Community Health Needs Assessment 2012 - Saint Joseph Hospital

Community Health Needs 

Assessment 

FY 2013

Community Health Needs Assessment 2013 

Contents 

Introduction ...........................................................................................................................1 

Executive Summary .................................................................................................................... 1 

Organization Description ........................................................................................................... 3 

How the Assessment was Conducted...................................................................................6 

Community Served by the Hospital ....................................................................................7 

Identification and Description of Geographical Community .................................................. 7 

Defined Community or Service Area ......................................................................................... 7 

Community Population and Demographics ............................................................................. 10 

Socioeconomic Characteristics of the Community ................................................................. 11 

Income, Poverty and Unemployment .................................................................................. 11 

Uninsured Status ................................................................................................................. 12 

Education............................................................................................................................. 12 

Community Health Care Resources ........................................................................................ 14 

Hospitals .............................................................................................................................. 14 

Ambulatory Care Clinics ..................................................................................................... 15 

Other Licensed Facilities ..................................................................................................... 15 

Health Departments ............................................................................................................. 15 

Health Status of the Community .......................................................................................16 

Leading Causes of Death .......................................................................................................... 17 

Primary Health Conditions Responsible for Inpatient Hospitalization ............................... 18 

Health Outcomes and Factors............................................................................................ 19 

Health Statistics and Rankings ................................................................................................ 19 

Primary Data .......................................................................................................................22 

Community Input-Surveys ....................................................................................................... 22 

Community Input-Focus Group and Interview Results ........................................................ 27 

Key Themes Provided Through Participant Comments ...................................................... 29 

Health Issues of Uninsured Persons, Low-Income Persons 

and Minority Groups .................................................................................................... 29


Contents (continued) 

Children at Risk................................................................................................................... 31 



Violence in the Community ...................................................................................................... 32 

Priority Community Health Needs Identified ..................................................................33 

Appendices ..................................................................................................................................... 37 

Appendix A: Saint Joseph Berea CHNA Advisory Committees 

Appendix B: CHNA Timeline 

Appendix C: Saint Joseph Berea CHNA Survey Tool 

Appendix D: Summary of SJB CHNA Survey, Focus Groups and Interview Results 

Appendix E: CHNA Community Analysis and Evaluation Meeting 

Appendix F: Acknowledgements – May need to put steering committee here 

Appendix G: Sources


Introduction 

During 2012, a community health needs assessment was conducted by Saint Joseph Berea to support its 

mission to enhance the health of people in the communities it serves, to comply with the Patient Protection 

and Affordable Care Act of 2010 and federal tax-exemption requirements, and to identify health needs of 

the community to help prioritize the allocation of hospital resources to meet those needs. Based on current 

literature and other guidance from the Treasury and IRS, the following steps were completed as part of the 

community health needs assessment: 

The ―community‖ served by was defined utilizing inpatient and outpatient data on patient origin. 

This process is further described in Community Served by the Hospital. 

Population demographics and socioeconomic characteristics of the community were gathered and 

reported using various sources (See Appendix G). The health status of the community was then 

reviewed. Information on the leading causes of death and morbidity information was analyzed in 

conjunction with health outcomes and factors reported for the community by CountyHealthrankings.org. 

Health factors with significant opportunity for improvement were noted. 

An inventory of health care facilities and resources was prepared. 

Through a collaborative process conducted by Saint Joseph Berea with the Madison County 

Health Department, the Kentucky Hospital Association and the University of Kentucky, community 

input was obtained through a community survey, a series of six focus groups and six key informant 

interviews.. 

Information gathered in the steps above was analyzed and reviewed to identify health issues of uninsured 

persons, low-income persons and minority groups and the community as a whole. Health needs were prioritized 

utilizing a method that weighs: 1) the ability to evaluate outcomes; 2) the size of the problem; 3) 

the seriousness of the problem; 4) prevalence of common themes; 5) how closely the need aligns with the 

strategies and strengths of the hospital and KentuckyOne Health; and 6) an evaluation of existing hospital 

programs responding to the identified need. Information gaps were identified during the prioritization 

process and reported. 

Executive Summary 

Saint Joseph Berea conducted the required Community Health Needs Assessment in FY12 –FY13 to further 

assist the hospital in understanding the health needs of the community and how it can address those 

needs, recognizing that some things are beyond its capacity. The hospital worked in collaboration with the 

Madison County Health Department, local businesses, community groups, churches, city and county agencies, 

local physicians and hospital leadership to fulfill the requirements of the assessment. Primary data 

made available through a health needs assessment survey, focus groups and key informant interviews was 

collected and compiled giving a perspective on what the community sees as primary health needs and 

possible solutions. Secondary data from local, state and federal sources was compiled from information on 

disease prevalence, health indicators, health equity and mortality. 

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Identified needs were prioritized utilizing a method that weighs: 1) the impact on vulnerable populations; 

2) the importance to the community; 3) the size of the problem; 4) the seriousness of the problem; 5) prevalence 

of common themes; 6) how closely the need aligns with the strategies and strengths of the hospital 

and KentuckyOne Health; and 7) an evaluation of existing hospital programs responding to the identified 

need. by a community advisory group and given to the hospital steering committee for review. Once the 

primary health issues in the community were identified, Saint Joseph Berea went through the process of 

grouping and identifying the health priorities to be addressed. 

The top five priorities include: 

o Mental health – including, but not limited to alcohol/drug abuse, depression/anxiety, mental/behavioral 

health problems, suicide… 

o Obesity – specifically, nutrition and physical activity… 

o Cardiopulmonary – heart disease/stroke, high blood pressure, pulmonary… 

o Senior issues – physical issues connected with aging, Alzheimer’s/dementia, resources… 

o Collaboration of care - pulling community resources/groups together to address common health issues 

and concerns… 

Saint Joseph Berea is grateful to the community members who collaborated with us in completing this 

community health needs assessment. This is an active community that truly wants to better the health of 

those who live here. 

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Organization Description 

Saint Joseph Berea, formerly Berea Hospital, began in 1898, as an eight-bed cottage on the Berea College 

campus in Berea, Kentucky. Now a 25-bed facility, Saint Joseph - Berea provides health care to residents 

in Madison, Jackson, Rockcastle and Garrard Counties. Berea is located in Madison County and according 

to the 2012 County Health Rankings, it is the 20 th healthiest county of Kentucky’s 120 counties. On April 

1, 2003, Berea Hospital joined Catholic Health Initiatives, one of the largest Catholic health care systems 

in the U.S. In November of 2005, the hospital consolidated with Saint Joseph HealthCare Kentucky (becoming 

Saint Joseph Health System in Lexington in 2007), taking a new name – Saint Joseph Berea. And 

in December 2011, Saint Joseph Health System became part of KentuckyOne Health, maintaining the 

Catholic legacy and original mission of the hospital to bring quality health care to the Appalachian communities 

that it serves regardless of their race, creed or ability to pay. 

Saint Joseph Berea is a critical access hospital, which serves over 19,000 families. The hospital is known 

for providing excellence of care while utilizing advanced medical technology in a friendly, family-like atmosphere. 

Competence, commitment and dedication are the hallmarks of Saint Joseph Berea, which is licensed 

by The Joint Commission on Accreditation of Healthcare Organizations and the Kentucky Cabinet 

of Health Services. Memberships in the American and 

Kentucky Hospital Associations are also held. Since joining 

the Catholic Health Initiatives (CHI) system, Saint 

Joseph Berea has adopted CHI’s mission and core values. 

With a full complement of inpatient and outpatient services, 

Saint Joseph Berea is committed to providing the 

highest quality of care at a reasonable cost in a personal 

and compassionate family-oriented environment. Through 

provision of a broad range of hospital and community 

services Saint Joseph Berea works with an extensive 

medical staff of primary care physicians and specialists to 

deliver services and programs that embrace superior value 

and integrity. 

Services include a fully staffed 24 hour emergency department that treats more than 22,000 patients a year. 

The emergency department also trains for disaster preparedness annually with the federal governments 

Chemical Stockpile Emergency Preparedness Program (CSEPP) and has a 24/7 Sexual Assault Nurse Examiner 

(SANE) program. Services also include acute and intensive care; general surgery; outpatient surgical 

services; physical, occupational and speech therapy; diabetes treatment; diagnostic services including 

MRI, radiology and nuclear medicine; outpatient laboratory; cardiopulmonary services, and oncology services. 

Specialty clinics include services in cardiology, gynecology, neurology, psychology, orthopedics, 

oncology, ophthalmology, pulmonary, ENT/Hearing Tests, podiatry and cardiothoracic surgery. 

Special departments of the hospital are Berea Family Medicine (a designated rural health care clinic), 

Breast Center, Berea Specialty Clinic, Diabetes and Nutrition Center, Cardiovascular Services through the 

Saint Joseph Berea Heart Institute, Senior Renewal Center, Sleep Wellness Center, Surgical Services, Pain 

Management Clinic, MedWorks and Wound Care Center. 

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Community involvement and partnerships are very important to Saint Joseph Berea. The hospital has a 

close relationship with the Madison County Health Department, local government, businesses, civic organizations, 

educational systems and community agencies. This includes Bowl for Kids’ Sake, Relay for Life, 

A Day of Hope, hosting the Berea Farmers’ Market, Spoonbread Festival, blood drives, medical screenings 

and health fairs. Lights for Life is a community and employee supported program that provides prescription 

assistance and other medical supplies if there is a need when they are discharged from the hospital. 

Henrietta Childs fund provides assistance for uninsured Berea residents who need to have a small procedure 

but do not have the means to pay. Each year the hospital hosts Get Healthy Berea, an event coordinated 

with local schools and businesses to promote health and wellness. Medical staff volunteers for 

Surgery on Sunday, a program for patients who do not have insurance or the means to pay for needed surgical 

procedures. All medical staff volunteer their time for this program. It is also a clinical site for Eastern 

Kentucky University, Somerset, University of Kentucky and Berea College for students who need clinical 

hours in a variety of medical professions including Nursing, Emergency Room, Health Information, Pharmacy, 

Pulmonary, Lab and Radiology. 

Another important community relationship is the volunteer services provided at Saint Joseph Berea. The 

volunteers not only run the gift shop, greet visitors, provide information and assist as needed, they support 

hospital programs such as providing a gift bag to all oncology patients who come to their first chemotherapy 

treatment and providing items for the patient clothing closet. Two large projects they have helped us 

with includes paying to seal and re-stripe the front parking lot to promote safety for visitors and purchasing 

a Cholestech machine that will enable us to provide more thorough community health screenings. 

Saint Joseph Berea Hospital is part of KentuckyOne Health, the largest health system in Kentucky with 

more than 200 locations including hospitals, outpatient facilities and physician offices, and more than 

3,100 licensed beds. An 18-member volunteer board of directors governs KentuckyOne Health, its facilities 

and operations, including Saint Joseph Berea Hospital, with this mission: 

Our Purpose 

To bring wellness, healing and hope to all, including the underserved. 

Our Future 

To transform the health of communities, care delivery and health care professions so that individuals and 

families can enjoy the best of health and wellbeing. 

Our Values 

Reverence: Respecting those we serve and those who serve. 

Integrity: Doing the right things in the right way for the right reason. 

Compassion: Sharing in others’ joys and sorrows. 

Excellence: Living up to the highest standards. 

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How the Assessment was Conducted 

Saint Joseph Berea collaborated with the Madison County Health Department, the Kentucky Hospital Association 

and local community groups to conduct the Community Health Needs Assessment (CHNA). An 

advisory committee consisting of representatives from the Madison County Health Department, Berea College, 

Senior Citizens, HeadStart, Union Church, St. Clare’s Catholic Church, Madison County Schools, 

Berea Police Department, White House Clinic and hospital leadership and staff began meeting in January 

2012 to decide how the assessment would be conducted and what it would consist of. See Appendix B for 

CHNA Timeline. 

