117) of respondents
also had a “Routine health checkup” and a flu shot (55% n=112). Comments listed as “Other” are available
in Appendix B. Respondents were asked to select all that applied, therefore percentages do not total 100%.
(n= 205)
Preventative Service
Routine blood pressure check
Routine health checkup
Flu shot
Cholesterol check
Mammography
Pap smear
Colonoscopy
Prostate (PSA)
None
Children's check up/Well baby
Other
Count
128
117
112
108
73
50
42
34
17
15
7
Percent
62%
57%
55%
53%
36%
24%
20%
17%
8%
7%
3%
Additional Health Care Services Desired (Question 13)
Respondents were asked to identify additional health care services they desired locally. There was a diverse
range of requests, including a female OB/GYN, dialysis, and cardiology. A few respondents indicated, “They
(Essentia Health Fosston) have everything a small community needs” and “we have everything”. Please
reference Appendix B for a complete listing of additional services desired locally.
28
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Hospital Care Received in the Past Three Years (Question 14)
Of the 216 surveys returned, 50% (n=109) of respondents reported that they or a member of their
household had received hospital care (i.e. hospitalized overnight, day surgery, obstetrical care,
rehabilitation, radiology or emergency care) during the past three years. This is a substantially lower
number than seen in other community health needs assessments conducted by The Center where
percentages are typically in the 70% range for having utilized a hospital service. (N=216)
No Answer, 4%
Yes, 50%
No, 46%
No Answer
No
29
Yes
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Hospital Location (Question 15)
Of the 109 respondents who received care at a hospital within the past three years, 63% (n=69) report
Fosston as the facility their household uses the most for day surgery, obstetrical care, rehabilitation,
radiology, emergency care or overnight hospitalization. Respondents were asked to select only one
response. Comments listed as “Other” are available in Appendix B. (n=109)
Hospital Location
Fosston
Bemidji
Other
Fargo
Crookston
Thief River Falls
VA
Mahnomen
Count
69
15
9
7
4
4
1
0
Percent
63%
14%
8%
6%
4%
4%
1%
0%
Reason for Selecting the Hospital Used (Question 16)
Of respondents who received care in a hospital, the primary reason for selecting a site was “Closest
to home” (70%, n=108) which is the most frequent response in other rural community health needs
assessments conducted by The Center. Respondents were asked to select three field choices that
most applied, so percentages do not total to 100%. Comments listed as “Other” are available in
Appendix B. (n=155)
Reason
Closest to home
Prior experience with hospital
Referred by physician
Hospital's reputation for quality
Emergency, no choice
Recommended by family or friends
Closest to work
Required by insurance plan
Cost of care
Other
VA/Military requirement
Count
108
81
59
55
30
18
16
14
7
7
6
Percent
70%
52%
38%
35%
19%
12%
10%
9%
5%
5%
4%
Location for Future Hospitalization (Question 17)
Respondents were asked to identify which hospital they or a household member would use in the
event of a future hospitalization. Most respondents selected Fosston as their top choice (53%, n=
30
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
114) while Bemidji was ranked a distant second (13%, n=29). Comments listed as “Other” are
available in Appendix B. (n=192)
Hospital Location
Fosston
Bemidji
Fargo
Other
Thief River Falls
Crookston
VA
Mahnomen
Count
114
29
19
12
7
6
4
1
Percent
53%
13%
9%
6%
3%
3%
2%
0%
Primary Care Received in the Past Three Years (Question 18)
Ninety-four percent (n=203) of respondents reported that they or a member of their family had
received primary care services from a family physician, physician assistant, or nurse practitioner over
the past three years. This is a higher percentage from other rural community health needs assessments
conducted by The Center. (N=216)
No
4%
No Answer
2%
Yes
94%
No Answer
Yes
31
No
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Location of Primary Health Care Provider (Question 19)
Of the respondents that indicated having seen a primary care provider over the last three years, 65%
(n=123) reported the location of their primary health care provider was in Fosston. Seven percent
(n= 14) of respondents visited a primary care provider in Bagley and 5% (n=10) in Bemidji.
Respondents were asked to select only one response. Comments listed as “Other” are available in
Appendix B. (n=189)
Location
Fosston
Bagley
Bemidji
Crookston
Other
Thief River Falls
Oklee
Fargo
Mahnomen
VA
Erskine
Count
123
14
10
9
9
8
5
4
4
3
0
Percent
65%
7%
5%
5%
5%
4%
3%
2%
2%
2%
0%
Reason for Selecting a Primary Care Provider (Question 20)
Respondents who indicated they or someone in their household had been seen by a primary care
provider within the past three years were asked why they chose that primary care provider. “Closest
to home” (62%, n=126) was the most frequently cited factor in primary care provider selection,
followed by “Prior experience with the clinic” (58%, n=119). Respondents were asked to select all
that applied, so percentages do not total to 100%. Comments listed as “Other” are available in
Appendix B. (n= 204)
Reason
Closest to home
Prior experience with clinic
Appointment availability
Clinic's reputation for quality
Recommended by family or friends
Length of waiting room time
Required by insurance plan
Referred by physician or other provider
Other
VA/Military requirement
Count
126
119
59
54
30
24
16
14
10
9
32
Percent
62%
58%
29%
26%
15%
12%
8%
7%
5%
4%
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Cost of care
Indian Health Services
7
2
3%
1%
Reasons for Seeking Primary Care Outside of Essentia Health Fosston (Question 21)
Respondents were asked to identify why they may seek primary health care services outside of
Essentia Health Fosston. Thirty-six percent (n=55) reported they seek health care services
elsewhere because they have a “Prior relationship with another health care provider” or because the
location of the primary care provider was closest to their home (24%, n=36). Twenty-four percent
(n=37) indicated they use local health care services. Respondents could select all that apply, so
percentages do not total 100%. Comments listed as “Other” are available in Appendix B. (n=153)
Reason
Prior relationship with other health
care provider
N/A: I/we use local services
Closest to home
Quality of staff
Other
Quality of equipment
More privacy
Closest to work
Cost of care
Required by insurance plan
VA/Military requirement
Count
Percent
55
37
36
32
17
12
12
10
9
9
9
36%
24%
24%
21%
11%
8%
8%
7%
6%
6%
6%
Location of Future Primary Health Care Provider (Question 22)
Seventy-three percent (n=153) of respondents indicated Fosston as the location for their future
primary health care provider needs, followed by Fargo (21%, n=44) and Bemidji (20%, n=43).
Respondents were asked to select only one response. Comments listed as “Other” are available in
Appendix B. (n=211)
Location
Fosston
Fargo
Bemidji
Bagley
Other
Crookston
Erskine
Count
153
44
43
20
20
15
9
33
Percent
73%
21%
20%
9%
9%
7%
4%
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Thief River Falls
VA
Oklee
Mahnomen
9
9
8
5
4%
4%
4%
2%
Use of Health Care Specialists during the Past Three Years (Question 23)
Sixty-six percent (n=143) of respondents indicated that they or a household member had seen a
health care specialist during the past three years, which is comparable to other rural community
health needs assessments conducted by The Center. (N=216)
No Answer, 5%
No, 29%
Yes, 66%
No Answer
Yes
34
No
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Type of Health Care Specialist Seen (Question 24)
Survey respondents reported seeing a wide array of health care specialists. The type of specialists most
frequently reported were “Dentist” (41%, n=58), “Chiropractor” (26%, n=37) and “Orthopedic
surgeon” (20%, n=28). The use of dentistry and chiropractic services is similar to other communities.
Again, respondents were asked to select all that applied, so percentages do not total to 100%.
Comments listed as “Other” are available in Appendix B. (n=143)
Health Care Specialist
Dentist
Chiropractor
Orthopedic surgeon
General surgeon
Ophthalmologist
Physical therapist
Cardiologist
Dermatologist
Neurologist
OB/GYN
Urologist
Other
Mental health counselor
Rheumatologist
Dietician
ENT (ear/nose/throat)
Oncologist
Radiologist
Pulmonologist
Allergist
Neurosurgeon
Psychiatrist (M.D.)
