At Katherine Shaw Bethea Hospital, our mission is to restore, maintain, and enhance health by providing superior care now and in the future. Since Katherine Shaw Bethea Hospital was founded in 1897 by Solomon Hicks Bethea in memory of his late wife, we have been an integral and highly visible part of the Dixon community.
The Community Health Needs Assessment is a process we undertake every three years in compliance with federal requirements. But it’s more than that. It’s also a chance for us to listen to the people we serve and challenge ourselves to better understand and respond to their health needs. Sometimes we hear similar concerns or challenges that have been facing our community—and communities across America—for years. Sometimes we hear new questions or issues that have just come up. Altogether, the CHNA process helps us listen to our community and plan a response to better meet their needs.
Definition of Community & Demographics
For this Community Health Needs Assessment, we define our community as Lee County, Illinois. KSB Hospital is located in Dixon, Illinois, which is the county seat of Lee County. In addition to the hospital, KSB operates Commerce Towers Clinic, Town Square Centre Clinic, Edwards Clinic, Lawless Eye & Vision Center, KSB/Physicians Immediate Care, a physical therapy clinic, and the Lovett Center in Dixon, as well as the Amboy Clinic and Ashton Clinic in Lee County. KSB also has clinic locations in Oregon, Mount Morris, and Polo in Ogle County. We define our Primary Service Area as 15 ZIP Codes in Lee and Ogle Counties, with a total population of approximately 45,000—of which 2/3 are in Lee County, led by Dixon’s 61021 ZIP Code with about 22,000 people. Because of the significant population share in Dixon and Lee County, and because of how data is commonly collected and reported, we chose to identify Lee County as our community for this CHNA.
Lee County has a population of 34,406, according to the U.S. Census Bureau 2017 estimate. Looking at Lee County population by age shows a notably higher percentage of the population over age 65 than the state or national averages—with 18.0% in Lee County versus 14.3% in Illinois and 14.9% in the United States. As a corollary, the population age 17 and under in Lee County, 20.0%, is lower than the state, 23.0%, or national, 22.9%, levels. The median age in Lee County is 42.7, compared to 37.7 in Illinois, and 37.8 in the United States.
Lee County also has less racial diversity than Illinois or United States totals. Lee County is comprised of 90.8% white, 5.2% black, and no other race above 1%. Additionally, 5.9% of Lee County residents are Hispanic or Latino.
Existing Health Care Facilities & Resources
Lee County residents are served primarily by KSB Hospital and the KSB Medical Group for medical needs. KSB Hospital is an 80-bed acute care hospital offering emergency medicine, labor & delivery, inpatient psychiatry, multi-disciplinary surgery, and a comprehensive set of diagnostic imaging and laboratory services. The KSB Medical Group is a multi-specialty physician practice offering services in 10 locations across six local communities in Lee and Ogle Counties. In addition to the physician practices, KSB also offers outpatient and clinic services in physical therapy, behavioral health, home care, respiratory therapy and sleep lab, and wellness, among others.
The mental health needs of Lee County residents are also served by Sinnissippi Centers, a comprehensive provider of behavioral health and substance abuse counseling services. Local residents can receive urgent medical care at KSB/Physician’s Immediate Care. Many providers offer dental and orthodontic services, and several local stores offer pharmacy and optometry services.
Obtaining the Data
Data for this CHNA was obtained from a variety of sources, both in person and online. Demographic data and health indicators were obtained on the Community Commons website through their CHNA Report tool. Population data was obtained from the U.S. Census Bureau website and their American Community Survey tool.
As part of a strategic planning process in early 2019, KSB administration and members of the Board of Directors conducted more than 100 in-person interviews with stakeholders and representatives of widely varied parts of the community. Those interviews were documented in a standardized way and allowed several valuable insights into the health needs and perceived levels of access to various services within our community.
A CHNA survey was opened to the general public in September 2019 and responses were solicited through the KSB Hospital website and social media accounts. We received 122 responses, including 14% from individuals who received financial assistance in past year such as TANF, Public Aid, Medical Card, Food Stamps, Township Assistance, or other types of aid, not including Medicare or Social Security.
Data from these reports, interviews, and surveys were shared with the KSB Wellness Steering Committee to solicit input and stimulate discussion of community health needs among a committee that meets throughout the year to discuss wellness initiatives.
Health Needs of the Community
The surveys, interviews, census information, demographics, and health indicator data—combined with input from clinicians and organizational leaders—indicate the following to be the top health needs of the community: behavioral health, obesity and physical inactivity, access to care and transportation, food insecurity, and tobacco and e-cigarette use.