Once the primary service area was determined a survey was sent to random households inviting individuals 

to complete and return to Saint Joseph Berea. The survey covered a broad range of topics from access 

to health care to perception about the most pressing health care needs and recommendations. The survey 

was also available online. It was available in English and Spanish. The survey was conducted from September 

1 – November 9, 2012. There were a total of 949 respondents. No one responded in Spanish. 74% 

were from Madison County: 43% of which were from Berea and 29% from Richmond, 8% from Jackson 

County, 6% from Rockcastle County and 6% from Garrard County. The majority of the respondents were 

female (67%). The most responses were from the 65+ (31%) age group; second, 40-54 (26%); third was 

55-64 (25%) and the under 26 groups were 18%. The majority of respondents were Caucasian (96%). Only 

3% were African American; 1% was Native American; less than 1% was Hispanic; 1% was of other ethnicities. 

The information on race closely corresponds to that of Madison County (2011 MCCHIP). See Appendix 

C for Survey Tool. 

Six focus groups were conducted with different community groups to seek their input on the health care 

needs of the community. 

Senior Citizen Advisory Group 

Berea Head Start Center with parents and administrator 

Shannon Johnson Elementary Teachers 

St Joseph Berea employees/volunteers 

First Responders group with EMS, Fire and Police departments 

Farristown Baptist Church event with community members 

There was a total of 61 participants plus facilitators. The focus groups were held from October 3 through 

November 16.The groups represented a broad spectrum of the community including African American, 

business, first responders, religious community, education, lower income, various age groups, caregivers 

and those with medical needs. 

Six interviews were conducted with physicians, community leaders, business and community members. 

We thought this would be a more personal approach. The responses were similar to the focus groups but 

with a little more detail. See Appendix D for survey, focus group and interview questions and results. 

In addition, secondary data from local, state and federal sources was compiled from demographic and socioeconomic 

sources from information on disease prevalence, health indicators, health equity and mortality. 

Identified needs were prioritized through that process and presented to hospital administration for 

review. 

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Community Served by the Hospital 

Identification and Description of Geographical Community 

Berea, population 13,561 (2010), is located in Madison County, Kentucky. Berea is only 40 miles south of 

Lexington, KY and 15 miles from Richmond, KY. Incorporated in 1890, Berea was named in 1854 by 

Rev. John Fee for the town mentioned in Acts 17:10 where the inhabitants ―received the word with all eagerness‖ 

and at that time opposed slavery (in a slave state); a commitment which has evolved today into 

broad support for human equality. The town is known for Berea College, with its commitment to interracial 

co-education and service to the Appalachian Region. Berea is the ―Folk Arts and Crafts Capital of 

Kentucky- Where Art’s Alive.‖ Berea hosts the headquarters of the Kentucky Guild of Artists and 

Craftsmen-50 years old in 2011, the Kentucky Artisan Center, along with a colony of studio artists; its employment 

base includes over 3,500 jobs in manufacturing. Berea has a pedestrian-friendly culture supported 

by miles of bike trails, sidewalks and regularly held 5K-walks and 10K-runs. 

Madison County’s population density is just over 187 people per square mile. A little more than half of the 

residents can be found in Richmond (31,364 residents), which is the county seat, and in Berea (13,561) 

with approximately 38,000 living in many of Madison County’s unincorporated communities including 

Waco, paint Lick, Boonesboro, Bighill, Bybee, Kirksville, Round Hill, Union City and Valley View or in 

the more rural farming areas. 

Interstate 75 bisects Madison County from North to South, running through Richmond and Berea. Berea is 

located 33 miles south of Lexington (second largest city in Kentucky), 114 miles south of Louisville (largest 

city in Kentucky), 119 miles south of Cincinnati, Ohio and 134 miles north of Knoxville, Tennessee. 

Interstate 75 brings travelers to the community of Berea because of its cultural contributions. The interstate 

also brings travelers to Saint Joseph Berea who fall ill or are in accidents while passing through the area. 

(http://bereaky.gov/for-visitors/community-profile)/ 

Defined Community or Service Area 

A community is defined as the geographic area from which a significant number of the patients utilizing 

hospital services reside. While the community health needs assessment considers other types of health 

care providers, hospitals are the single largest provider of acute care services. For this reason, the utilization 

of hospital services provides the clearest definition of the community. 

Saint Joseph Berea primary service area was identified based on the patient origin of inpatient discharges 

by zip code from July 1, 2011 to June 30, 2012 (See Exhibit 1). Saint Joseph Berea defines its community 

for this community health needs assessment based on where the majority of its inpatients reside. It is 

followed by a map showing Saint Joseph Berea’s geographic location and the footprint of Saint Joseph 

Berea primary service area identified in Exhibit 1 which includes Madison, Jackson, Rockcastle and Garrard 

Counties. A demographic snapshot for these zip codes is provided in Exhibit 2 and displays the hospital’s 

defined primary service area, identifies the zip codes that comprise this community, and illustrates 

its geographic relationship to surrounding counties. 

When specific information is not available by zip code, this community health needs assessment relies on 

county-level data. 

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Because over 63 percent of Saint Joseph Berea’s discharges originate in Madison County, it collaborated 

with the Madison County Health Department in conducting its community health needs assessment. 

Jackson, Rockcastle and Garrard Counties are also served by served by Saint Joseph Berea but in a much 

smaller capacity. 

Exhibit 1 

Saint Joseph Berea CHNA Community 

Summary of Inpatient Discharges by Zip Code (Descending Order) 

7/1/11 – 6/30/12 

Zip Code City County Discharges 

% of Total Discharges 

40403 Berea Madison 625 51.1% 

40447 McKee Jackson 172 14.1% 

40456 Mt. Vernon Rockcastle 66 5.4% 

40461 Paint Lick Garrard 59 4.8% 

40475 Richmond Madison 126 10.3% 

40481 Sandgap Jackson 38 3.1% 

The Community Needs Index (CNI) identifies the severity of health disparity for every zip code in the 

United States and demonstrates the link between community need, access to care, and preventable hospitalizations. 

The CNI uses research, literature and experiential evidence to identify top five prominent barriers 

that enables them to quantify health care access in communities across the nation. These barriers include 

those related to income, culture/language, education, insurance, and housing. Using this data a score is assigned 

to each barrier condition (with 1 representing less community need and 5 representing more community 

need). The scores are then aggregated and averaged for a final CNI score (each barrier receives 

equal weight in the average). A score of 1.0 indicates a zip code with the lowest socio-economic barriers, 

while a score of 5.0 represents a zip code with the most socio-economic barriers. 

The CNI for Saint Joseph Berea’s service area is presented in Exhibit 2 on the following page. 

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Exhibit 2 


CNI Health Disparities 

Source: http://www.dignityhealth.org/Who_We_Are/Community_Health/212401 

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Community Population and Demographics 

Saint Joseph Berea’s primary service area is comprised of four counties: Madison, Jackson, Rockcastle and 

Garrard, but since approximately 63% of the hospital’s discharges come from Madison County, our focus 

for this report will be on Madison County. Exhibit 3 shows demographics and socioeconomic characteristics 

of Saint Joseph Berea’s primary service area for the most recent period available. 

Madison County is one of Kentucky’s fastest growing areas. According to the 2010 US Census, the population 

of Madison County was 82,916, a 17% increase over its 2000 population count. Berea is the third 

fastest growing city in Kentucky at a rate of 34.3%. This has brought additional housing, industries and 

businesses, schools, and expanded community resources. Interstate 75, crossing through the county from 

north to south (see above map), influenced the growth of the county. Interstate accessibility provided opportunities 

both in and out of the county for labor, shopping, and access to additional services not available 

locally. 

Exhibit 3 


2012 Demographic Snapshot 

DEMOGRAPHIC CHARACTERISTICS 

Madison County Kentucky USA 

Number % of Total Number % of Total Number % of Total 

Total Population 82,916 100% 4,339,367 100% 308,745,538 

100% 

2010 Population 

Total Male Population 40,264 49% 2,134,952 42.9% 151,902,805 49.2% 

Total Female Population 42,652 51% 2,204,415 50.8% 156,842,733 

50.8% 

2000 Population 82,916 100% 4,042,288 100% 

Population, %age Change, 

2000-2010 

17% 7.4% 

Percent of Population that 

is Older than 64 years 

8.8% 13.3% 12.9% 

Median Household Income $38,596 $42,248 $52,762 

U.S. Census Bureau American Fact Finder 

AGE DISTRIBUTION 


Age Group Number % of Total Number % of Total Number % of Total 

0-4 years 5,069 6.1% 290,407 6.7% 20,201,362 6.5% 

5-19 years 17,116 20.6% 850,736 19.7% 63,066,194 20.4% 

20-34 years 20,665 24.9% 867,398 20.1% 62,649,947 20.3% 

35-44 years 10,751 13.0% 584,865 13.6% 41,070,606 13.3% 

45-54 years 10,888 13.1% 636,992 14.8% 45,006,716 14.6% 

55-64 years 9,115 11.0% 513,381 11.9% 36,482,729 11.8% 

65+ years 9,312 11.2% 570,334 13.2% 40,267,984 13.0% 

Total 82,916 99.9% 4,314,113 100% 308,745,538 99.9% 


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The 65+ year age group is becoming the fastest growing age group as Baby Boomers age. This brings 

with it a whole other set of issues in areas, such as Madison County, where a number of retirees haven 

chosen to relocate. 

POPULATION DISTRIBUTION – RACE/ETHNICITY 


Number % of Total Number % of Total Number % of Total 

White 74,967 90.4% 3,809,537 87.8% 223,553,265 72.4% 

African-American 3,565 4.3% 337,520 7.8% 38,929,319 12.6% 

Hispanic/Latino 1,813 2.2% 132,836 3.1% 50,477,594 16.3% 

American Indian/Alaska Native 

225 0.3% 10,120 0.2% 2,932,248 0.9% 

Two or More Races 1,447 1.7% 75,208 1.7% 9,009,073 2.9% 

Asian 753 0.9% 48,930 1.1% 14,674,252 4.8% 

Some Other Race Alone 116 0.1% 55,551 1.3% 19,107,368 6.2% 

Native Hawaiian/Pacific Islander 

30 0.0% 2,501 0.1% 540,013 0.2% 


HOUSEHOLD INCOME DISTRIBUTION 


Household Income Number 

% of Totatatal 

% of To- 

% of To- 

Number 

Number 


Exhibit 4 


Median Household Income, Poverty and Unemployment Rates of Community 

2007-2011 Data 

Garrard 

County 

Jackson 

County 

Madison 

County 

Rockcastle 

County 

Kentucky 

U.S. 

Median Household Income $40,137 $21,448 $41,876 $26,967 $42,248 $52,762 

Population in Poverty 20.9% 35.6% 20.3% 29.2% 18.1% 14.3% 

Unemployment Rate 10.3% 16.2% 7.7% 11.7% 9.5% 8.9% 

U.S. Census Bureau & Bureau of Labor Statistics 

Median household income below 2012 Federal Poverty Level ($23,050) for a family of two adults and two children. 

Uninsured Status 

Exhibit 5 


Health Insurance coverage Status by Age (Under 65 Years) and Income 

(at or Below 400%) of Poverty 2010 

All Income Levels 

At or Below 400% of FPL 

Under 65 Percent Under 65 Percent Under 65 Percent Under 65 Percent 

County Uninsured Uninsured Insured Insured Uninsured Uninsured Insured Insured 

Garrard 3,118 21.7% 11,231 78.3% 2,849 25.8% 8,185 74.2% 

Jackson 2,386 20.6% 9,203 79.4% 2,258 22.5% 7,774 77.5% 

Madison 12,898 18.9% 55,248 81.1% 11,755 24.1% 36,946 75.9% 

Rockcastle 3,010 21.0% 11,340 79.0% 2,333 23.2% 9,360 76.8% 

Kentucky 640,974 17.5% 3,012,207 82.5% 585,339 22.4% 2,032,203 77.6% 

Source: US Census Bureau 

Saint Joseph Berea community has more uninsured than both Kentucky and the US benchmark for uninsured. 