Occupational therapist
Social worker
Endocrinologist
Psychologist
Gastroenterologist
Pediatrician
Substance abuse counselor
Speech therapist
Count
58
37
28
26
24
23
22
19
15
14
13
13
12
12
10
10
10
10
8
7
7
7
6
6
5
5
4
4
3
1
35
Percent
41%
26%
20%
18%
17%
16%
15%
13%
11%
10%
9%
9%
8%
8%
7%
7%
7%
7%
6%
5%
5%
5%
4%
4%
4%
4%
3%
3%
2%
1%
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Location of Health Care Specialist (Question 25)
Of the 143 respondents that indicated they saw a health care specialist in the last three years, 36%
(n=52) saw a specialist in Fosston, 30% (n=43) saw a specialist in Fargo, and 29% (n=42) saw a
specialist in Bemidji. Respondents could select more than one location, therefore percentages do
not total to 100%. Comments listed as “Other” are available in Appendix B. (n= 143)
Location
Fosston
Fargo
Bemidji
Other
Crookston
Thief River Falls
Bagley
VA
Mahnomen
Oklee
Erskine
Count
52
43
42
36
14
12
11
5
4
3
2
36
Percent
36%
30%
29%
25%
10%
8%
8%
3%
3%
2%
1%
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Overall Quality of Services at Essentia Health Fosston (Question 26)
Respondents were asked to provide quality ratings for a variety of services offered at Essentia Health
Fosston using a scale of 1-4 where 4= Excellent, 3= Good, 2= Fair, and 1= Poor. “Don’t Know” was
also an available choice. Non-numerical selections were eliminated, and the sums of the average
weighted scores were calculated. “Hospital outpatient services” received the top average weighted
score for quality with 3.29 out of 4.00. The total average weighted quality score for the hospital was
3.13 indicating the overall quality of services at the hospital as good. The average range of overall
quality of services in other rural community health needs assessments conducted by The Center is
3.13-3.47. A chart of the average weighted scores is below. Percentages and counts from each
category are available in the table on the next page.
3.00
2.00
1.00
0.00
Average Weighted
Score
4.00
2.95 3.00 3.03
3.25 3.14
3.07 3.18 3.03 3.20
3.29 3.17
Essentia Health Fosston Services
37
2.75
3.13
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Table of Overall Quality of Services at Essentia Health Fosston
(Question 26)
Service
Assisted living
Chemotherapy
Diabetic/nutrition
education
Emergency room
Exercise
management for
persons with
chronic diseases and
disabilities
Excellent
Good
4
3
51%
(n=19)
0%
(n=0)
38%
(n=8)
38%
(n=8)
36%
(n=14)
41%
(n=16)
50%
(n=43)
34%
(n=30)
45% (n=13)
31% (n=9)
Fair
2
41%
(n=15)
10%
(n=2)
13%
(n=5)
8%
(n=7)
Poor
Don’t
Know
No
Answer
1
Average
Weighted
Score
8%
(n=3)
n=110
n=69
2.95
14%
(n= 3)
n=122
n=73
3.00
n=103
n=74
3.03
n=57
n=72
3.25
n=110
n=77
3.14
10%
(n=4)
8%
(n=7)
17%
(n=5)
7% (n=2)
General surgery
46%
(n=26)
30%
(n=17)
10%
(n=6)
14%
(n=8)
n=83
n=76
3.07
Home health
50%
(n=19)
28%
(n=11)
11%
(n=4)
11%
(n=4)
n=106
n=72
3.18
Hospice/respite
program
48%
(n=14)
17%
(n=5)
14%
(n=4)
n=110
n=77
3.03
Hospital inpatient
services
Hospital
outpatient
services
49%
(n=30)
11%
(n=7)
n=84
n=71
3.20
n=78
n=70
3.29
n=103
n=78
3.17
n=116
n=76
2.75
1182
885
3.13
Nursing home
Orthopedic
surgery
N=
49% (n=33)
42%
(n=15)
21%
(n=6)
33%
(n=20)
7%
(n=4)
38% (n=26) 7% (n=5)
40%
(n=14)
9%
(n=3)
20%
(n=7)
26%
(n=9)
9%
(n=3)
241
166
64
38
6% (n=4)
9%
(n=3)
14%
(n=5)
54
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Perception of Personal Health (Question 27)
Respondents were asked how they would rate their own level of health. Fifty-one percent (n=111)
perceived their personal level of health to be “Unhealthy” and only 1% (n=2) indicated their level of
health as “Very healthy.” This is atypical compared to other community health needs assessments
conducted by The Center where generally 50% of respondent indicate their health as “Somewhat
healthy”. In question number one, 5% (n=10) of respondents perceive the level of community health to
be “Unhealthy”. This indicates an opportunity to improve Fosston residents’ perception of their
personal health. (N=216)
60%
51%
50%
Percentag
e
40%
27%
30%
20%
10%
11%
5%
1%
5%
0%
Level of Personal Health
39
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Report Experiencing Symptoms of Depression (Question 28)
Respondents were asked, “In the past three years, have there been periods of at least three
consecutive months where you felt depressed on most days, although you may have felt okay
sometimes?” Eighteen percent (n=38) report “Yes” they have recently experienced symptoms of
depression. This is an opportunity for the hospital to reach out to local residents on stress and
symptom management. (N=216)
No Answer
6%
Yes
18%
No
76%
No Answer
Yes
40
No
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Frequency of Physical Activity (Question 29)
Forty-two percent (n=90) of respondents report engaging in physical activity “2-4 times per week”
and 29% (n=63) report daily physical activity. These results are encouraging given respondents’
perception of personal health as being “Unhealthy”. (N=216)
42%
45%
40%
35%
29%
Percentag
e
30%
25%
20%
13%
15%
7%
10%
8%
2%
5%
0%
No
Answer
Daily
2-4 times 3-5 times 1-2 times
per week
per
per
month
month
Frequency of Physical Activity
41
None
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Prohibited from Getting Medications (Question 30)
Respondents were asked if cost prohibited them from receiving prescription medications or taking
medications regularly. Eighty-one percent (n=175) of respondents are not prohibited by cost in
receiving medications, whereas 7% (n=15) have experienced difficulties in this area. (N=216)
Not applicable, I don't take
medications
9%
No Answer, 3%
Yes, 7%
No, 81%
No Answer
Yes
No
Not applicable, I don't take medications
42
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Have Health Insurance (Question 31)
Eighty- six percent (n=185) of respondents report having health insurance. Eleven percent (n=23)
do not have health insurance. This rate is comparable to other community health needs
assessments conducted by The Center. (N=216)
No, 11%
No Answer, 4%
Yes, 86%
No Answer
Yes
43
No
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Reasons for Not Having Health Insurance (Question 32)
Of the 23 respondents who indicated they do not have health insurance, 74% (n=17) report they did
not have health insurance because they “Cannot afford to pay for health insurance”. Respondents
were asked to mark all answers that applied, thus the percentages do not total 100%. Comments
listed as “Other” are available in Appendix B. (n=23)
Reason
Cannot afford to pay for medical insurance
Choose not to get medical insurance
Other
Employer does not offer insurance
Cannot get medical insurance due to medical
issues
Count
17
4
4
1
Percent
74%
17%
17%
4%
0
0%
Awareness of Programs that Help Pay Health Care Bills (Question 33)
Forty-two percent (n=91) of respondents are aware of programs that help pay health care bills, but
do not qualify to use them, whereas 20% (n=43) are unaware of these types of programs. (N=216)
42%
45%
40%
35%
Percentag
e
30%
20%
25%
20%
15%
12%
13%
13%
10%
5%
0%
No Answer
Yes, and I
use them
Yes, but I
No
do not
qualify
Awareness of Programs that Help Pay for Health Care Bills
44
Not sure
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Focus Group Findings
Introduction
The National Rural Health Resource Center (The Center) of Duluth, Minnesota was contracted by
Essentia Health Fosston (Essentia) to conduct focus groups to provide qualitative data as a
supplement to the community survey. The purpose of the focus groups was to hear directly from
local residents on the strengths and needs of health services in Fosston.
Focus Group Methodology
Four focus groups were scheduled in Fosston, Minnesota in April 2012. Focus group participants were
identified as people living in Fosston and the surrounding area. Invitations were mailed with the focus
group questions attached (Appendix C). Twenty- four people participated in total. The focus groups
were designed to represent various consumer groups of local health services including senior citizens,
caregivers, business owners, clergy, health care providers and special populations in the community
(Amish and Russian Orthodox). Four focus groups were held at Essentia Health Fosston’s Community
Education Classroom. Each focus group session was approximately 60 minutes in length and included
the same questions. The questions and discussions at the focus groups were led by Kami Norland of
the National Rural Health Resource Center. No identifiable information is disclosed in the focus group
summary to maintain confidentiality.