To identify and prioritize the needs, we used the Hanlon Method of health problem priority setting, and the PEARL test for feasibility. The Hanlon Method measures the size of the health problem, the impact of the health problem, and the effectiveness of intervention. The scoring identified the following three key priorities which will become the focus of implementation plans from KSB Hospital during the life of this Community Health Needs Assessment:
- Behavioral Health
- Obesity & Physical Inactivity
- Access to Care & Transportation
Priorities Not Selected
In the 2016 CHNA, we identified food insecurity as a key priority and enacted an implementation plan to meet the need. This plan included KSB participation in several community efforts to provide food to both children and adults who were food insecure. We are continuing to participate in these efforts and have been pleased with the progress they’ve made toward reducing food insecurity. At the time of the 2016 CHNA, the food insecurity rate was 12.9%, which was above the state and national averages. The latest data shows that number has dropped to 9.9%, which is below the state and national averages. The food insecurity rate for children has dropped from 21.5% to 14.9%. While there is still room for improvement, and KSB will remain engaged with “Fighting Hunger, Feeding Wellness” and hosting food drives to reduce food insecurity, the gains made in the last three years have led this to become a priority which was not selected among the top three items in this year’s CHNA.
Additionally, while KSB will also be engaged from a clinical and educational perspective in tobacco use and e-cigarette use, we did not score this in the top three because of the number of other community organizations who are sharing responsibility for intervention in this area. The Lee County Health Department, local school districts, law enforcement, and parent and student advocates are working to educate and prevent tobacco and e-cigarette usage. KSB will participate in these efforts even though this is not one of the top three priorities listed in this CHNA.
Behavioral health has been part of Community Health Needs Assessments since our first process in 2013. At KSB Hospital, we offer both inpatient and outpatient behavioral health services. We also partner with strong local providers like Sinnissippi Centers, a multi-county behavioral health and substance use disorder service provider. Together we offer behavioral health screenings in primary care offices and the emergency department. We also created the role of Mental Health Crisis Preventionist to be trained and ready to respond with de-escalation techniques and support patient and staff safety.
We’re investing in telehealth equipment and training in order to address the workforce recruitment challenges, especially with regard to psychiatrists and the necessity of physician services in the KSB inpatient behavioral health unit. Recruitment for an on-site psychiatrist continues, and remote telehealth providers help ensure continuity of services in our community during the search for difficult-to-recruit positions. We also made significant capital investments to improve patient safety within the inpatient unit.
Still today, surveys indicate widespread need for behavioral health services. More than 50% of survey respondents said they or someone in their household had experienced anxiety in the past year, and 45% answered affirmatively for depression. Further, 12% said yes for bipolar disorder and 9% yes for ADHD.
- Working with the Brain Health Now organization to help end the stigma around mental illness by hosting staff meetings, community seminars, and using the outreach toolkit
- Formation and expansion of KSB Mental Health Committee to focus on staff training in mental health awareness, CEU training for professionals, community awareness seminars, and fundraising
- Project OPEN, a community project of medical, behavioral health, public health, education, court, and law enforcement organizations to help build a network to prevent opioid addiction through awareness, education, and training
- Engagement with third-party behavioral health service line operators in order to improve efficiency, adopt clinical best practices, and strengthen operational sustainability of the spectrum of mental health services at KSB
- Hosting a ten-part community educational event series on Brain Health with presentations by behavioral health experts to help reduce stigma and provide tips on supporting positive brain health
- Monthly brain exercise classes to help aging local residents better understand brain health and how they can promote physical and mental wellness
- Path 2 Purpose, a free, voluntary program for teenagers who want to improve their mood and learn coping skills to manage difficult situations, in conjunction with a grant from the National Center for Rural Health Professions
- Implementation of a Zero Suicide initiative through screenings and assessments of all patients across KSB service lines and facilities
Obesity & Physical Inactivity
Again in the 2019 Community Health Needs Assessment, both survey and health indicator data show that residents of Lee County experience obesity or being overweight at rates that exceed state and national averages. Survey responses show 63% of people have personal or family experience with being obese or overweight. County health data shows 37.6% obesity and 53.4% overweight, compared to 29.4% obese and 36.4% overweight at the state level.
Further survey responses indicate 49% have personal or family experience with high blood pressure and 43% with high cholesterol. And 26.5% say they have no physical activity outside of work, compared to a state average of 21.8%.
The incidence of obese, overweight, or inactive residents presents significant health challenges, including high blood pressure and cholesterol, diabetes, and many other associated clinical issues.
KSB will continue to offer and support local opportunities for physical activity and exercise. KSB is a lead sponsor of the annual Reagan 5K Run during the Dixon Petunia Festival, which also includes the KSB Corporate Challenge for employer-based team competition. KSB also hosts exercise classes for activities like a six-week course on resistive band training, a six-week course on interval training, and yoga.