About one quarter of the community who is below poverty level is uninsured and without a means 

to pay for many of their medical expenses. 

Education 

The educational attainment of community residents may impact the local economy. Higher levels of 

education generally lead to higher wages, less unemployment and job stability. These factors may 

indirectly influence community health. Exhibit 6 provides a profile of Madison County Schools. 

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Exhibit 6 


Madison County Schools 

Grade Levels School System Programs 

K-12 

Madison County School District 

Berea Independent School District 

(Berea Community School) 

10 Elementary schools 

4 Middle Schools 

2 High Schools 

1 Semi-Private (Model Lab) 

1 Elementary 

1 M-iddle School 

1 High School 

Private Schools Bluegrass Christian K-12 

St Mark’s Catholic PK-5 

Colleges 

/Universities 

Berea College 

Eastern Kentucky University 

National College 

Liberal arts college that was established in 1855 and does 

not charge tuition. Students participate in a full work study 

program. It offers bachelor degree programs. There are 

approximately 1550 students from 44 states and 58 foreign 

countries. 70% of students come from Appalachia region of 

Kentucky. 

EKU offers more than 160 degree programs in associate, 

bachelors, masters and doctoral levels. The enrollment is 

over 16,500 including satellite campuses. 

A small Private two-year career college offering associate 

degrees and diplomas in health care, business, and other 

vocations. 

Exhibit 7 


Educational Attainment by County – Ages 25 and Over 

2005-2009 Estimate (ACS) 

High School 

Diploma, GED 

or more 

Bachelor’s 

Degree or 

Higher 

Kentucky 

H.S. College H.S. College 

Madison 83.6% 26.4% 80.3% 20% 84.6% 27.5% 

Jackson 55% 9.1% 80.3% 20% 84.6% 27.5% 

Rockcastle 58.5% 10.1% 80.3% 20% 84.6% 27.5% 

Garrard 67.4% 12.1% 80.3% 20% 84.6% 27.5% 

Source: UK AG Community & Economic Initiative of Kentucky (CEDIK) 

Exhibit 7 indicates Madison County residents obtain a bachelor’s degree or higher at rates greater than 

state and national averages; in Madison County the rate is 26.4 percent. 

USA 

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Community Health Care Resources 

The availability of health care resources is critical to the health of a county’s residents and a measure of 

the soundness of the area’s health care delivery system. An adequate number of health care facilities and 

health care providers is vital to sustain a community’s health status. Fewer health care facilities and health 

care providers can impact the timely delivery of services. A limited supply of health resources, especially 

providers, results in the limited capacity of the health care delivery system to absorb charity and indigent 

care as there are fewer providers upon which to distribute the burden of indigent care. The next section 

addresses the availability of health care resources to the residents of Saint Joseph Berea’s service area. 

Hospitals 

Madison County has one other hospital besides Saint Joseph Berea. Patty A Clary is located in Richmond, 

14 miles north of Berea. A third hospital in the area is Rockcastle Regional, in Rockcastle County. Exhibit 

9 provides a listing of hospitals. 

Exhibit 8 


Summary of Area Hospitals 

Facility County Facility Type Total Beds ICU Beds 

Baptist Health Richmond Madison Acute Care 105 8 

Saint Joseph Berea Madison Critical Access 25 4 

Rockcastle Regional Rockcastle Acute Care 26 2 

Ambulatory Care Clinics 

Exhibit 9 provides a list of ambulatory care center as of FY2012 most of which are in Fayette County, 

adjacent to Madison County. Fayette is also where Saint Joseph Berea sends patients for care not available 

here. 

Facility 

Exhibit 9 


Summary of Ambulatory Care Clinics 

Location 

Pinnacle Management LLC dba Richmond Open MRI 103 Alycia Drive Richmond KY 40475 

Dermatology Associates of Ky, PSC 250 Fountain Court Lexington KY 40509 

Kentucky Imaging Center 3475 Richmond Road, Suite 150 Lexington KY 40509 

Kentucky Surgery Center 240 Fountain Court Lexington KY 40509 

Lexington Clinic 1221 South Broadway Lexington KY 40504 

Lexington Diagnostic Center 1725 Harrodsburg Road Suite 100 Lexington KY 40504 

Lexington Surgery Center 1451 Harrodsburg Road, Ste 102 Lexington KY 40544 

Physician Services 1721 Nicholasville Rd. Lexington KY 40503 

Stone Road Surgery Center 280 Pasadena Dr. Lexington KY 40503 

Source: http://chfs.ky.gov/ohp/healthdata 

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Other Licensed Facilities 

There are licensed services other than hospitals and ambulatory care clinics in Madison County. These include 

home health, hospice, adult day care, ambulatory surgery centers, rehabilitation agencies and private 

duty nursing providers. A complete inventory may be obtained through the Kentucky Cabinet for Health 

and Family Services at http://chfs.ky.gov/ohp/con/inventory.htm. 

Physicians 

Exhibit 10 

Saint Joseph Berea CHNA 

Physicians 

Health Care Providers 

Available Madison Kentucky Physicians Available Madison Kentucky 

All Physicians 108 10,115 Total Physicians 108 10,115 

Primary Care Physicians 67 4,241 Total Primary Care 67 4,241 

Physician Specialists 41 5,874 Family Practice 27 1,547 

Registered Nurses 1,072 47,948 General Practice 3 116 

Nurse Practitioners 56 2,797 Internal Medicine 22 1,375 

Physician Assistants 15 772 

Obstetrics and Gynecology 

5 493 

Pharmacists 86 4,524 Pediatrics 10 710 

Dentists 31 2,461 Other Specialty 41 5,874 

Health Departments 

Madison County Health Department is the only health department in Madison County two offices, one in 

Richmond and one in Berea. Saint Joseph Berea has a very good collaborative relationship with them, especially 

the office in Berea. 

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Health Status of the Community 

This section of the assessment reviews the health status of Madison County residents. As in the previous 

section, comparisons are provided with the state of Kentucky and the United States. This in-dept assessment 

of the mortality and morbidity data, health outcomes, health factors and mental health indicators of 

Madison County residents that make up the community will enable Saint Joseph Berea to identify priority 

health issues related to the health status of its residents. 

Good health can be defined as a state of physical, mental, and social well-being, rather than the absence of 

disease or infirmity. According to Healthy People 2010, the national health objectives released by the U.S. 

Department of Health and Human Services, individual health is closely linked to community health. 

Community health, which includes both the physical and social environment in which individuals live, 

work and play, is profoundly affected by the collective behaviors, attitudes and beliefs of everyone who 

lives in the community. Health people are among a community’s most essential resources. 

Numerous factors have a significant impact on an individual’s health status: lifestyle and behavior, human 

biology, environmental and socioeconomic conditions, as well as access to adequate and appropriate health 

care and medical services. Studies by the American Society of Internal Medicine conclude that up to 70 

percent of an individual’s health status is directly attributable to personal lifestyle decisions and attitudes. 

People who do not smoke, who drink in moderation (if at all), use automobile seat belts (car seats for infants 

and small children)j, maintain a nutritious low-fat, high-fiber diet, reduce excess stress in daily living 

and exercise regularly have a significantly greater potential of avoiding debilitating diseases, infirmities 

and premature death. 

The interrelationship among lifestyle/behavior, personal health attitude and poor health status is gaining 

recognition and acceptance by both the general public and health care providers. Some examples of 

lifestyle/behavior and related health care problems include the following: 

Lifestyle/Behavior 

Primary Disease Factor 

Smoking Lung cancer Emphysema 

Cardiovascular disease 

Chronic bronchitis 

Alcohol/Drug Abuse Cirrhosis of liver Malnutrition 

Motor vehicle crashes 

Mental illness 

Unintentional injuries 

Suicide 

Poor Nutrition 

Driving at Excessive Speeds 

Lack of Exercise 

Overstressed 

Obesity 

Digestive disease 

Depression 

Trauma 

Motor vehicle crashes 


Depression 

Mental illness 

Alcohol/Drug abuse 


Page 15


Health problems should be examined in terms of morbidity as well as mortality. Morbidity is defined as 

the incidence of illness or injury and mortality is defined as the incidence of death. However, the law does 

not require reporting the incidence of a particular disease, except when the public health is potentially 

endangered. 

Due to limited morbidity data, this health assessment relies heavily on death and death rate statistics for 

leading causes in death. Such information provides useful indicators of health status trends and permits an 

assessment of the impact of changes in health services on a resident population during an established 

period of time. Community attention and health care resources may then be directed to those areas of 

greatest impact and concern. 

Leading Causes of Death 

Exhibit 10 

Saint Joseph Berea CHNA 

Leading Causes of Death in Madison County, 

Kentucky and the US, 2007 

Rate per 100,000 Total Population 

Leading Causes of death 

Madison 

Co. Kentucky US 

250 

200 

Cancer 208.7 211.1 178.4 

150 

Heart Disease 211.8 218.2 190.9 

100 

Stroke 58.3 47.2 42.2 

Chronic Lower Respiratory 

Disease 56.8 58.6 40.8 

Unintentional Injuries 37.6 51.8 40 

50 

0 

Cancer 

Heart 

Disease 

Stroke 

Chronic 

Low er 

Respiratory 

Disease 

Unintentional 

Injuries 

Source: 2011 MCCHIP 

Madison Co. Kentucky US 

According to the 2011 Kentucky Health Facts, the leading causes of cancer in Madison County were lung, 

colorectal, breast and prostrate. Madison County ranks higher than the national benchmark for all except 

unintentional injuries and lower than Kentucky benchmark for all except deaths due to strokes. Kentucky, 

as a whole, ranks higher than the US benchmark in leading causes of death. 

Page 16


Primary Health Conditions Responsible for Inpatient Hospitalization 

The Top 10 primary health conditions responsible for inpatient hospitalizations in Madison County are listed 

below. The top four for Madison County include circulatory, respiratory, labor and delivery and digestive 

system. However, Saint Joseph Berea does not provide services for labor and delivery. 

Top 10 Primary Health Conditions Responsible for Inpatient 

Hospitalizations (Rate per 100,000), 

Madison County, 2011 

Mental Diseases/Disorders 

Metabolic Diseases/Disorders 

Kidney and Urinary Tract 

Nervous System 

Musculoskeletal Sys & Connective Tissue 

Digestive System 

Newborns/Neonates 

Pregnancy, Childbirth, and Puerperium 

Respiratory System 

Circulatory System 

313 

357 

445 

529 

690 

739 

996 

1,124 

1,124 

1,176 

Rate per 100,000 

Population 

Source: Kentucky Inpatient Hospitalizations Claims Files, Kentucky Department for Public Health 

Page 17


Health Outcomes and Factors 

Health Statistics and Rankings 

An analysis of various health outcomes and factors for a particular community can, if improved, help make 

that community a healthier place to live, learn, work, and play. And a better understanding of the factors 

that affect the health of the community will assist with how to improve the community’s habits, culture 

and environment. This portion of the community health needs assessment utilizes information from 

County Health Rankings, a key component of the Mobilizing Action Toward Community Health 

(MATCH) project, a collaboration between the Robert Wood Johnson Foundation and the University of 

Wisconsin Population Health Institute. 