Demographics
Of the 24 focus group participants, there were 14 females and 10 males. The ages ranged from
approximately 30-90 years old. It is typical to see a greater participation rate from females as they are
often times the primary health care decision maker within a household. All of the respondents reported
having direct experience with the health care services provided in Fosston. The majority of the
respondents have resided in Fosston for more than 20 years.
Focus Group Findings
In your opinion, what are some of the strengths of the health services available in Fosston and
the surrounding area?
Essentia has a reputation of providing friendly, accessible, competent health care services. “Over the
last 10 years, the reputation of this facility has improved dramatically and has become a respectable
leader in the community,” replied a focus group respondent. The improved reputation was attributed
to the excellent leadership, remodeling of the facility and quality customer service. “You are not just
a number when you walk through these doors” reported several participants. All physicians and staff
were noted for “going the extra mile” to see that quality and safety measures were taken with patient
care. “I appreciate that my physician knows who I am and who my parents and kids are, and he
understands my family’s medical history very well. You don’t get this level of quality, accessible care
in larger facilities,” credited a focus group participant. “I love my doc, although I think he’s too
overworked; the physician assistants are also great,” replied another participant.
45
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Participants recognized how convenient it is to have health care accessible locally. “When I moved to
Fosston a few years ago, I was surprised at the number of specialty services that are available,”
replied a focus group participant. Access to a variety of specialty services, including oncology,
urology, cardiology, optometry, obstetrics, general surgery and hospice were identified as major
strengths to the community.
“The high level of skilled staff and advanced technology in Fosston saved my father’s life. I am
grateful,” reported a focus group participant. Focus group participants acknowledge local physicians’
high level of competency of care and commend them for recognizing their limitations and effectively
referring to other providers as appropriate. Care coordination between Essentia Health Fosston to
larger facilities runs smoothly, but transition efforts from the larger facilities to Essentia Health
Fosston are not as congruent.
Focus group participants reported pride in the appearance of the hospital’s remodeling efforts. “The
building is one’s first impression, and it is mighty impressive here,” replied a participant. “The
facility is always clean and well taken care of,” reported many. One individual reported that when he
has visitors from out of town come by, he always takes them on a tour of the hospital because it is a
hub of connectivity and community pride.
Participants reported that the hospital is very connected in the community and genuinely cares about
the health and wellbeing of area residents by sponsoring health fairs, the creation of walking paths
and area gardens.
In your opinion, what are some of the barriers of the health services available in Fosston
and the surrounding area?
Many participants struggled to identify some of the barriers of the health services available in
Fosston, with most noting how privileged they feel to live in a small town with such comprehensive
health care services. However, others felt that the general population was unaware of the breadth and
depth of services offered locally. “People don’t realize the high level of advanced equipment and
technology available in Fosston.” Individuals recommended the distribution of a quarterly newsletter,
utilization of social media outlets (blogs, Facebook, etc.) or increased community outreach efforts to
educate individuals of the services and equipment available locally.
46
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Participants also noted their observance of increased emergency department visits for non-emergency
situations. “Many people avoid or delay treatment by a primary care provider or dentist; opting to be
treated in the ER, particularly if they are uninsured or underinsured” cited a few respondents. This is a
national trend in health care resulting in increased health care costs and is driven by a health system
that focuses on illness as opposed to prevention and wellness.
In terms of prevention and wellness efforts, “The hospital does well with respecting the Amish and
Russian Orthodox populations, but should be mindful of their unique needs in future planning efforts
to assure that they are included in prevention initiatives” encouraged a few respondents as they noted
these populations had lower frequencies of vaccinations and higher birthing rates by midwives outside
of the community. “Generally speaking, I think the Amish are traveling to Crookston for the delivery
of babies because they don’t want to see a male OB locally; but I think they maintain primary care
services in Fosston.” Representatives from the Amish and Russian Orthodox populations were invited
to participate in the focus group sessions, however no representatives responded.
How would you describe the availability and quality of care of health services available at
Sanford Fosston?
“The quality of care is outstanding! We have it all,” replied a group of participants. “I feel confident
that Essentia Health Fosston will take good care of my family across the whole lifespan,” noted one
participant. Other positives regarding the availability and quality of care included: communication
efforts between Fosston and other health care providers has increased, overall hospital reputation has
improved, accurate diagnosis and effective treatments are provided, primary care doctors appear to
know their limitations for when referrals must be made, referrals and transfers made are efficient,
many specialty services are offered locally, coordination with the ambulance service is excellent, and
Essentia Health Fosston always seems to be engaged in a continuous process of performance
improvement.
Focus group participants recommended increasing awareness and visibility of local health services in
the newspaper. In addition, creating a health resource directory online to inform community
members of all of the health services available in town would be beneficial. “People may be driving
elsewhere for some services just because they didn’t know they could get the care they need right
here in town.” Other recommendations included a process improvement of the intake worker asking
individuals what level of assistance the hospital could provide to assist patients’ understanding of
diagnostic or treatment interventions. For instance: participants thought it would be really helpful if
a nurse called the patient to interpret lab or test results, provided baseline information for what is
“normal,” set goals with the patient
47
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
for improving the lab result, and offered practical suggestions for methods of improving
(or coping with) the overall lab result.
What are some of the benefits of having health services available locally?
Convenience was the primary benefit to having health services available locally. “It’s nice to not have
to travel or take more time off from work just to see the doctor,” said one respondent. “I’m more
likely to see the doctor and get the care I need when I need it because care is local,” said another
participant. Several participants noted the importance of having physicians available locally to detect
health concerns at the earlier stages of diagnosis before problems escalate and require greater
interventions.
Another benefit of having health services available locally is the positive economic impact of the
facility on the community. A recommendation from one participant was to have a hospital economic
impact assessment conducted to help the community understand how valuable local health care
services are to the financial well-being of the area.
Why might people leave the community for health care?
One reason cited for why people may leave the community for health care is the need for advanced
specialty care services. Specific specialty care services mentioned were: midwifery, high risk
pregnancies and neo-natal care, neurology, psychiatry and psychology services, dialysis treatments,
and dentistry. Dentistry was noted because local dentists can only afford to take on a set number of
Medicare patients.
Other reasons why one may leave the area include: previous reputation as a “band aid shop”, poor
experiences, or the perception that a larger facility is better. “It’s hard to dispel a bad reputation, but
friendliness and quality of care provided by the staff are changing this perception,” noted respondents.
What type of new health care services would you like to see available locally?
“It’s hard for a small community to offer advanced specialty services due to the small volume of
patients; therefore a feasibility study of any additional specialty service should be conducted” advised
a few participants. If participants had the option of selecting additional services offered locally, they
requested: advanced OB/GYN for high risk pregnancies, pediatrics, child psychiatry/psychology,
psychiatric emergency care, dialysis treatment, and neurology.
48
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
There were also recommendations to increase the awareness and marketing of existing health
services and information on programs that help low income folks pay for
medical expenses.
Do you have any additional comments or suggestions regarding health services in
Fosston?
Participants again commended the board, leadership, and physicians for providing excellence in
safe, quality care. Miscellaneous suggestions included: improve access to handicap parking;
offer valet parking for elderly or disabled; wheelchairs do not fit in exam rooms comfortably
without furniture being moved; the new remodeling is nice
but it is a long way to walk for registration or the nurses’ station; improve signage to
prevent people from getting lost in the new remodel; educate the community about hospice and
end of life services; offer grief support classes- particularly for youth; offer education on
advanced directives; encourage the local pharmacy to stay open until the clinic closes.
In Conclusion
Based on the above qualitative information, it appears that Essentia Health Fosston is providing
high quality, personalized health care services. Community members prefer to receive health
care services within Fosston when possible and have a few specific suggestions for improving
local utilization of health care. Increasing the marketing of existing services more widely
accessible would also increase local utilization. Focus group participants appreciate and value
the personalized care they receive at Essentia Health Fosston.