KSB will also sponsor a new team-based weight loss competition called the HealthyWage Jackpot Challenge, which includes access to an app with support, motivation, and mini-challenges to engage team members in healthy weight loss goals. KSB is the presenting sponsor of the KSB Wellness Center exercise facility in the Dixon Family YMCA, with donations to purchase new exercise and weight equipment. KSB clinicians also offer a ‘prescription’ for the Dixon Family YMCA, the Nash Recreation Center, and Anytime Fitness, which provides a free trial to residents looking to start new healthy habits. A registered dietitian host one-on-one nutrition and fitness consultations with local patients. KSB will also sponsor a bike giveaway and an adolescent bike riding group in conjunction with the Dixon City Market events.
- Offer recurring classes on exercise types and new training methods to help local residents find an individualized way to incorporate physical activity in to their life
- Sponsor the HealthyWage Jackpot Challenge to promote team weight loss and provide app-based education and support
- Reach patients through one-on-one consultations with a registered dietitian in a clinical or community setting
- Sponsor Learning to Live Well educational series with specialized sessions for nutrition, exercise, goal-setting, and seasonal focus on New Year’s resolutions, health during the holidays, and other relevant topics
- Ongoing financial commitment to the KSB Wellness Center at the Dixon Family YMCA, and engagement with Dixon Park District plans for the construction of a new community center with wellness and fitness services
- Hosting weekly free blood pressure checks at local grocery store, and expanding to Oregon Clinic
- Monthly wellness screenings for cholesterol and one-on-one consultations with a registered dietitian
Access & Transportation
Health services may be available within a community but local residents are unable to access those services because they don’t know about them, they can’t find transportation to them, they can’t get a convenient scheduled appointment time, or they have financial limitations to access.
CHNA survey respondents rated “public transportation for all residents” with the lowest score out of 11 categories on the survey. Additionally, “easy to find information about local services” was the third-lowest score. Scoring slightly better were public transportation for seniors or those with disabilities. The Lee-Ogle Transportation System offers regional public transportation, but has more riders from the senior or disabled populations than from the population at-large.
KSB will seek to offer medical services when possible via virtual visits, thus alleviating the need for transportation for some types of medical visits. A wider implementation of telemedicine will provide local residents with a cost-effective way to receive medical care without the resulting transportation hurdles that may apply for patients with limited options.
Additionally, KSB is participating in a grant-sponsored mobility project with the Lee-Ogle Transportation System to identify solutions to mobility problems for low-income individuals and children. The mobility project members interviewed low-income individuals and users of public transportation to about the challenges they face, and what options they have for transportation today.
- Launch and scale up KSB Care Anywhere virtual visits through the Zipnosis telemedicine platform to offer medical care from the convenience of the patient’s home or workplace to alleviate the need for transportation and reduce work- and school-related scheduling conflicts
- Use of KSB Hospital advertising spending, social media presence, facility signage, and website to share and disseminate information on health and wellness services that are available within our community
- Participate on steering committee of Lee-Ogle Transportation System mobility project and share information on appointment cancellations and no-shows related to patient transportation problems
- Identify possible solutions including launch of Lyft or Uber ride-sharing platforms in the local area, and provide financial support to defray the cost of using public transportation, taxis, or ride-sharing to get to clinical appointments, pharmacies, or health and wellness activities
Primary & Chronic Health Needs of Uninsured Persons, Low-Income Persons, and Minority Groups
The CHNA process took into account the unique health needs of uninsured persons, low-income persons, and minority groups. Responses to the survey included 14% from households who had received Medicaid, SNAP, and other public services for low-income individuals and families. That response rate is slightly lower than, but close to, the observed Medicaid rate of 19% Lee County.
Representatives from the Lee County Health Department and Lee-Ogle Transportation System contributed to discussions about community health needs and prioritization. Both organizations regularly provide services to uninsured people, low-income people, minority groups, and individuals with mobility or transportation limitations. Both the online survey and the one-on-one interviews included representatives from various ethnic and socio-economic groups, and those diverse perspectives greatly contributed to the discussion and prioritization exercise.
Limits to Our Data & Assessment
All data sets have limitations, including timeliness, sample size, and geographic constraints. We used the most recent available data, which was very recent for items like census and demographic estimates, but somewhat older for some county health incidence data found in the Community Commons CHNA report compilation. Our survey and interview data may be limited by anecdotal or incomplete personal perspectives, but we attempted to account for this by taking in to account more than 200 different perspectives, and by referring to numerical indicators where possible.
Availability of the Community Health Needs Assessment
The KSB Community Health Needs Assessment 2019 is available to the general public on ksbhospital.com/CHNA and a free printed copy is available to individuals who make a request to KSB Hospital, 403 E. First St, Dixon, IL 61021
Special thanks to the following individuals who offered expertise, input, and participation in discussions on the Community Health Needs Assessment:
Cathy Ferguson, Lee County Health Department
Greg Gates, Lee-Ogle Transportation System
Joseph Welty, MD
Pratip Nag, MD
And to the 100+ community members who participated in one-on-one interviews with KSB Administration and Board members, and the 120+ respondents to the CHNA online survey.
Appendices & Links