The County Health Rankings model is grounded in the belief that programs and policies implemented at 

the local, state and federal levels have an impact on the variety of factors that, in turn, determine the health 

outcomes for communities across the nation. The model ranks all 50 states and the counties within each 

state based on two types of health outcomes—how long people live (mortality) and how healthy people 

feel (morbidity)—and four health factors. These are defined below: 

Health Outcomes – rankings are based on an equal weighting of one length of life (mortality) 

measure and four quality of life (morbidity) measures. 

Health Factors – rankings are based on weighted scores of four factors: 

o 

o 

o 

o 

Health behaviors (6 measures) 

Clinical care (5 measures) 

Social and economic (7 measures) 

Physical environment (4 measures) 

Those having high ranks, e.g. 1 or 2, are considered to be the ―healthiest.‖ A more detailed discussion 

about the ranking system, data sources and measures, data quality and calculating scores and ranks can be 

found at the website for County Health Rankings (www.countyhealthrankings.org). 

As part of this community health needs assessment, the relative health status of Madison County is 

compared to the state of Kentucky and a national benchmark. A better understanding of the factors that 

affect the health of the community will assist with how to improve the community’s habits, culture and 

environment. 

Page 18


The following table from County Health Rankings summarizes the 2012 health outcomes for all counties 

that comprise the majority of the community for Saint Joseph Berea. Each measure is described and 

includes a confidence interval or error margin surrounding it–– if a measure is above the state average and 

the state average is beyond the error margin for the county, then further investigation is recommended. 

Health Outcomes—rankings are based on an equal weighting of one length of life (mortality) measure and 

four quality of life (morbidity) measures. While most of the counties within Saint Joseph Berea’s service 

area compare favorably to state of Kentucky, each measure was significantly below national benchmarks 

with opportunities for improvement. 

Exhibit 11 


Health Outcomes (2012) 

Garrard Jackson Madison Rockcastle National 

County County County County KY Benchmark 

Mortality 

Premature death - Years of potential life lost 

before age 75 per 100,000 population (ageadjusted) 

7,706 12,070 7,285 10,411 8,761 5,466 

Morbidity 

Poor or fair health - Percent of adults reporting 

fair or poor health (age-adjusted) 19% 36% 18% 29% 22% 10% 

Poor physical health days - Average number 

of physically unhealthy days reported in past 

30 days (age-adjusted) 5.5 7.3 4.3 6.6 4.7 2.6 

Poor mental health days - Average number 

of mentally unhealthy days reported in past 

30 days 

(age-adjusted) 

3.6 7.4 3.6 5.0 4.3 2.3 

Low birth weight - Percent of live births 

with low birth weight (


Exhibit 12 


Health Factors (2012) 

Garrard Jackson Madison Rockcastle National 

County County County County KY Benchmark 

Health Behaviors 

Adult smoking - Percent of adults that report 

smoking at least 100 cigarettes and that they currently 

smoke 0.0% 35.0% 22.0% 32.0% 27.0% 14.0% 

Adult obesity - Percent of adults that report a 

BMI >= 30 33.0% 33.0% 30.0% 36.0% 33.0% 25.0% 

Physical inactivity - Percent of adults aged 20 

and over reporting no leisure time physical activity 36.0% 37.0% 30.0% 38.0% 31.0% 21.0% 

Excessive drinking - Percent of adults that report 

excessive drinking in the past 30 days 10.0% 6.0% 10.0% 10.7% 8.0% 

Motor vehicle crash death rate - Motor vehicle 

deaths per 100K population 16.0 43.0 16.0 32.0 22 12 

Sexually transmitted infections - Chlamydia rate 

per 100K population 188.0 147.0 223.0 83.0 311 84 

Teen birth rate - Per 1,000 female population, 

ages 15-19 48.0 62.0 33.0 62.0 52 22 

Clinical Care 

Uninsured - Percent of population under age 65 

without health insurance 20.0% 21.0% 18.0% 20.0% 17.0% 11.0% 

Primary care physicians - Ratio of population to 

primary care physicians 2,431:1 13,385:1 1,679:1 1,664:1 1232:1 631:1 

Preventable hospital stays - Hospitalization rate 

for ambulatory-care sensitive conditions per 1,000 

Medicare enrollees 88.0 102.0 66.0 186.0 104 49 

Diabetic screening - Percent of diabetic Medicare 

enrollees that receive HbA1c screening 90.0% 85.0% 88.0% 80.0% 82.0% 89.0% 

Mammography screening - Percent of female 

Medicare enrollees that receive mammography 

screening 61.0% 49.0% 61.0% 56.0% 63.0% 74.0% 

Social & Economic Factors 

High school graduation - Percent of ninth grade 

cohort that graduates in 4 years 73.0% 72.0% 77.0% 83.0% 78.0% 

Some college - Percent of adults aged 25-44 

years with some post-secondary education 43.0% 35.0% 62.0% 39.0% 55.0% 68.0% 

Unemployment - Percent of population age 16+ 

unemployed but seeking work 11.8% 17.1% 8.8% 11.3% 10.5% 5.4% 

Children in poverty - Percent of children under 

age 18 in 

poverty 26% 40% 25.0% 35.0% 26.0% 13.0% 

Inadequate social support - Percent of adults 

without social/emotional support 26.0% 17.0% 26.0% 20.0% 14.0% 

Children in single-parent households - Percent 

of children that live in household headed by single 

parent 24.0% 34.0% 33.0% 24.0% 32.0% 20.0% 

Violent crime rate - Deaths due to homicide per 

100,000 population (age-adjusted) 67.0 35.0 204.0 87.0 288 73 

Physical Environment 

Air pollution-particulate matter days - Annual 

number of unhealthy air quality days due to fine 

particulate matter 0 0 0 0 2 - 

Air pollution-ozone days - Annual number of 

unhealthy air quality days due to ozone 0 0 0 0 2 - 

Access to recreational facilities - Rate of recreational 

facilities per 100,000 population 0.0% 0 13.0% 0 8 0.0% 

Limited access to healthy foods - Percent of 

population who are low-income and do not live 

close to a grocery store 0% 0% 0% 0% 7.0% 16 

Fast food restaurants - Percent of all restaurants 

that are fast-food establishments 50 50.0% 59.0% 41.0% 54.0% 25.0% 

Page 20


Primary Data 

As part of the Community Health Needs Assessment (CHNA) conducted by Saint Joseph Berea, feedback 

was sought from the general public regarding what they considered the greatest health needs and possible 

opportunities in the community. The primary data was collected from September –November 2012. Methodology 

used to collect data included a community wide survey, focus groups and interviews. Please 

refer to Section II – ―How the Assessment was Conducted‖ for details regarding methodology used. 

Community Input-Surveys 

The survey was mailed to random households in our primary service area. It was available in English and 

in Spanish. As previously mentioned, there were 949 respondents. Our primary objective was to have a 

better understanding of community perception regarding greatest health problems, personal health issues, 

barriers, opportunities and whether people knew about and/or used the services of Saint Joseph Berea. 

The chart reflects all of the responses regarding the most important health problems in the community. 

More than three were often selected; this was allowed because we did not have a way to identify top ones. 

The top ten identified in the survey were obesity, alcohol/drug abuse, diabetes, cancers, heart disease, aging 

problems, high blood pressure, depression/anxiety, Alzheimer’s/dementia and child abuse/neglect. The 

comment responses included drug abuse and health insurance/costs. Based on the percentages we carried 

this to the top 13 to include respiratory, mental health and dental. This information was weighted with other 

data collected to determine our top five health problems. This was explained earlier in the ―How the Assessment 

was Conducted‖ section of the report. 

Page 21


When asked to rate the respondent’s personal health, 45.7% said they were healthy, 9.1% said they were 

very healthy and 35.1% said they were somewhat healthy. This was interesting when asked if they had any 

chronic diseases. After evaluation of data, it was presumed that those with the mentioned health issues had 

them under control (through medication, diet) or believed themselves healthy despite their health issues. 

Page 22


Over 23.9% (nearly 1/3) of respondents have had a family member diagnosed with Alzheimer’s or dementia. 

The largest group of respondents to our survey was in the 65+ group. Their comments were personal 

and supportive of individuals with this disease. Many family members in the Saint Joseph Berea community 

try to care for the elderly and those with dementia at home. 

What can Saint Joseph Berea do to help those with dementia? The majority of comments centered around 

these areas: 

• Educate employees on how to care for patients with dementia. 

• Education and resources and support in an effort to keep them at home. 

• Show respect and compassion; help patient and family to maintain dignity. 

• Listen to and involve the caregivers. 

• Provide quality ER care for elderly and patients with dementia. 

When asked if your family had been affected by alcohol abuse, the majority said no (60.3%), but almost 

40% said yes (39.7), confirming other data which identified alcohol abuse as a top need. 

Page 23


How would you address alcohol/drug 

abuse? 

• Counseling/rehabilitation 

• Education 

• Jail/stiffer penalties 

• Hold doctors responsible 

Respondents were asked to identify major barriers in seeking health care. The majority of respondents 

have some form of health care coverage whether it is private, Medicare, Medicaid or Military/VA. Still, 

almost 60% of the 532 respondents said co-pay, or out-of-pocket expenses prevented them or someone in 

their household for seeking health care. Other health barriers included procedures not covered by insurance 

and high deductibles. However, 62% saw their family doctor at least twice in the last 12 months. 

Respondents skipped the following services due to out-of-pocket costs: 

Page 24


Information was gathered regarding usage of health care services at Saint Joseph Berea and other facilities 

and counties. 

• 52% said they use the services provided at Saint Joseph Berea. 

• When asked how they heard about the hospital, word of mouth (49%) and physicians (32%) were the 

main responses. Advertising (25%) and community outreach (10%) were also listed. 

• 19% were hospitalized in the last 12 months. Other hospitals used were Baptist Health (Patty A. Clay) 

21% and Rockcastle Regional (4%). 41% were not hospitalized. 

• 82% of respondents said they seek health care in Madison County, 55% seek care in Fayette County 

(major hospitals in Central Kentucky), less than 15% sought care in Rockcastle, Jackson or Garrard 

Counties. 

Page 25


Community Input-Focus Group and Interview Results 

Focus groups and key informant interviews provided opportunities for the community to express strengths, 

needs and opportunities. The same general questions were asked the focus group and interview participants. 

Each responded based on the background and affiliation of the particular group or individual. 

1. What are the health issues that have impacted you or the community? 

Obesity 

Diabetes 

Heart disease 

Cancer 

Oral health 

COPD 

Alzheimer’s disease/dementia 

Stroke 

Drugs/Alcohol 

Mental Health 

Kidney Disease 

Falls 

Arthritis/Joint Pain/Fibromyalgia 

Vision 

As with the survey results a connection can be made between the different diseases. Obesity is listed as the 

number one problem. This one disease alone can be the cause of other diseases listed. According to an article 

from the Kentucky Department for Public Health, obesity in children has short term and long term 

results put them at risk as youth/teens and adults. Diabetes, heart disease, stroke, high cholesterol, high 

blood pressure, bone and joint problems (arthritis), sleep apnea, several types of cancer and social/psychological 

problems such as poor self-esteem. 

http://chfs.ky.gov/NR/rdonlyres/70814C96-7EA2-470F-B5A2- 

75A1249A348F/0/101409ObesityChildren.doc 

2. What are the resources and barriers? 

Resources: 

Two colleges: Berea and EKU 

Walking/Hiking/Bike trails 

Hospital location and services 

Food Bank/BUURR 

Libraries 

Adult Day Care 

Family centers at schools 

SJB Patient and Family Fund 

Affordable Care Act 

Hopes Wings for battered/abused women 

Liberty Place for Women with alcohol/drug 

problems 

Barriers: 

Lack of pediatricians 

Urgent care not adequate 

Misunderstanding of behavioral/mental 

issues 

Medicaid coverage issues 

Cost of healthy or organic foods 

Lack of preventative care for the poor 

without Berea Health Ministries 

Lack of sidewalks 

Money for programs 

Page 26


3. What is your vision for a healthy community? 

Outpatient services for mental/behavioral health issues 

Better access to health care for preventative care: free/low cost health assessments, blood pressure, 

diabetes, etc. 