5. Input from Persons Who Represent the Broad Interests of the Community Served
by the Hospital Facility
5.1. When and How These Persons Were Consulted
A diverse representation of community members participated as survey respondents as well as
focus group participants. These participants were all contacted by National Rural Health
Resource Center. The process and methodologies are described earlier in this document.
5.2. Organizations Consulted
Appendix D provides a complete list of community participants, business owners, and all
organization that participated in this CHNA process.
49
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
5.3. Individuals with Special Knowledge of or Expertise in Public Health
Appendix D provides a complete list of community participants, business owners, and all
organizations that participated in this CHNA process. Public Health was a contributing partner in
this endeavor. They are a continuing partner in the implementation of the action plan presented
earlier in this report.
5.4. Federal, Tribal, Regional, State, or Local Health or Other Departments or Agencies
with Current Data or Other Information Relevant to the Health Needs of the
Community
Appendix D provides a complete list of community participants, business owners, and all
organizations that participated in this CHNA process. Public Health was a contributing partner in
this endeavor. Secondary data from multiple sources including CDC’s BRFSS, the Census
Bureau, Hospital Compare and the University of Wisconsin’s County Health Profiles were
analyzed to provide broad-based health-related information to identify important health needs for
the population served by the Essentia Health-Fosston Hospital.
5.5. Individuals Who are Leaders, Representatives, or Members of Medically
Underserved, Low-Income, and Minority Populations and Populations with Chronic
Disease Needs
Appendix D provides a complete list of community participants, business owners, and all
organizations that participated in this CHNA process. Individual invites were sent to all of the
Amish population in the area as well as the Russian Orthodox population.
6. Community Health Needs Identified Through the CHNA
In response to the findings of the survey two meetings were convened with relevant community
partners. The three highest-priority health needs for the community served by Essentia HealthFosston are 1) Increase access to patient-centered health education (disease prevention and
wellness), 2) Increase access to primary care, and 3) Increase access to specialty care and
coordination with community agencies. Each of these health needs will be addressed by a
variety of efforts. The action plan below provides details about how these needs will be
addressed as well as how successful implementation will be measured.
50
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Essentia Health Fosston
Community Health Assessment Action Plan
Community Health Concern (Goal): Increase access to patient-centered health education (disease prevention and wellness)
Objective (Activities)
Increase collaboration among
partners to address health
education/promote health across the
lifespan
Expand the community health
coalition to include new identified
members.
Schedule quarterly meetings for the
community health coalition to
identify local health resources,
improve continuity of care and
evaluate collaborative grant
opportunities
Direct health education activities
towards individuals without chronic
disease (prevention); individuals
with risk factors (pre-diagnosis);
individuals with chronic disease
(coping/reduction in severity)
Develop core measure data and
Activity
Lead
EHF:
Candy
Keller
with
Lynae
Finseth as
Mentor
Timeline
Partners
12/20122013
and
Ongoing
City of Fosston
Civic Center
School
Public health
Churches
Ministerial
association
Ad hoc
business
leaders
EH Fargo
First Care
Foundation
(consider using
coalition of
SHIP as the
venue for
furthering this
initiative)
Ongoing
51
Resources
Needed
Grants
Committed
people
Marketing
Staff time
Measure of Success
Invite new members to participate in
quarterly community health coalition
meetings
4 interagency process improvements or
coordination of care activities will be
conducted annually
Ex: Harness the benefits of Fit Trail into
patient’s continuum of self care
Health Fair
5K run/walk
Community Garden/fresh vegetable
Facilitate 3 community health education/
prevention activities annually (03/13/2013
update)
Health Fair scheduled for April 25.
Activity report and results expected by
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
develop services within and across
partnerships to improve results In
addition to facility generated data,
Explore public health data to
determine which health metrics will
be used to monitor for community
health improvement.
May 1.
5K run walk in partnership with Rotary is
planned for early May.
Lynae
Currently
in
progress
Activity report and results expected by
May 1.
Planning for Health care week activities
will start shortly with a week-long series of
events, educational opportunities and
celebrations
Objective: to develop and formalize a plan
for regular outreach to the community for
wellness and prevention: EX: an “I can be
healthier” program. This program will
expand from 3 community health
education/prevention activities annually to
the level of partners to support the
program. Funding options will be explored
regularly as part of the program.
4/09/2013: Meeting with Public Health re: Community Transformation Grant (CTG). CTG group: Sara Reese, Kristen Fagerlund,
Lynae Finseth, Candy Keller, Pat Wangler. Also invited but not in attendance were Kristi Sveningson and Sheila Follis from EHF.
Plan:
Do a community Health Status search for people in Eastern Polk County-Sara Reese.
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Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Purchase “My Plate” educational materials through CTG grant in time to use at April 25 health fair: Candy to purchase; Grant to
reimburse.
Develop a draft plan for “Community Health Improvement” with an event focus on screening and metrics measurement as well as
education to enable individuals to take charge of their health and disease prevention. Staff education to become
presenters/providers of the plan will include but not be limited to motivational interviewing. Potential name for program: “To a
Healthier ME” or something like that. Pat, Lynae and Candy will meet to draft prior to care coordination meeting on May 9 for
review and input and be prepared for further input at next meeting of CTG.
Next CTG group meeting: June 18, 2013 at noon. Pat will add Michelle Marx to the team.
Meeting held June 18, 2013: Attendees were Sara Reese and Kristen Fagerlund from Polk County Public Health, Lynae Finseth,
Candy Keller, Sheila Follis and Pat Wangler. Not present: Kristi Sveningson and Michelle Marx.
Training: Participate in Clinic-Community Learning network facilitated by ICSI which will involve 3 half-day face to face and 9
virtual education and collaborative sessions. Team members will be identified for enrollment. Program starts July 2013 and goes
through June 2014. Nutrition, Physical activity and tobacco use behaviors.
Objective: enhance current health, wellness and disease prevention activities within the community of EHF employees, the
community at large at events, places of work and business, places where people gather such as church and the school.
Necessary to make the program availability adequate to meet the need: trained staff time, time to train additional staff, an on the
road ready display and equipment case/kit for staff that enables them to present, screen and do the work of prevention and
screening equipment and tools.
Polk County Public Health Grant Funding Request- Essentia Health Fosston: $3000
53
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Purpose: to address 1) Community Health Concern Strategic Initiative within the Community Health Assessment Action Plan and
2) Quality Outcomes for Tobacco Cessation. Funds used for staff time and resources to formalize internal (such as but not limited
to staff time to develop an Epic work flow for a tobacco-user referral process related) and community initiatives for health
promotion, prevention and early detection such as healthy eating, physical activity and smoking cessation (such as, but not limited
to a healthy eating resources/ “to-go” kit for health screenings/promotion). Staff time and travel will also be used to participate in
the 12 month “Clinic-Community Learning Network”.
June 18, 2013: First Care Foundation approval to fund $15,000 of cost of program implementation; program naming contest
announced.
Community Health Concern (Goal): Increase access to primary care (will continue to work with system integration)
Objective (Activities)
Evaluate internal processes to improve
access to primary care
Evaluate extended clinic hours
Evaluate the need for an urgent care
Streamline patient access to care from
registration to discharge to follow-up:
identify reason for dropped registration
calls, evaluate online self-scheduling,
consider home monitoring systems for
home-bound population, evaluate gaps in
transportation to appointments, establish
Activity
lead
EHF:
Lynae
Finseth,
Devra
Carlson,
Dr.
Winjum,
Schedulin
g/registrati
on
Timelin Partners
e
2013Essentia West
2015
Resources
Needed
Staff time
Informatio
n system
Measures of Success
Develop plan for clinic
hours to increase
opportunity for patients to
be seen in the clinic rather
than ER. Monitor plan by
review of timing and
appropriateness of patients
seen in ER
Implement a minimum of
___ process improvements
that streamline the patient
experience
54
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
nurse hotline
Evaluate external processes to improve
access to primary care
Partner with county and other health
services to identify opportunities to
improve care coordination and
prevention: i.e. flu shots
Continually assess the need for different
provider types and recruit to the
identified need
Carrie
Nephew
(task
force
currently
active)
2012>
Polk County
Pharmacies
Home Health
Nursing home
Assisted living facilities
WIC
Social Services
President
EHF
HR
CMO
CSE
Essentia West Region
Facilitate quarterly
communication with
partners to identify
improvements with care
coordination
Adequate # and type of
providers are on staff to
fulfill growth plan for
primary care and specialty
outreach.