Increase hiking, recreational and walking trails, exercise programs, playgrounds, weight management 

programs to address obesity 

Incentives for providers to come/stay in Berea 

Ability for seniors to stay at home 

Health meals at food banks, fast foods, meal services in schools 

Support programs for elderly, families, alcohol/drug, etc. 

Smoking bans 

Environmental concerns with fumes from factories 

“A health community has residents who have access to preventative care, with places to exercise and 

where they can buy healthy food.” 

“Sustainability and environmental concerns are considered as extremely important and necessary 

components of all projects and policies.” 

4. What are some solutions to improving the health of the community? What can the community 

do? 

In addition to what is listed in the vision of a health community, participants suggested: 

Address and follow up care for drug/alcohol issues 

Obesity clinic and nutrition education for children and adults 

Expand bike and walking trails 

Address mental health issues in a positive way 

Domestic violence awareness and programs 

Diabetes support and education 

Senior services that provide at home care and long term care support 

Community wide smoking cessation program 

Additional surgeon at the hospital and a pediatrician 

Expanded transportation in the community 

Inpatient mental health beds 

Improve public awareness 

5. What is great about our community? 

Libraries 

Small town; feel safe 

Necessary services available 

Community members work together to achieve a common goal 

Affordable housing 

Access to employment 

Saint Joseph Berea: Love the community art in the hospital and it is a caring and compassionate 

hospital 

Page 27


Participants in the survey, focus groups and interviews were also asked to give their perception of 

Saint Joseph Berea. 

Strong focus on its mission – Services provided for all not matter their ability to pay. 

Personal experience and that of family members has been very good 

The cardiovascular center is a good addition. 

The emergency room meets a community need 

o Most respondents mentioned positive experiences, but a few were not so good because of 

the wait primarily 

Would like to see more diabetes education 

Appreciate the services that are provided: heart institute, outpatient dietician, wound care center, 

specialists, chemotherapy, pain clinic, Senior Renewal 

Involvement in and support of the community and schools 

Registration for lab, X-rays, etc. sometimes takes too long 

Unclear of all the services provided; suggest promoting more through different community resources 

Concern about the speed bumps that have been added and impact on patients in ambulances 

Key Themes Provided Through Participant Comments 

“We may have many resources for the elderly to utilize, but there needs to be a connector, someone/group 

that can pull all of the resources together to provide care the elderly need.” 

“Madison County needs affordable drug abuse treatment. Jail isn’t the answer, treatment is.” 

“Make sure your cafeteria and vending machines offer healthy food options. Promote healthy food and set 

an example for other work places in the community.” 

“We like having services close to home without traveling to Lexington all of the time.” 

“The obesity rate is appalling…I worry about the long term affects it will have on the community.” 

“My husband and I are raising our three grandchildren. He has Medicare, but I don’t have insurance due 

to cost. Neither of us has dental care…Working people who don’t qualify for assistance are left to suffer.” 

―I definitely feel more should be done for depression and mental problems. These diseases are so misunderstood.” 

Health Issues of Uninsured Persons, Low-Income Persons and Minority Groups 

To assess health issues impacting those in the community who are low-income and uninsured, Saint Joseph 

Berea referred to the Madison County Health Department’s Community Health Needs Assessment 

for 2011 (MCCHIP). Their analysis reported that Madison County residents faired better than the state as 

a whole. (See Appendix for website to view full report). 

Page 28


However, the Madison County Health Rankings 2012 report noted that the county showed improvement 

overall except in Clinic Care and Social and Economic Factors which went from being 5 th highest county 

in Kentucky in 2010 to 19 th in 2012. Changes were attributed to reduced high school graduation, increased 

unemployment, children in poverty, inadequate social support and single-parent households (Madison 

County, KY - County Health Rankings 2010-2012 Report) 

Comments received from the CHNA survey and focus groups sighted lack of preventative care for those 

who are poor and do not have insurance. Some have been refused treatment because they did not have the 

ability to pay. Lack of dental care and inability to pay for treatment came up as a major health concern. 

Berea Health Ministries provided service until it closed its doors in August, 2012. Richmond has Health 

Now! for those with no insurance and limited to no ability to pay. Saint Joseph Berea Family Medicine has 

been designated a rural health clinic. Neither the clinic nor the hospital refuse treatment for anyone who is 

in need. Financial counselors work with patients to make sure they have medical treatment that is needed. 

Per Capita Income & Poverty Level, 2011 

30.0% 

27.4% 

25.0% 

20.0% 

20.3% 

20.6% 

18.1% 

Per Capita Income 

15.0% 

10.0% 

Persons below poverty 

level 

5.0% 

0.0% 

Madison Co. 

Kentucky 

Percent Without Health Insurance, 25-65 y.o. 

18.8% 

18.6% 

18.4% 

18.2% 

18.0% 

17.8% 

17.6% 

18.6% 

Madison Co. 

18.0% 

Kentucky 

Page 29


Children at Risk: 

Madison Co. 

2006 

Madison Co. 

2010 

Kentucky 

2010 

U.S. 

2010 

Children living in Poverty 19.8% 25% 26% 13% 

Children in single-parent households 33% 32% 20% 

Free and reduced rate lunches 47% 50% 

Source: Madison County Community Health Improvement Plan 2009 

The concern stems from a study in the 2011 Kids Count Data Book that shows the amount of children living 

in poverty in Madison County from 19.8% in 2006 to over 25% in 2010. To go along with this the 

number of free lunches and reduced meals for children has increased from 47% in 2006 to 50% in 2011. 

Diseases associated with children living in poverty include untreated dental problems, causing them to lose 

teeth too early; poor nutrition leading to health problems and obesity in some; and living in unsafe housing 

conditions can worsen asthma or chronic bronchitis. 

Children living in single-parent households are measured because children in these households are statistically 

―at risk for adverse health outcomes such as mental health problems (including substance abuse, depression, 

and suicide) and unhealthy behaviors such as smoking and excessive alcohol use.‖ In addition, 

self-reported health and mortality among lone parents tended to be worse than parents living as couples 

(Excerpted from an article in the Richmond Register on April 12, 2012, ―18 Percent in County without 

Health Insurance). 

The Madison County Health Department has made an effort to increase enrollment of the number of youth 

under the age of 19 enrolled in Kentucky Child Health Insurance Program (KCHIP). Their goal was to increase 

it from 9% in 2000 to 15% by 2014 (from 1262 youths to 1451). 

Aging Population 

According to the Department of Aging 

for Kentucky, the over 60 population 

is the fastest growing population 

and estimated to increase 91% 

from the year 2000 to the year 2030. 

In Disabilities (including Alzheimer’s/Dementia) 

and poverty levels 

are unique needs that will impact 

this group and put an extra burden 

on families who take the role as caregivers. 

Another factor in looking 

at the aging demographic is that over 

half of the grandparents in Kentucky 

care for their grandchildren. Additionally, 

23% of aging make up total mental health population in Kentucky. Services for the aging population 

are limited, and the ones available are not always known by the elderly or their caregivers. Information 

is based on the Kentucky State Plan on Aging, 2009-2012 report. 

Page 30


Violence in the Community 

Crime (excluding violent crime) has increased in Madison County up from 5,115 arrests in 2005 to 7,048 

arrests in 2010. Violent crimes include homicide, forcible rape, robbery and aggravated assault. 

Violent Crime Rate 

per 100,000 population 

350 

300 

288 

250 

200 

204 

150 

100 

73 

50 

0 

Madison Co. Kentucky U.S. 

Page 31


Priority Community Health Needs Identified 

Using findings obtained through the community survey and collection of primary and secondary data, 

Saint Joseph Berea completed an analysis of these inputs (see Appendix D and E) to identify community 

health needs. The following data was analyzed to identify health needs for the community: 

Using all of the data we had received we came up with our Top Five Priorities. 


Top Five Priority Health Issues 

Rank Primary Need Groupings 

1 Mental Health Alcohol & drug abuse 

Depression/anxiety 

Mental/behavioral health problems 

Suicide 

2 Obesity Nutrition 

Physical Inactivity 

3 Cardiopulmonary Heart disease/stroke 

High blood pressure 

Pulmonary 

4 Senior issues Physical issues connected with aging 

Alzheimer’s/Dementia 

Lack of Resources 

5 Collaboration of Care Resource guide for community 

Screenings 

Education 

Prevention 

Community wellness council 

Process 

Several steps were taken to determine the top priorities. 

First, we took the results of our primary data from the survey, focus groups and interviews initially. We 

brought together our CHNA advisory group, SJB steering committee and other members of the community 

to discuss the findings and come up with what they considered top priorities. The participants were divided 

into two groups. Each group went through a series of questions to determine needs and how to address 

them. (See Appendix E for list of participants and methodology). 

Page 32


Activity 1: 

Given the mission, vision and values of SJB and the Community Assessment data, identify the most important 

health issues or problems for St. Joseph Berea Hospital to address in the next 3-5 years. 

Group #1 

1. Mental health services/Drug addiction 

2. Collaboration of care/services 

3. Chronic disease prevention 

4. Lack of insurance 

Group #2 

1. Healthy Family 

2. Dental Care 

3. Alcohol/Drug Abuse 

4. Exercise Programs 

5. Address Connection Between Issues/ Healthy 

Education In All Ages 

(Their complete analysis of top needs can be found in Appendix E). 

The following process was used in weighting the primary and secondary data described above. Once this 

was finished the Saint Joseph Berea steering committee reviewed the findings and data that had been 

weighted (See Exhibit 13), grouped needs and identified the top five health priority issues. 

Leading Causes of Death: Leading causes of death for the community were reviewed and the death rates 

for the leading causes of death for each county within the Saint Joseph Berea CHNA community were 

compared to U.S. adjusted death rates. Causes of death in which the county rate compared unfavorably to 

the U.S. Adjusted death rate resulted in a health need for the CHNA Community. 

Primary Causes for Inpatient Hospitalization: The primary causes for inpatient hospitalization resulted in 

an identified health need for the community. 

Health Outcomes and Factors: An analysis of the County Health Rankings health outcomes and factors 

data was prepared for each county within the Saint Joseph Berea CHNA Community. County rates and 

measurements for health behaviors, clinical care, social and economic factors and the physical 

environment were compared to national benchmarks. County rankings in which the county rate compared 

unfavorably (by greater than 30 percent of the national benchmark) resulted in an identified health need. 

Primary Data: Health needs identified through community surveys, focus groups and key informant 

interviews (if applicable) were included as health needs. Needs for vulnerable populations were separately 

reported on the analysis in order to facilitate the prioritization process. 

To facilitate prioritization of identified health needs, a ranking and prioritization process was used. Health 

needs were ranked based on the following seven factors. Each factor received a score between 0 

and 4. 

1) How many people are affected by the issue or size of the issue? For this factor ratings were 

based on the percentage of the community who are impacted by the identified need. The 

following scale was utilized. >20% of the community=4; >10% and 5% and


2) What are the consequences of not addressing this problem? Identified health needs which 

have a high death rate or have a high impact on chronic diseases received a higher rating for this 

factor. 

3) The impact of the problem on vulnerable populations. Needs which pertain particularly to 

vulnerable populations were received a rating of 4 for this factor. 

4) How important the problem is to the community. Needs identified through community 

surveys and/or focus groups. 

5) Prevalence of common themes. Determined by how many sources of data (Leading Causes of 

Death, Primary Causes for Inpatient Hospitalization, Health Outcomes and Factors and Primary 

Data) identified the need. 

6) How closely does the need align with KentuckyOne Health strategies? 

7) Does the hospital have existing programs which respond to the identified need? 

Page 34


Exhibit 13 

Saint Joseph Berea 

Prioritization of Health Needs 

Each need was ranked based on these seven prioritization metrics. These were the top priority issues that emerged: 

How many 

people are 

affected by the 

issue? 

What are the 

consequences 

of not addressing 

this 

problem? 

What is the 

impact on 

vulnerable 

populations? 

How Important 

is it to the 

community? 

How many 

sources 

identified 

the need? 

How closely 

does the 

need align 

with Kentucky-One 

Health 

strategies? 

Does the 

hospital 

have existing 

programs 

which respond 

to 

the identified 

need? 

Total 

Cancer 1 4 0 4 2 4 2 17 

Heart Disease 1 4 4 4 1 4 3 21 

Chronic Lower 

Respiratory Disease 

1 4 4 3 1 4 2 19 

Stroke Cerebrovascular 

Disease 1 4 0 3 1 4 1 14 

Adult Smoking 4 3 0 1 1 1 1 11 

Adult Obesity 4 3 4 4 2 2 1 20 

Physical Inactivity 4 3 4 4 1 1 1 18 

Motor Vehicle 

Crash Rate 1 1 0 1 1 1 1 6 

Sexually Transmitted 

Infections 2 2 0 2 1 1 1 9 

Teen Birth Rate 2 2 0 1 1 1 1 8 

Uninsured 3 2 4 2 1 2 4 18 

Lack of Primary 

Care Physicians 4 3 2 2 1 4 3 19 

Children in Poverty 

4 4 4 2 1 3 2 20 

Page 1


Children in Single 

Parent Households 

4 4 2 3 1 1 2 17 

Violent Crime 

Rate 4 1 0 4 1 1 1 12 

Limited Access to 

Healthy Foods 3 3 3 3 1 2 1 16 

Substance Abuse 4 2 0 4 1 4 1 16 

Diabetes 3 3 0 4 1 4 3 18 

Aging Problems 3 2 4 4 1 3 3 20 

High Blood Pressure 

3 3 0 4 1 3 3 17 

Mental Health 4 3 3 4 1 4 2 21 

Child 

Abuse/neglect 3 4 0 4 1 1 13 14 

Dental 3 4 3 2 1 1 1 15 

Health Care Costs 0 4 3 3 1 3 3 17 

Lack of Transportation 

2 2 1 1 1 1 8 

Finally, the Saint Joseph Berea steering committee came together to evaluate all of the findings. We prioritized based on CHNA data, analysis/evaluation 

meeting, secondary data and hospital data/needs. The top five priorities were selected and five sub-committees were formed to deal with each one. 

Page 2

Saint Joseph Berea Community Health Needs Assessment 

APPENDICES 

Appendix

Appendix A: Saint Joseph Berea CHNA Advisory Committee 

There were two groups that oversaw the work of completing the Saint Joseph Berea CHNA: 

Saint Joseph Berea CHNA Project Steering Committee 

Greg Gerard, President 


Chris Schill, Director 

Saint Joseph Berea Foundation 

Kate Heckman, Public Relations 


Chris Schweighardt, CNO/COO 


Elena Baker, Employee Health/Education 


Ruth Hawkins, Director 

Madison County Health Dept 

Flora Washburn, Mgr, Mission Services 


Saint Joseph Berea CHNA Community Advisory Committee 

Carla Gilbert, Retired Pastor 

Union Church 

Chris Schweighardt, CNO/COO 


Cora Fletcher, Director 

Berea Health Ministries 

Elena Baker, RN 

Saint Joseph Berea Education 

Flora Washburn, Mgr, Mission Services 

Saint Joseph Berea Mission 

Fr Michael Flanagan, Priest 

Saint Clare's Catholic Church 

Greg Gerard, President 


Jake Reed, Lieutenant 

Berea Police Dept 

Jim Rousey, Consultant 

Consultant, Kentucky Department for Public 

Health 

Kathy Todd, P.E. Teacher 

Madison County Schools 

Luke Finster, Director 

Berea Headstart 

Nancy Mowbray, RN 

Saint Joseph Berea RN 

Paula Woodman, Director 

Berea Senior Citizens 

Ruth Hawkins, Director 


Sarah Mashburn, OT 

Saint Joseph Berea Rehab 

Stephanie Moore, Executive Director 

White House Clinic 

David Gregory, Chief 

Berea Police Dept 

Tamara Sandberg, Executive Director 

Kentucky Association of Food Banks 


2 

Appendix 2/19/2013

Appendix B: Saint Joseph Berea CHNA Timeline 

(Updated: October 20, 2012) 

Task 1 Task 2 Task 3 

January 2012 Establish Assessment 

Infrastructure 

o Facilitator: Flora Washburn 

o Steering Committee: SJB 

o Data Gatherer: EKU and 

Berea College Interns 

KyOne Timeline Established 

o Jan-June 2012: start process 

o July 2012: Begin assessment 

forums, surveys, etc 

o Sept-Oct 2012: Surveys/forums 

completed by end of month 

o December 2013 Review data 

o January 2013 Draft finalized 

o April 2013 Present to Board 

o May 2013 Revise and finalize 

o June 2013 Publish CHNA 

Identify Community 

Representatives 

o Key community 

representatives 

o Identify interest 

groups for input 

February 2012 

Feb 2 – First CHNA community 

meeting 

Establish meeting schedule 

March 2012 

No Meeting 

April 2012 

May 2012 

CHNA Committee 

o Requirements 

o Process 

o Timeline 

o Resources needed 

o Roles 

Establish questions for SJB 

CHNA survey. 

o Answers will help us to know 

how to address health issues. 

Establish Assessment Timeline 

o Review requirements 

o Review steps 

Review meeting schedule after 

discussion of timeline 

Establish Community 

Definition 

o Discuss 

appropriate 

definition of 

geographical area 

for “community” 

to be completed by 

June meeting 

No meeting. Correspondence 

through email. 

June 2012 

Plan focus groups; delivery of 

survey, process for July 

July 2012 

Beginning of KyOne FY2013 

o Now able to begin surveys 

o Now able to have focus group 

meetings 

o May begin process for 

identifying needs 

CHNA to be started and completed 

within this fiscal year: Begin surveys, 

reporting, etc after July, 2012; report 

must be complete and published by 

June 30, 2013 

August 2012 

Focus groups 

Interviews 

Surveys 

Delayed until September due to 

production of survey 

September 2012 

Focus groups 

Interviews 

Surveys 

On target 


3 

Appendix 2/19/2013

October 2012 

November 2012 

November 2012 

Dec 4, 2012 

December 2012 

All data to be collected by 

October 31. 

Focus groups and interviews 

extended to November 9. 

Organize data and information 

that has been collected. 

Convene Community Committee 

o Review survey information 

o Identify significant needs 

Steering Committee Finalizes 

Needs List 

o Review data and input from 

community and community 

committee 

o Identify Top 5 needs 

Surveys completed by Oct 31. 

Focus groups and interviews 

extended. 

Develop Draft Report of data 

collected and analyzed to present at 

Implementation meeting. 

Identify Needs & implementation 

o Committee makes 

recommendation on significant 

needs 

o Identify needs that should not be 

addressed and why 

Use all data collected to make this 

decision. 

January 15, 2013 CHNA Draft Report due KentuckyOne Health system Healthy 

Community committee will review 

and prepare board report. 

January 24, 2013 SJB Implementation Meeting o Top 5 identified needs 

o Identify which needs are 

appropriate and financially 

feasible for the hospital to meet 

o Identify which needs cannot be 

met and why 

Create an 

implementation plan 

based on SJB/KYOne 

Health strategic plan. 

February 12, 2013 

February-March, 

2013 

CHNA Written Report and 

Implementation plans due 

KentuckyOne Health system 

strategy team reviewing for 

implementation plan for system 

and strategic plan 

Completed report with 

implementation strategy to KYOne 

Will return to hospitals for questions, 

concerns, strategies. 

March 2013 Develop System-level plan KentuckyOne Health Communities: 

Montgomery/Bridges/Francis 

April 3, 2013 

Present CHNA Reports to the 

KyOne Board 

o Ask for approval 

o Bring back recommendations 

May 2013 

Convene Community Committee 

for Final time 

o Provide report from KyOne 


4 

Appendix 2/19/2013

June 2013 

board 

o Seek final recommendations 

Finalize Report for Publication 

and Reporting in Schedule H, 

Form 990 

Make available on hospital website 


5 

Appendix 2/19/2013

Appendix C: Saint Joseph Berea Survey Tool 


6 

Appendix 2/19/2013

Appendix D: Summary of Survey, Focus Groups & Interviews 

Saint Joseph Berea Community 

Health Needs Assessment 

Results of Survey, Focus Groups & Interviews 

Mission of Saint Joseph Berea 

The mission of Catholic Health Initiatives is 

to nurture the healing ministry of the Church 

by bringing it new life, energy and viability in 

the 21st century. Fidelity to the Gospel 

urges us to emphasize human dignity and 

social justice as we move toward the 

creation of healthier communities. 


7 

Appendix 2/19/2013

Vision 

Our Vision is to live up to our name as 

One CHI 

Catholic: Living our Mission and Core Values. 

Health: Improving the health of the people and 

communities we serve. 

Initiatives: Pioneering models and systems of care to 

enhance care delivery. 

Core Values 

Reverence 

Profound respect and awe for all of creation, the foundation that shapes 

spirituality, our relationships with others and our journey to God. 

Integrity 

Moral wholeness, soundness, fidelity, trust, truthfulness in all we do. 

Compassion 

Solidarity with one another, capacity to enter into another’s joy and sorrow. 

Excellence 

Preeminent performance, becoming the benchmark, putting forth our 

personal and professional best. 

Reviewing the Data 

• Purpose: Gather information from our primary 

service area regarding health needs and 

opportunities 

• Data collection: 

– Survey: sent to primary service area 

– Focus Groups: community groups 

– Interviews: community members 


8 

Appendix 2/19/2013

Survey 

• Dates: September – November 9, 2012 

• Distribution: 

– Random mailing 

– Farmers market, health fairs, etc. 

– and on-line link 

• Number of Questions: 28 questions 

– Opportunities for comments: 5 

• Respondents: 949 

1. 

1. 

2. 


9 

Appendix 2/19/2013

3. 

4. 

Comment: If you have a family member with 

Alzheimer's or dementia, what can we do to help them 

in our hospital? 

• Train employees on how to care for patients with dementia. 

• Transportation 

• Family resources and support; ways to keep them at home. 

• Show them respect and help patient and family maintain dignity. 

• Better care and attention for those with dementia when in the hospital. 

• Do not let age or dementia be a factor in quality of care when in the ER. 

• Medications. 

• Compassion, love and care. 

• Keep doing what you are doing. 

• Listen to the POA/Caregivers! Don't speak to us as if patient is not there! 


10 

Appendix 2/19/2013

5. If you are a woman over 50, 

have you had a mammogram? 

84% (404) Yes 16% (77) No 

6. If not, what are barriers? 

7. 

8. Have you or your family been affected by 

alcohol abuse? 

60.3% No 

39.7% Yes 

Comments: How do you think alcohol/drug 

issues should be addressed? 


11 

Appendix 2/19/2013

9. What additional health services are needed 

locally to better address the health problems 

of Berea and the surrounding area? 

(15.2%) 

(14.8%) 

(13.1%) 

(8.2%) 

(8.2%) 

(7.8%) 

(32.7%) 

10. If the health care services you need were here, 

would you utilize them or still go elsewhere? 

11. What kind of health care coverage do you have 

for anyone in your family 18 years and older? 


12 

Appendix 2/19/2013

12. In the past 12 months, have you decided to NOT 

use any of the following services because of out of 

pocket (personal) cost? (Check all that apply.) 