Staff Retention Rate:
2012: 80%
2013: 87%:
Community Health Concern (Goal): Increase access to specialty care and coordination with community agencies
Objective (Activities)
Activit
y lead
Timelin
e
Partners
Evaluate implementing tele-health
EHF
2013-
Essentia Health
55
Resourc Measures of Success
es
Needed
Standard Identify 3 strategies or best practices for
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Form a tele-health group to discuss system
best practices, lessons learned,
logistics, physician “buy-in”, etc.
Participate in educational sessions
regarding workflow, internal
processes, reimbursement, etc. on
tele-health implementation
Evaluate gaps in services in the
area that lead to inappropriate
use of ER
Evaluate appropriateness of use
of ER services including chronic
pain, dental issues, drug seeking
and other non-emergent access
to ER because more appropriate
level of services is not available
when needed and develop an
improvement plan. Evaluate
coordination of care between
specialty care services and
primary care
Inquire with EMS/EMT
providers on opportunities to
improve care coordination and
referrals
2015
Devra
Carlso
n
20132014
Carol
Abele
2013
Public health
North Western
Mental Health
Center,
Crookston, MN
IT and
Telecon
nectivity
using
same
platform
implementing tele-health successfully
City of Fosston
School
Public health
Law
enforcement
Mental Health
Churches and
Ministerial
association
Pharmacist
Meeting
space &
time
Complete and prioritize the approach to gaps
in service
Identify role of nurse triage lines
Complete evaluation of pain care and identify
strategy
Develop a strategy for drug seeking behavior
Regional EMS
Office of Rural
Health
56
#1: mental health. Effective Jan 2013 began
working with North Western Mental Health
Center in Crookston to develop tele-health
services.
Community paramedic program: 1 paramedic
enrolled in program which will be completed
by the end of July 2013 and 2nd paramedic will
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
be enrolled in the next session late this
summer/fall.
Increase outpatient coordination and follow-up
for chronic disease and post hospital services:
Patients in Coordinated Care Program
increased from 50 to 91 within this fiscal year.
Program is in early development stages and
growth is expected to continue at an
accelerated rate in FY 2014.
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Community Health Needs Assessment
7. Existing Healthcare Facilities and Other Resources within the Community Available to
Meet the Community Health Needs Identified Through the CHNA
Please see Appendix E.
7.1. Process for Identifying and Prioritizing Resources/Services to Meet the Community
Health Needs
Polk County Public Health Grant Funding Request- Essentia Health Fosston: $3000
Purpose: to address 1) Community Health Concern Strategic Initiative within the Community
Health Assessment Action Plan and 2) Quality Outcomes for Tobacco Cessation. Funds used for
staff time and resources to formalize internal (such as but not limited to staff time to develop an
Epic work flow for a tobacco-user referral process related) and community initiatives for health
promotion, prevention and early detection such as healthy eating, physical activity and smoking
cessation (such as, but not limited to a healthy eating resources/ “to-go” kit for health
screenings/promotion). Staff time and travel will also be used to participate in the 12 month
“Clinic-Community Learning Network”.
June 18, 2013: First Care Foundation approval to fund $15,000 of cost of program
implementation; program naming contest announced.
8. Making the CHNA Report Widely Available to the Public
This report was made widely available to the public by the following methods:
Posting a PDF of the report under the “Community Benefit/CHNA” tab on the hospital facility’s
homepage along with instructions for downloading it. Providing paper copies without charge at
the hospital facility upon request
58
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
References
1.
REG-106499-12. Department of Treasury Internal Revenue Service. Community Health
Needs Assessments for Charitable Hospitals. 78 FR 20523. 2013. Accessible at:
https://federalregister.gov/a/2013-07959.
2.
Essentia Health is one of six U.S. organizations to earn ACO accreditation | COO John
Smylie discusses the accreditation process in Wednesday webinar. 2013. Accessible at:
http://essentiahealth.org/Main/PressReleases/Essentia-Health-is-one-of-six-US-organizationsto-242.aspx.
3.
Berwick DM, Nolan TW, Whittington J. The Triple Aim: Care, Health, and Cost. Health
Affairs. 2008;27(3):759-769.
4.
Agency for Healthcare Reserach and Quality. Patient Centered Medical Home Resource
Center. Accessible at:
http://pcmh.ahrq.gov/portal/server.pt/community/pcmh__home/1483/PCMH_Defining%20th
e%20PCMH_v2.
5.
Notice 2011-52. Department of Treasury Internal Revenue Service. Notice and Request
for Comments Regarding the Community Health Needs Assessment Requirements for Taxexempt Hospitals. 2011. Accessible at: http://www.irs.gov/pub/irs-drop/n-11-52.pdf.
6.
Improving Health in the Community: A Role for Performance Monitoring. The National
Academies Press; 1997. Reprinted with permission from Permissions Coordinator, 2013 by the
National Academy of Sciences, Courtesy of the National Academies Press, Washington, D.C.
7.
University of Wisconsin Population Health Institute. County Health Rankings 2012.
Accessible at: www.countyhealthrankings.org.
8.
Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System.
Accessible at: http://www.cdc.gov/brfss/.
9.
Lutfiyya MN, McCullough JE, Saman DM, et al. Rural/urban differences in health services
deficits among U.S. adults with arthritis: A population-based study. Journal of Nursing
Education and Practice. 2013;3(11):43-53.
10.
Agency for Healthcare Research and Quality. National healthcare disparities report.
National Center for Health Statistics. 2007. Accessible at: http://www.ahrq.gov/htm.
PMid:23062678.
11.
Graves BA. Telehealth for communities: Toward eliminating rural health disparities.
Online Journal of Rural Nursing and Health Care. 2010;10(1).
59
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Appendix A---Survey Used By National Rural Health Resource Center
60
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Community Health Needs Assessment
61
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Community Health Needs Assessment
62
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Community Health Needs Assessment
63
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Community Health Needs Assessment
64
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Community Health Needs Assessment
65
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Community Health Needs Assessment
Appendix B- Responses to Other and Comments
2. In the following list, what do you think are the three most serious health concerns in our
community?
-Cost of medical health care
-Drugs
-Diet
-Many apply
3. Select the three items below that you believe are most important for a healthy community.
-A safe place to walk and play
-Bike trails
-Outside sports
-Actual demonstrations with samples of replacing healthier alternatives for less healthy ingredients in
many recipes. I’ve attended these in other areas and enjoyed them
6. How do you learn about the health services available in our community?
-Size of area
-Work affiliation
-Live in community
-Family employment
-Always been here
-Posters
-I drive by there a lot
-Being proactive
-Wife works 1st Care
-Only one available
7. Which community health resources, other than the hospital or clinic, have you used in the last three
years?
-Cardiologist
-White Earth Res
-Wellness Center
-Home town
-Bone builders
-Body work therapists
-Massages
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Community Health Needs Assessment
8. In your opinion, what would improve our community’s access to health care?
-Work with U of M or Mayo
-Alternative medicine
-Cost – fees too high (4)
-Good now
-Less midlevel care
-Have it all here
-I believe the bus that goes to Fargo for medical should negotiate to take any clinic
-Confidentiality
-Quit treating patients as if it were drive through service
11. If yes, what were the three most important reasons why you did not receive health care services?
-Went to ER but no one answered buzzer. I was taken to Bemidji instead: Please note, this did not happen
at Essentia
-Tried to make it through
-Did get care
-Too long to diagnose
-Visited clinic several times. Put off by lack of discovering condition by Dr. too fast to give medicine
-Used home remedies instead
12. Preventative testing and services can lead to early diagnosis of serious health problems when treatment
and lifestyle changes can make the most difference. Which of the following services have you used in the
past year?
-Diabetic
-All labs
-Dexa-scan in Bagley
-Lab/blood glucose check
-Injection
-Vitamin D12 shot
-Dental, eye exams
13. What additional health care services would you use if available at Essentia Health
Fosston?