13. Do any of the following prevent you or any member 

of your household from seeking health care? 

(Check all that apply.) 

14. How many times a year do you use the 

following services? 


13 

Appendix 2/19/2013

15. Do you use the services of St. Joseph 

Berea? 

16. How do you learn about health care services at 

Saint Joseph Berea? (Check all that apply.) 

17. In the past 12 months, have you or a family member 

been hospitalized at Saint Joseph Berea for any of 

the following? (Check all that apply.) 


14 

Appendix 2/19/2013

18. How satisfied were you or someone in your 

household with the services you received at Saint 

Joseph Berea? 

34% (25) 

43.0% (320) 

53.6% (399) 

19. Please check all hospitals where you were 

hospitalized overnight or sought care in the past 12 

months. 

20. What is your zip code? 

Berea: Madison Co. 

Richmond: Madison Co. 

Jackson Co. 

Rockastle Co. 

Garrard Co. 

60 

59 

72 

278 

404 

Overall Madison Co. = 700 Responses 

1.) Berea (40403, 40404, 40405) = 404 

2.) Richmond (40475, 40476) = 278 

3.) Waco (40385) = 18 

Overall Jackson Co. = 72 Responses 

1.) Mckee (40447) = 45 

2.) Annville (40402) = 15 

Waco: Madison Co. 

Estill Co. 

Lincoln Co. 

Other 

Fayette Co. 

Jessamine Co. 

18 

13 

9 

9 

3 

2 

3.) Tyner (40486) = 10 

4.) Sand Gap (40481) = 1 

5.) Gray Hawk (40434 = 1 

Overall Rockcastle Co. = 60 Responses 

1.) Mt. Vernon (40456) = 42 

2.) Brodhead (40409) = 14 

3.) Livingston (40445) = 3 

4.) Orlando (40460) = 1 

Powell Co. 

Laurel Co. 

1 

1 

Overall Garrard Co. = 59 

1.) Lancaster (40444) = 30 

2.) Paint Lick (40461) = 29 

0 50 100 150 200 250 300 350 400 450 


15 

Appendix 2/19/2013

Demographics 

• 21. What is Your Gender? 

– Male 33.4% (305) 

– Female 66.6% (608) 

• 22. What is Your Age? 

– 0-18 1.2% (11) 

– 19-25 2.0% (18) 

– 26-39 15.4% (141) 

– 40-54 26.1% (239) 

– 55-64 24.9% (228) 

– 65+ 30.5% (280) 

23. What is Your Marital Status? 

24. What is the highest level of education 

have you completed? 


16 

Appendix 2/19/2013

Demographics 

• What is Your Race? 

– White 95.7% (881) 

– Black/African American 2.5% (23) 

– Hispanic/Latino 0.8% (7) 

– Native American 1.1% (10) 

– Other 1.0% (9) 

• What is Your Employment Status? 

– Full Time 44% (404) 

– Retired 38.6% (354) 

– Unemployed 7.1% (65) 

– Part Time 6.4% (59) 

– Student 3.2% 29) 

27. What is Your Household Income? 

28. What counties do you go to for health 

services (doctor, hospital, dentist, etc.)? 


17 

Appendix 2/19/2013

Focus Groups 

• Purpose: Meet with community groups to determine 

community health needs 

• Held in different locations to ensure diverse representation 

• There were six focus groups: 

– Senior Citizen Advisory Group 

– Berea Head Start Center 

– Shannon Johnson Elementary 

– St. Joseph Berea employees/volunteers 

– First Responders 

– Farristown Baptist Church Event 

• Total of 61 participants plus facilitators 

Focus Groups – Health Issues That Have 

Impacted You or the Community 

• Obesity 

• Diabetes 

• Heart disease 

• Cancer 

• Oral health 

• COPD 2 

• Alzheimer’s disease/dementia 

• Stroke 

• Drugs/alcohol 

• Mental health 

• Kidney disease 

• Shortage of providers in the area 

• Limited healthcare services in Berea 

overall 

• Wait times to see providers 

• Medicaid MCO’s not accepted 

• Kentucky Spirit ending contract 

• Medicaid recipients treated differently 

at providers’ offices 

• Falls 

• Arthritis 

• Joint pain 

• Vision 

• Fibromyalgia 

Focus Groups: What is Your Vision of a 

Health Community? 

• Outpatient services for mental health issues 

• Better access to health care for all: 

– access to free/low cost health assessments: blood pressure, diabetes, etc. 

(Preventative care) 

• Hiking, recreational trails, walking paths, exercise programs, playgrounds, 

weight management programs to address obesity 

• Incentives for providers to come to Berea (not travel to Lexington) 

• Stay at home services for seniors 

• Healthy meals: food banks, fast foods, meal services, education 

• Support programs 

• Smoking bans 

• Environmental concerns: control fumes from factories 


18 

Appendix 2/19/2013

Focus Groups: What are Resources & 

Barriers? 

• Two colleges: Berea and EKU 

• Addition of Walking/hiking/bike 

trails 

• Location of the hospital 

• Food bank 

• Libraries 

• Adult day care 

• Family centers at schools 

• Lack of pediatricians 

• Urgent Care not adequate 

• Misunderstanding of behavioral 

health issues 

• Medicaid coverage 

• Cost of organic/healthy foods 

• Poverty/unemployment 

• Lack of preventative services for 

low income (Berea Health 

Ministries) 

• Lack of sidewalks 

What is your perception of Saint Joseph 

Berea? 

• Very good experience personally and of family members; staff 

helpful; friendly caring staff 

• Good services for small community 

• Atmosphere: spiritual, artwork 

• Involvement in and support of the community and schools 

• ER experience: good by most, not so good by others: 

appreciate the nurses 

• Registration for lab, X-rays, etc takes too long 

• Unclear as to all services provided (several comments on 

need for diabetes education and support; surprised to hear 

SJB offered these services) 

What is your perception of Saint Joseph 

Berea? List of services mentioned. 

• Heart Institute 

• Outpatient Dietician 

• Wound Care Center 

• Specialists 

• Chemotherapy 

• Pain Clinic 

• Senior Renewal 

• Access to care for those who do not have insurance/financial 

resources 


19 

Appendix 2/19/2013

What’s great about our community? 

• Small, beautiful community that is safe for families 

• Welcoming, open to diverse groups 

• Having a local college and good libraries 

• It is a welcoming community with a fascinating 

cultural history and positive collaboration between 

resources and local agencies! It has a social 

conscience and is cognizant of its role as 

environmental steward. 

Interviews 

• Six interviews from community leaders and citizens 

• Purpose: input from those directly involved with the 

community and services 

• Same questions: Responses to questions similar to 

focus groups but with more detail 

What is your vision for a healthy 

community? (In addition to focus groups) 

• Strong faith-based community that supports 

spiritually, as well as, local community outreach 

• Easy access to Lexington for additional services and 

specialized treatments 


20 

Appendix 2/19/2013

What is your perception of Saint Joseph Berea 

overall and of specific programs and services? 

• Strong focus on its mission; good services for all no 

matter ability to pay 

• Concern about government cuts 

• Cardiovascular center a good addition 

• Need more diabetes education 

• Better art in registration (to fit healing environment) 

What Resources are Availability? (In addition 

to focus groups) 

• SJB Patient and Family Fund 

• Affordable Care Act 

• Food Bank/BUURR 

• Urgent Care and ER 

• Church offers screenings and ultrasounds annually 

through Life Screening 

• Wide variety of health practices available 

• Hospital is nearby 

What are the Barriers? (In addition to focus 

groups) 

• Funding for projects 

• Preconception that smaller hospitals not as good as 

larger 

• Motivation of individuals to change 

• A gatekeeper to determine if someone should go to 

ER or stay home 

• Poverty: people choose between food or health 


21 

Appendix 2/19/2013

What can our community do to improve the 

health and quality of life in the community? 

• Expand bike & walking trails 

• Offer nutrition programs where people live so they 

don’t have to worry about transportation. 

• Organize and promote available resources for elderly 

• Improve & address mental health issues in a positive 

way 

• Promote services that are available 

What is Great About Our Community? 

• Libraries, city efforts in wellness 

• Art in hospital 

• Caring/compassionate hospital 

• Small town; safe overall 

• Have most of the services that are needed 

• People in the community are willing to work together 

to achieve a common goal 

• Affordable house; close to larger communities 

• Jobs 


22 

Appendix 2/19/2013

Appendix E: CHNA Community Meeting December 4, 2012 

Analysis and Evaluation of Priority Needs Identified 

Attendees: 

AGENDA: 

Name 

Albright, Shelia 

Balinger, Dale 

Finster, Luke 

Gerard, Greg 

Hill, Darnell 

Hawkins, Ruth 

Heckman, Kate 

Jones, Jenny 

Jordison, Lloyd 

Lainhart, Jennifer 

Moore, Stephanie 

Mowbray, Nancy 

schill, Chris 

Schweighardt, Chris 

Shackelford, Lorah 

Washburn, Flora 

Woodman, Paula 

Affiliation 

Comprehensive Care 

D & B Electric 

Head Start 

SJB President 

Upward Bound Ministries 


SJB Public Relations 

Berea Parks & Recreation 


Hope's Wings 

White House Clinics 

SJB Emergency room RN 

SJB Foundation 

SJB CNO/COO 

SJB Rehab+B3 

SJB Mission Services 

Berea Senior Citizens 

St. Joseph Berea Survey Data Results Presentation – Flora Washburn 

Group Processing – Ruth Hawkins, Facilitators 

Activity 1: 9:50 – 10:05 Given the mission, vision and values of SJB and the Community 

Assessment data, identify the most important health issues or problems for St. Joseph 

Berea Hospital to address in the next 3-5 years. 

Process: 

Utilize a “round robin” format in each group to list issues or problems (10 minutes) 

From the list of issues, each group member then selects the most important 5 issues to 

be addressed (5 minutes) 

(This will be done by each participant being give 5 sticky dots to cast votes. Participants 

may place all 5 votes on 1 issue or they may be spread across multiple issues.) 

NOTE: While there may be 1 or more health issues or problems to which you are personally 

committed, keep in mind that your focus is related to the needs of the community. 

Activity 2: 10:05 – 10:30 Related to each of the TOP 5 health issues or problems, in 

order of priority, identify KNOWN services currently offered by St. Joseph Berea Hospital, medical 

& community partners that address each of the TOP 5 health issues or problems identified. (Use 

“round robin” technique) (25 minutes) 


23 

Appendix 2/19/2013

Activity 3: 10:30 – 11:00 Related to each of the TOP 5 health issues or problems, 

identify service gaps or needed services to address each issue. (Use “round robin” technique.) 

(30 minutes) 

Activity 4: 11:00 – 11:20 What actions should St. Joseph Berea Hospital take in meeting 

these health issues or problems? (Use “round robin” technique.) (15 minutes) 

From the list of actions, each group member then selects the most important 5 actions to be 

taken by the hospital over the next 3-5 years. (5 minutes) 

(This will be done by each participant being give 5 sticky dots to cast votes. Participants may 

place all 5 votes on 1 issue or they may be spread across multiple issues.) 

11:20 – 11:45 Small Group Reporting 

11:45 – 12:00 Next Step, Q & A 

SMALL GROUP GROUND RULES 

Silence all cell phone. Please leave the room if you must respond to a call. 

Respond briefly to the group activity, thus allowing each participant an opportunity to 

take his/her turn. 

Maintain respect of views or opinions that might differ from yours. 


24 

Appendix 2/19/2013

Summary of Priority Needs Identified From Meeting 

Purpose of Meeting: 

The purpose was to analyze/evaluate and prioritize community health needs in order to give the 

hospital a base by which to determine which community health needs it can address and which 

ones it can’t. 