-None, I prefer the Sanford system
-Not applicable: I don’t use Fosston
-Kidney
-Nutrition/diet
-Endocrinologist
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Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
-Pediatric dermatologist
-Counselors
-Looking into the future. Possibly dialysis, since I have diabetes
-They have everything for a small community
-OB/GYN (2)
-Pediatrics
-Allergist
-Expanded infusion center
-Back specialist
-Mental health
-They meet all our needs
-Cardiologist
-Previously a family member could have benefited from a dialysis unit locally
-OB, if there was a female provider and if one (specific) nurse did not work at
Essentia. She is rude and disrespectful to patients and their families
-Why isn’t the non-invasive test for colonoscopy available here? More men folk would get tested if it
were available
-Rheumatologist, urologist
-Weight loss and exercise advice and leadership groups
-Alternative medicine
-More mental health services
-When you call in and ask what doctor is on call they refuse to tell you who you’re
seeing
-I would use Fosston more if the waiting time for an office visit was shorter. 3:15 appointment wasn’t seen
until 4:15
-Cancer screening
-I would not come to Essentia if I can avoid it. I’d drive to Bemidji or Fargo as I
have in the past
-Neither my husband nor I go to that facility. He goes to Sanford Fargo & I go to
Sanford in TRF.
-Cardiology (pacemaker)
-I don’t know; I’ve been going to Crookston, Altru for 20 years. I only went to PT in
Fosston, which didn’t help me; waste of money
-None of the marked items were at Essentia
15. If yes, which location does your household use the MOST for hospital care?
-Bagley (2)
-Twin Cities
-U of M
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Community Health Needs Assessment
-Park Rapids
-Only Sanford
-Sioux Falls
-Minneapolis
-Grand Forks (5)
-Mayo AZ Abbott NW Minneapolis
16. Thinking about the hospital you use most frequently, what are the three most important reasons
for selecting that hospital?
-In Bagley, it is the lesser of 2 evils
-Physicians expertise
-County worker
-Privacy
-Preferred dr.
-Unsurpassed customer service including test and appt scheduling, Efficiency
17. If you or a household member needed to be hospitalized in the future, where would that hospital be
located?
-Altru Grand Forks (8)
-Bagley
-Depends on reason or specialty (7)
-Only Sanford
19. Where was that primary health care provider located?
-White Earth
-Sanford
-Naytah Waush
-Fertile (3)
-Clearbrook
-Fargo
-Grand Forks (2)
-319th med group GFAFR
20. Why did you select the primary care provider you are currently seeing?
-PA’s rep
-Used to live there
-He’s outstanding MD
-More knowledgeable willing to diagnose treat
69
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Community Health Needs Assessment
-Years with same dr.
-Prior experience with PA
-Seeing them for over 10 years
-History with clinic
-Natural approach, herbs, diet, mental health
-Professionalism of ALL staff
-My physician is there and records
-Because (specific provider) does not help me the way I need or care
-Like my Dr.
-Know dr.
21. If you routinely seek primary health care outside of Essentia Health Fosston, why?
-More opportunities/specialists in Bemidji; better access to Fargo specialists
-No gossip
-Referrals to Mayo & Sioux Falls
-Specialist
-Ob/gyn
-Special services
-Fosston care
-Never get to see your family dr.
-Quicker service
-Specialist in Fargo
-Do not need this care
-More natural/holistic approach
-We have no confidence in Fosston Essentia. Would never go there; experiences have always been bad;
made me worse
-Just moved to Fosston area from Grand Forks
22. If you needed primary care services in the future which facility would you choose?
-Minneapolis
-Fargo
-319th Med group
-Clearbrook
-Park Rapids
-Grand Forks
-Sanford
24. What type of health care specialist was seen?
70
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Community Health Needs Assessment
-Vascular surgeon
-Disease specialist
-Doctor
-Radiation
-Internal medicine
-Foot doctor (2)
-Cancer Dr.
-Hip replacement Bemidji
-Kidney specialist
-Surgeon (2)
-Back dr.
-Unsure of title, specializes in repetitive stress injuries
25. Where was the health care specialist seen?
-Twin Cities (2)
-Park Rapids (2)
-Rochester
-Mayo
-U of M (2)
-McIntosh MN (3)
-Minneapolis (3)
-Fargo (3)
-Altru Grand Forks (16)
-Sanford
-Red Lake Falls
-Minneapolis (2)
-Detroit Lakes
32. If you do NOT have health insurance, why?
-HIS
-Lost job; work comp
-Just taken off
-Don’t qualify
37. What is your employment status?
-Self employed (2)
-Food provider
-Daycare provider
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COMMENTS
-Getting rid of (a specific person) would do more for the Fosston hospital than all of the above. She is
despised and hated by all employees and has fired or forced out the most talented people because they are a
threat to her
-The receptionists are poor to assist with scheduling appointments
-Will not bring my family to EHF because of the way we were treated by (a specific person). We made a
formal complaint. The next time I was hospitalized she treated me and my family worse. I was afraid to talk
to anyone about it because it only made the care we received worse. We will never use this facility again
-If I was going to change health care facilities or move I would choose Fosston
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Appendix C- Focus Group Invitation and Questions
600 East Superior Street
· Suite 404
Duluth, Minnesota 55802
March 19, 2012
Dear Community Leader:
Please accept this invitation to participate in a focus group conducted by the National Rural
Health Resource Center on behalf of Essentia Health. Focus groups are an excellent way for
individuals to express their opinions in a candid and confidential environment. The goal of this
focus group is to assist Essentia Health in identifying strengths and needs of health services for
Fosston and the surrounding region.
This information will be used for strategic planning, grant applications, new programs and by
community groups interested in addressing health issues. This process was developed to maintain
quality health care to serve the continuing and future health and wellness needs of the region.
Participants for focus groups were identified as those living in the area that represents various
groups of health care consumers including community leaders, seniors, ministerial and health care
providers. Whether you or a family member are involved with local health care services or not, this
is your opportunity to help guide responsive, high quality local health services in the future.
We invite you to participate in the focus group scheduled for Thursday, April 12, 2012 from
7:30 am – 8:30 am for a light breakfast in the Education Meeting Room at Essentia Health
Fosston, 900 Hilligoss Blvd SE, Fosston, MN. Your identity is not part of the focus group report and
your individual responses will be kept confidential. Refreshments will be provided by Essentia
Health.
To confirm your attendance, please contact Kim at the National Rural Health Resource Center at 1800-997-6685, Ext. 0 or e-mail [email protected] by Friday, April 6, 2012. We look
forward to your participation. Thank you.
Sincerely,
Kami Norland, Community Specialist
73
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Community Health Needs Assessment
Focus Group Questions
The questions below are the types of questions that will be asked during this focus group. The purpose of
this focus group is to identify the strengths and needs of health services in the Fosston region. No
identifiable information will be disclosed in the report and the results will assist the medical center with
future care and planning.
1. In your opinion, what are some of the strengths of the health services available in Fosston
and the surrounding area?
2. In your opinion, what are some of the barriers of the health services available in Fosston and the
surrounding area?
3. How would you describe the availability and quality of care of health services available at the local
hospital and clinic?
4. What are some of the benefits of having health services available locally?
5. Why might people leave the community for health care?
6. What type of new health care services would you like to see available locally?
7. Do you have any additional comments or suggestions regarding local health services?
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Appendix D---Participants in the Essentia Health-Fosston CHNA
Cardiac Rehab patients
Name
AGNES, DEBORAH L
AGNES, ORLEAN J
ANDERSON, MAVIS E
ANDERSON, RUTH E
ARNESS, DUANE
ASSELIN, KARI A
BACHAND, CHARLES F
BALL, LOIS M
BALSTAD, CHARLES A
BALSTAD, JOHN C
BAUMANN, CARL
BENSEN, LARRY R
BENSON, EUGENE L
BJORNERUD, BETTY J
BRINKMAN, BARBARA C
BRINKMAN, JOYCE
BRINKMAN, NORDIN
CARLIN, GARY
CASKEY, KATHERINE O
DUFAULT, LUCILLE M
EKEBERG, VERNA A
ERICKSON, GORDON M
FORSBERG, RICKIE
FREDRICKSON, MARGARET
GRAY, ROY
HAMLIN, SHARON S
HANSON, DARRIN K
HANSON, NORMAN H
HEGGE, CLIFFORD G
HEMPHILL, IRENE M
HENDERSON, BARBARA E
HOLZKAMM, WILLIAM N
JENSEN, ROBERT
JENSEN, SHIRLEY
Address
309 N CORMONTON
AVE
309 N CORMONTON
AVE
224 N FOSS AVE
713 N GRANUM
15707 SANDY BEACH
RD
117 2ND ST NE
24059 275TH AVE SE
820 MARY AVE
42362 320TH AVE SE
27386 450TH ST SE
42378 405TH ST SE
104 HAGEN AVE APT 2
PO BOX 85
816 3RD ST NE
36073 400TH ST SE
425 RIVERSIDE NE
36073 400TH ST SE
417 6TH ST NE
PO BOX 43
409 8TH ST NE
705 2ND ST NE
14495 CABLE LAKE RD
33571 400TH AVE SE
1121 315TH AVE
17121 SANDYLANE SE
809 N WOODS AVE L30
36712 240TH AVE SE
36712 240TH AVE SE
37994 370TH AVE SE
618 3RD ST NE
406 3RD ST NE
117 2ND ST NE
827 N EATON
827 N EATON
75
City
State
Zip code
FOSSTON
MN
56542
FOSSTON
FOSSTON
FOSSTON
MN
MN
MN
56542
56542
56542
MENTOR
FOSSTON
BROOKS
FOSSTON
FOSSTON
FOSSTON
BAGLEY
ERSKINE
MENTOR
FOSSTON
FOSSTON
MCINTOSH
FOSSTON
FOSSTON
FOSSTON
FOSSTON
FOSSTON
MENTOR
GULLY
LENGBY
MENTOR
FOSSTON
MCINTOSH
MCINTOSH
FOSSTON
FOSSTON
FOSSTON
FOSSTON
FOSSTON
FOSSTON
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
56736
56542
56715
56542
56542
56542
56621
56535
56736
56542
56542
56556
56542
56542
56542
56542
56542
56736
56646
56651
56736
56542
56556
56556
56542
56542
56542
56542
56542
56542
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
JOHNSON, JEROME C
JOHNSON, ROBERT A
JORE, KENNETH C
KROGSTAD, BLANCHARD
KROGSTAD, DORIS V
LAFRINIERE, CECELIA
LANE, MARY KAY
LARSON, KENNETH A
LEE, ROBERT J
LEPIER, DOROTHYMAE E
MIENERT, BEATRICE C
MILLER, NANCY C
MYHRUM, BETTY L
MYHRUM, RANDOLPH E
OLSON, DUANE G
OSTGARDEN, LOIS M
PAQUIN, RICHARD
REIERSON, ILENE
RICKETTS, MARY J
RINGSTAD, DELORIS A
SANDSMARK, RICHARD A
SCHLEICHER, LLOYD B
SIEDSCHLAG, MARJORIE
SISTAD, ILENE I
SIVERSON, AUDREY E
SLOUGH, GERALD O
SOMDALEN, DELORIS
STARK, DENISE A
SWANSON, GERALD T
TROGSTAD, HAZEL
VENNES, MERLIENE
VOTAVA, EILEEN
VOTAVA, JAMES
WINKLER, MARY
WOLD, VERNON
103 S AMBER APT 103
11248 398TH ST
130 JACKSON AVE.
25894 430TH ST SE
25894 430TH ST SE
PO BOX 403
315 9TH ST NW
612 E 1ST ST
PO BOX 27
821 MARY AVE
34310 370TH ST SE
707 1ST ST E
5 E MONTANA APT 105
621 5TH ST NE
35309 390TH AVE SE
512 3RD ST NE
PO BOX 206
42602 300TH AVE SE
335 LARSON AVE N
217 KAISER AVE N
13586 ISLAND LK DR W
32487 267TH AVE SE
407 9TH ST NW
36917 395TH ST SE
412 N JOHNSON
913 5TH ST NE
1013 300TH AVE
645 CLEVELAND AVE
SW
525 CLEVELAND AVE
SW
37942 395TH ST SE
38993 325TH AVE SE
24202 350TH ST SE
24202 350TH ST SE
106 N JOHNSON
36769 300TH ST SE
76
FOSSTON
BAGLEY
MCINTOSH
WINGER
WINGER
BAGLEY
FOSSTON
FOSSTON
MCINTOSH
FOSSTON
FOSSTON
FOSSTON
WINGER
FOSSTON
FOSSTON
FOSSTON
MENTOR
FOSSTON
FOSSTON
FOSSTON
LENGBY
MCINTOSH
FOSSTON
FOSSTON
FOSSTON
FOSSTON
LENGBY
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
56542
56621
56556
56592
56592
56621
56542
56542
56556
56542
56542
56542
56592
56542
56542
56542
56736
56542
56542
56542
56651
56556
56542
56542
56542
56542
56651
MCINTOSH
MN
56556
MCINTOSH
FOSSTON
FOSSTON
MCINTOSH
MCINTOSH
FOSSTON
TRAIL
MN
MN
MN
MN
MN
MN
MN
56556
56542
56542
56556
56556
56542
56684
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
SPECIAL POPULATIONS
Amish population
Eli Troyer
41334 240th Ave SE
John and Susie Borntrager County Road 7
Winger
Gonvick
MN
MN
56592
56644
Erskine
Erskine
Fosston
MN
MN
MN
56535
56535
56542
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
MN
MN
MN
MN
MN
MN
MN
MN
MN
56542
56542
56542
56542
56542
56542
56542
56542
56542
Fosston
Fosston
Fosston
Fosston
Fosston
MN
MN
MN
MN
MN
56542
56542
56542
56542
56542
Erskine
Gully
MN
MN
56535
56646
Russian Orthodox
Stephan Kutsef
Marina Semerikove
Luba Avgi
Senior Members list
Eunice Reinbold
Carol Wold
Wayne Omundson
Mary Griffin
Marvol Beaumont
Mildred Beckstrom
Mildred Folstrom
Lynette Miller
Richard Miller
Donna Miller
Harvey Johnson
Lavine Johnson
Jan Olson
Fosston DAC
Gail Pearce
Marilyn Malmanger
21687 380th Street
SE
7321 Vance Ave
40926 370th Ave SE
217 N Omland Ave
710 N Eaton Ave
606 1st Street E
103 S Amber Ave
40317 350th Ave SE
216 3rd St NW
347 N Larson Ave
404 N Johnson Ave
404 N Johnson Ave
409 N Cormontan
Ave
103 S Amber Ave
103 S Amber Ave
718 3rd Street NE
326 Mark Ave N
20647 Duerr Circle
SE
35444 370th Ave SE
77
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
BUSINESS OWNERS
A & W Drive In
Ace Hardware
American Federal Bank
Anytime Fitness
Brouse, Woodke and Meyer
Carco Tire One Auto Services
Carlin Hoialment Feneral Home
Carlin Hoialment Feneral Home
Cutting Edge
Dairy Queen
Dollar Store Plus
East Polk County Heritage Center
Embassey Community Center
First National Bank
Fosston Theatre
Hair Special T's
Hair Talk
Homark Homes
Juve Real Estate - United Country
K's Variety
LePiers
Manecke Heating and Cooling
Millers Building Center
Minnesota Dehydrated Vegetables Inc.