Format: 

Meeting included community leaders and hospital leaders with intention of reviewing the data 

that was gathered from CHNA hospital survey, focus groups and interviews. Flora Washburn, 

SJB Mission Services, and Ruth Hawkins, Madison County Health Department, facilitated the 

meeting. 

Process: 

We reviewed the data as a group. Next step was to form into two smaller groups. Group 

members worked through 5 (timed) activities to: 1) identify the top 5 needs based on what they 

had heard earlier; 2) identify known services; 3) identify service gaps or services needed to 

address the needs; 4) recommend what actions Saint Joseph Berea should take to address the 

needs; and then 5) select the most important 5 actions to be taken by the hospital over the next 3- 

5 years. 

Outcomes: 

Activity 1: 

Given the mission, vision and values of SJB and the Community Assessment data, identify the 

most important health issues or problems for St. Joseph Berea Hospital to address in the next 3-5 

years. 

Group #1 

1. Mental health services/Drug addiction 

2. Collaboration of care/services 

3. Chronic disease prevention 

4. Lack of insurance 

Group #2 

1. Healthy Family 

2. Dental Care 

3. Alcohol/Drug Abuse 

4. Exercise Programs 

5. Address Connection Between Issues/ Healthy 

Education In All Ages 

Activity 2: 

Related to each of the TOP 5 health issues or problems, in order of priority, identify KNOWN 

services currently offered by St. Joseph Berea Hospital, medical & community partners that address 

each of the TOP 5 health issues or problems identified. 

Group #1 Group #2 

1/2. MENTAL HEALTH/ DRUG ADDICTION 

1. HEALTH FAMILY 

• Senior Renewal 

• WIC 

• Contract with The Ridge 

• Park/Rec 

• Informal relationship with Comp Care • Health Dept. 


25 

Appendix 2/19/2013

• Local chapter of NAMI 

3. COLLABORATION OF CARE/ TRANSITION OF CARE 

• Case managers help with transition 

• Contract with The Ridge 

• Referrals to Comp Care, MCHD 

• Meetings with nursing homes 

• Informal conversation between partners 

• EMR interfacing 

• Liberty House 

4. CHRONIC DISEASE PREVENTION 

• Patient education 

• Diabetes educator 

• Referrals to MCHD Diabetes center 

• Health promotion marketing 

• Screenings at community events 

• (blood pressure, glucose, BMI, body 

mechanics) 

• Schools/Family Resource Center 

• Faith Based 

• Berea College 

• Comp. Care 

• Social Services 

• KY River Foothill 

• Nami 

• Community Activities 

2. DENTAL CARE 

• White house clinic 

• Hospital fund SJB 

• Dr. Jones Pediatric Dentist 

• Private Dentist 

• Ahec (education) 

• Private dental insurance/plans 

3. ALCOHOL/DRUG ABUSE 

• Comp Care 

• AA 

• Celebrate Recovery 

• Allnon 

• Tentative Output Program 

• Liberty place 

• Subxene clinic 

• Upward bound 

• Health Dept. 

• Police Dept. (pill drop, educate parents) 

• Colleges 

• Public School 

• Drug court 

• Faith house 


26 

Appendix 2/19/2013

5. LACK OF INSURANCE 

• Charity care 

• Financial counselor 

• Community philanthropy 

• Auxiliary medication program 

4. EXERCISE PROGRAMS 

• Body recall 

• Parks/ Rec 

• YMCA 

• Fitness friend/family 

• Jazzercise 

• Total fitness 

• C Berry Center 

• Upward bound 

• Youth seg. 

• Schools 

• Senior Center 

• Get healthy Berea 

5. CONNECTION BETWEEN ISSUES/ HEALTH 

EDUCATION IN ALL AGES 

• Health Dept. 

• SJB (health events, lunch & learn) 

• Women & Health 

• Parks/Rec 

• Schools 

• Fitness Centers 

• Physicians 

• NAMI 

• Hopes Wings 

• Comp. Care 

• Wic 

• Head Start / Pre K 

Activity 3: 

Related to each of the TOP 5 health issues or problems, identify service gaps or needed 

services to address each issue. 



• Inconsistent protocol with referrals 

from ER 

• Lack of local treatment resources 

outside hospital 

• Lack of providers within hospital 

• Lack of training for providers within 

Emergency Dept 

• Providers dismiss issue as “untreatable” 

• Employee assistance program, Lack of 

utilization 

1. HEALTHY FAMILY 

• Communication (between agency) 

• Collaboration 

• Pro Health Counsel (community) 

• Increase community resources 

• Promote Health Education 

• Resource Guide 

• Berea Educational Website 

• Increase dental care for uninsured. 


27 

Appendix 2/19/2013

3. COLLABORATION OF CARE/ TRANSITION OF 

CARE 

• Competition for market share hinders 

collaboration 

• Lack of concentration of services 

• Lack of local services 

• Lack of awareness of local services 

• Lack of collaboration with home 

healthy services. 


• Collaboration of care – Lack of 

• Overcoming barriers for specific 

populations 

• Lack of community 

education/community awareness about 

services 

• Lack of focus on children/collaboration 

with schools 

• Comprehensive education 


• Charity care doesn’t meet all needs 

• Providers don’t take into account 

patient’s financial needs 

• Providers not aware of services hospital 

has 

• Complicated enrollment 

• Medicaid limitations 

2. DENTAL CARE 

• Co Pay Rates 

• Affordable dental care 

• No orthodontic/ Oral surgeons in Berea 

• Need additional dentist 

• Dentist not taking Medicaid 

• Dental education 

3. ALCOHOL/DRUG ABUSE 

• Lack mental health issues 

• Faith based 

• Kids better counseling 

• No treatment centers for men 

• Family member support groups 

• More centers for withdraw patients 

4. EXERCISE PROGRAMS 

• Lack on education (mental health) 

• Fund programs (scholarships for 

memberships)-kids activity 

• Increase trails (run, bike) 

• Increase pedestrian friendly (sidewalks) 

• Gyms 

• Rec. centers 

• Advertisement 

5. CONNECTION BETWEEN ISSUES/ HEALTH 

EDUCATION IN ALL AGES 

• Community 

• Cross education (facility) 

• Preventive health 

• Collaboration 

Activity 4: 

What actions should St. Joseph Berea Hospital take in meeting these health issues or 

problems? 



28 

Appendix 2/19/2013


• Continue developing outpatient mental 

services 5 

• Provide training for providers 1 

3. COLLABORATION OF CARE/ TRANSITION OF 

CARE 

• Continued engagement after discharge 4 

votes 

• Ask-a- nurse 3 votes 

• Outpatient inpatient relationshipformalize 

the program 2 votes 

• Interfacing EMR in region 

• Compile list of local services 1 vote 


• Health dept. resource information in 

Emergency Dept 

• Collaboration with Ky. River 

foothills/LKLP for transportations – 

raise awareness 2 votes 

• Share marketing tools 

• Develop community wide health 

education calendar 3 votes 

• Develop punch card of preventive SVCS 

+ info on where you can get them. 4 

votes 

• Reach out to schools-focus on BCS 3 

votes 


• Have informational sheets available 24/7 

(patients/providers) 3 votes 

• Connect hospital resources (PFAF) to 

patient needs 3 votes 

• Community Resource Guide – 11 votes 

• Wellness Counsel / Pro Health Counsel - 8 

• Faith based Communication (TV, Radio, 

Media)-4 

• Connections (partnering together) -4 

• Community Outreach -3 

• Mobile Clinics -3 

• Training Staff – 1 vote 

Activity 5: 

Identify the 5 most important actions to be taken by the hospital over the next 3-5 years. 



29 

Appendix 2/19/2013

1. Continue developing outpatient mental services 

-5 

2. Continued engagement after discharge -4 

3. Develop punch card of preventive SVCS + 

info on where you can get them -4 

4. Ask a Nurse -3 

5. Have informational sheets available 24/7 

(patients/providers) -3 

6. Connect hospital resources (PFAF) to 

patient needs -3 

7. Develop community wide health education 

calendar 3 

8. Reach out to schools-focus on BCS -3 

1. Develop a community resource guide. 

2. Create a wellness council for the 

county/community that could work 

together. 

3. Agencies coming together for direction, 

community resources, and partnering 

together; better connections 

4. Greater awareness of services through faith 

based communication (TV, Radio) and 

through the media 

5. Provide more community outreach; ie: 

mobile clinics 


30 

Appendix 2/19/2013

Appendix F: Acknowledgements 

Acknowledgements 

The Saint Joseph Berea Steering Committee was the convening body for this project. Many other 

individuals including community residents, key informants, and community-based organizations 

contributed to this community health needs assessment. 

Project Steering Committee and CHNA Advisory Committee 

Special thanks to all the community members, and hospital employees who committed time and 

information in order to complete this CHNA project. 

Eastern Kentucky University (EKU) and Berea College Professors and Interns 

Saint Joseph Berea was fortunate to have student interns with the cooperation of their professors assist in 

completing survey results, interviews and focus groups. They collected data, assisted with focus groups, 

worked on special projects and generally agreed to do all that was asked of them. Their assistance in 

pulling the pieces together was extremely helpful. 

Key Informants 

Thank you to the business persons, physicians, city officials, and individuals who participated in our key 

informant interview process, offering their perspective on community health needs. 

Focus Group Participants 

People from different walks of life participated in the Focus Group for Saint Joseph Berea Hospital’s 

CHNA. Focus group participants included members of the hospital’s patient advisory council, current and 

former patients, patient caregivers, first responders, parents, teachers and county agencies. In order to 

protect the privacy of the participants, individual names have not been listed. 


31 

Appendix 2/19/2013

Appendix G: Resources 

Annie E Casey Foundation: 2012 Kids Count Data Book 

http://datacenter.kidscount.org/DataBook/2012/OnlineBooks/KIDSCOUNT2012DataBookFullReport.pdf 

Berea, Kentucky City Government website 

http://bereaky.gov/for-visitors/community-profile/ 

County Health Rankings 

http://www.countyhealthrankings.org/rankings/ranking-methods/download-rankings-data/KY 

Dignity Health Community Health Needs Index 

www.dignityhealth.org/cni 

Kentucky Health Facts 

www.kentuckyhealthfacts.org 

Kentucky State Plan on Aging, 2009-2012 

e83a39f95aa5/0/kentuckystateplanonaging20092012finalproofed91009.pdf 

Madison County Health Department: 

MAPP CHNA Update 2011 

http://www.madisoncountyhealthdept.org/Documents/Community/MAPP2011.pdf 

Madison County Comprehensive Community Health Improvement Plan (MCCHIP) CHIP) 

2009-2014 with 2011 Review and Addendum 

http://www.madisoncountyhealthdept.org/Documents/Community/CHIP%20rv%2011%202012.pdf 

Madison County Quick Facts - Berea 

http://www.thinkkentucky.com/EDIS/cmnty 

Madison County, KY - County Health Rankings 2010-2012 Report 

U.S. Census Bureau 

http://factfinder2.census.gov 

http://chfs.ky.gov/nr/rdonlyres/3045c0d1-a6c0-498a-9347- 

Richmond Register newspaper: Nearly One in Four Madison County Children Live in Poverty 

http://richmondregister.com/localnews/x175566435/Nearly-1-in-4-Madison-County-children-live-inpoverty 

Richmond Register newspaper: 18 Percent in County without Health Insurance 


32 

Appendix 2/19/2013

http://richmondregister.com/localnews/x101449028/18-percent-in-county-without-health-insurance/print 

2011 Kentucky Health Issues Poll (KHIP) 

http://cincinnati.com/blogs/economics/2012/03/14/kentuckians-with-higher-incomes-report-better-healthhowever-more-people-living-in-poverty/ 


33 

Appendix 2/19/2013

Community Health Needs Assessment 2012 - Saint Joseph Hospital

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