Mirault's Home Furnishing
Murphy Flooring
Palubick's Foods and Deli
Prairie Pet Clinic
Sollie Realty Inc
Steve's Auto Parts
Super 8 Motel
Kay Balstad
Mark Burggraf
Dan Paulson
Mona Nelson
Mike Brouse
Dustin Carlson
John Carlin
Tim Carlin
Wendy Smeby
Tom Halland
Amy Brinkman
Wayne Holt
Norma Quam
Tom Senger
Bob Moore
Tina Olson
Susan Johnson
Kelly Viken
Mark Juve
Kay Balstad
Larry LePier
Jesse Manecke
Richard Miller
Jim Noyes
Greg Mirault
Bruce Murphy
Leah Hemmingson
Woody Enerson
Larry and Carol
Sollie
Steve Godtland
Bob Saeter
Ultima Bank Minnesota
Generations Clothing
Sun Opta
Fosston Co-op Seed Plant
13 Towns
Ventures Bar and Grill
Mark Finstad
Ray Miller
Virginia Essig
Bob Olson
Karla Anderson
Jesse Manecke
78
506 1st Street W
306 E 1st Street
209 Johnson Ave N
903 Hilligoss Blvd SE
108 W 1st Street
204 E 1st Street
417 6th street NE
417 6th street NE
604 6th Street NE
411 1st Street E
102 Kaiser Ave S
326 Mark Ave N
603 3rd Street NE
124 W 1st
105 1st Street W
903 Hilligoss Blvd SE
207 N Johnson Ave
Highway 2 East
118 Johnson Ave N
110 E 1st Street
320 E 1st Street
615 2nd Street NE
201 N Kaiser Ave PO Box 270
915 Omland Ave N
112 Kaiser Ave N
104 E 1st
107 N Kaiser Ave
124 Johnson Ave N
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
609 Hilligoss Blvd E
102 Kaiser Ave S Suite 1
Hwy 2 E 108 S Amber Ave
603 Hilligoss Blvd E PO Box
299
114 W 1st St
710 W 1st St, PO Box 27
217 S Kaiser
118 Johnson Ave N
104 Amber Ave S
Fosston
Fosston
Fosston
MN
MN
MN
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
MN
MN
MN
MN
MN
MN
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Maple Ridge
Linda Nelson
MINESTEREAL AND HEALTH
PROVIDERS
Vernes Church and Our Saviors
Lutheran Church
New Journey Church
Bethel Assembly
Calvary Free Lutheran Church
Kingo Lutheran Church
First English Lutheran Church
Hope Lutheran Church
Poplar Lake Lutheran Church
United Methodist Church
St. Mary's Catholic Church
Oak Park Lutheran Church
Rodnes Church
St. Francis Catholic Church
Saron Lutheran Church
Salem Lutheran Church
Grace Lutheran
Rev. Ryan Rasmussen
Rev. Skip Hanson
Rev. Jon Marx
Rev. Allen Arneson
Rev. John Dalen
Rev. Dean Bell
Rev. Paul Maggelson
Rev. John Anderson
Rev. Michelle Miller
Father Dave Super
Rev. Joseph Johnson
Rev. Peter Satren
Father Chuck Huck
Cornerstone Residence
Fosston Chiropractic
Fosston Family Dental
Fosston Family Dental
Marquis Mitchell DC Chiropractor
Nord's Pharmacy
Northwest Eye Clinic
Family Dentistry
Win-E-Mac Dental
Kari Swanson
Gabe Wiener, DC
Kurt Albright, DDS
Erica Nelson, DDS
Mitchell Marquis
John Nord
Bradley Neujahr
Roger Sjulson DDS
Steven Lesmeister, DDS
McIntosh Senior Living
Sharlene Knutsen
Pioneer Memorial Care Center
Poplar Meadows
The Country Place
Polk County Nursing Services
Polk County Public Health
Freedom Living Center
Melissa Chisholm
Carol Larson
Sheila Lee, RN
Jill Sonstelie
Sarah Reese
Danielle Paradis
Rev. Margaret Jacobus
Rev. Tim Lundeen
79
105 N Johnson Ave
145 State Stret NE
503 9th Street NW
PO Box 280
910 6th Street
220 N Johnson Ave
418 N Granum
508 N Foss Ave
406 2nd Street NE
725 6th NE
13478 330th Ave SE
35473 180th Ave SE
301 Governor Street
30306 220 Ave SE
29531 180th Ave SE
332 Vance Ave
115 1st Street E
104 N Johnson Ave
201 Hillestad Ave N
201 Hillestad Ave N
106 W 1st Street
115 N. Johnson Ave
111 2nd NE
109 N Johnson Ave
105 2nd St SW
600 NE Riverside
Ave
23028 347th Street
SE
325 Scots Ave SE
Hw 59 and 2
PO Box 334
721 Minnesota St S
306 Toupin Streett
Fosston
McIntosh
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Oklee
Erskine
Oklee
Erskine
Oklee
Erskine
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
McIntosh
MN
MN
MN
MN
MN
MN
MN
MN
MN
McIntosh
MN
Erskine
McIntosh
Erskine
McIntosh
Crookston
Oklee
MN
MN
MN
MN
MN
MN
MN
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Appendix E--- Existing Healthcare Facilities and Other Resources within the Community Available to Meet the Community
Health Needs Identified Through the CHNA
Address
Town
State
Hospitals
Altru Hospital
Essentia Health Fosston
Mahnomen Health Center
Riverview Health
Sanford Bagley Medical Center
Sanford Thief River Falls Medical Center
1200 S. Columbia Rd
900 Hilligoss Blvd SE
414 West Jefferson
323 S. Minnesota St.
203 4th St NW
120 Labree Ave S.
Grand Forks
Fosston
Mahnomen
Crookston
Bagley
Thief River Falls
ND
MN
MN
MN
MN
MN
58201
56542
56557
56716
56621
56701
701-780-5000
218-435-1133
218-935-2511
218-281-9200
218-694-6501
218-681-4240
Clinics
Altru Care
Altru Main Clinic
Altru Clinic Crookston
Altru Clinic Erskine
Altru Clinic Fertile
Altru Clinic Red Lake Falls
Chiropractic Health Clinic
Essentia Health Fosston
Essentia Health Bagley
Essentia Health Erskine
Essentia Health Oklee
Riverview Clinics Crookston
Riverview Clinics Fertile
Riverview Clinics Red Lake Falls
HWY 32 S.
1000 S Columbia Rd
400 S Minnesota St.
23076 347th St. SE
Mills St. & Main
312 International Dr.
106 W. 1st St.
900 Hilligoss Blvd. SE
121 Central St.
101 Vance Ave
Governor St. & 3rd Ave
323 S. Minnesota St.
306 Mill St.
Park Place Mall
Thief River Falls
Grand Forks
Crookston
Erskine
Fertile
Red Lake Falls
Fosston
Fosston
Bagley
Erskine
Oklee
Crookston
Fertile
Red Lake Falls
MN
ND
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
MN
56701
58201
56716
56535
56540
56750
56542
56542
56621
56535
56742
56716
56540
56750
218-681-2225
701-780-6000
218-281-9100
218-687-5317
218-945-6064
218-253-4343
218-435-6066
218-435-1212
218-694-6281
218-687-2051
218-796-4525
218-281-9200
218-945-6695
218-253-4606
80
Zip
Phone
Essentia-Fosston, Fosston, MN
Community Health Needs Assessment
Riverview Clinics East Grand Forks
Sanford Helath Mahnomen Clinic
Sanford Thief River Falls
Sanford Bagley Clearbrook Clinic
Sanford Bagley Clinic
1428 Central Ave NE
410 W.4th St.
1720 Hwy 59 S.
22 Elm St.
123 4th St. NW
East Grand Forks
Mahnomen
Thief River Falls
Clearbrook
Bagley
MN
MN
MN
MN
MN
56721
56557
56701
56634
56621
Dentists
Albright & Nelson Dental Clinic
Sandwick Orthodontics
Sjulson Family Dentistry
201 Hillestad Ave N
418 1st St. West
109 N Johnson Ave
Fosston
Fosston
Fosston
MN
MN
MN
56542 218-435-1717
56542 218-435-7263
56542 218-435-1599
Churches
Baptist Church Fosston
Bethel Assembly Church
Calvary Free Lutheran Church
First English Lutheran Church
Fosston United Methodist Church
Hope Lutheran Church
Kingo Lutheran Church
Poplar Lake Lutheran Church
St. Mary's Church Parish
505 9th St. NW
34647 410th St. SE
910 6th St NE
418 N Granum
406 2nd St. NE
508 N Foss Ave
220 N Johnson Ave
43261 380th Ave SE
725 6th NE
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
Fosston
MN
MN
MN
MN
MN
MN
MN
MN
MN
56542
56542
56542
56542
56542
56542
56542
56542
56542
Polk County Public Health
PO Box 403
Crookston
MN
56712 218-281-3385
Polk County Social Services
104 N Kaiser Ave
Fosston
MN
56542 218-435-1585
Northwest Regional Development Commission
115 South Main, Suite 1
Warren
MN
56762 1-800-333-2433
81
218-773-1390
218-935-2514
218-681-4747
218-776-3124
218-694-2384
218-435-6338
218-435-1252
218-435-1590
218-435-6263
218-435-6906
218-435-6765
218-435-6331
218-668-2288
218-435-6484