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Assessing the Needs of the CommunityOverview:Mayo Clinic Health System – Northland in Barron identified and prioritized community health needsthrough a comprehensive process that included input from a cross section of community andorganizational leadership as well as direct input from the community. The assessment was particularlyaimed at understanding the needs of the traditionally underserved in the community.The Mayo Clinic Health System regional Community Health Needs Assessment Committee (CHNAC) ledthe process of evaluating the health needs of our communities and determining our community healthpriorities. The committee was chaired by the regional chief executive officer and included leadershiprepresentation from the Northwest Wisconsin region of Mayo Clinic Health System which is comprisedof five hospitals located in Eau Claire, Barron, Bloomer, Menomonie and Osseo. Committee memberswere chosen for their expertise in directly providing services to meet the health needs of ourcommunities and for their involvement in existing community programs and services. The committeewas responsible for creating a thorough and organized needs assessment process as well as fordeveloping an effective plan to meet the identified needs.Process and Methods:The assessment process began with a thorough review of the Barron County Community Health NeedsAssessment (CHNA.) The purpose of the county report is to assess the needs in our community,identify community resources to address the most urgent needs and encourage action plans that solvecommunity problems.In January 2011, a group of health care leaders formed a steering committee to lead the CHNA forBarron County. Founding members of the steering committee include: Jolene Anderson, Marshfield ClinicDeb Dietrich, Mayo Clinic Health SystemKelli Engen, Barron County Public HealthLaura Johnson, Be Well Barron County CoalitionJenny Jorgenson, Mayo Clinic Health SystemLisa Laatsch, Lakeview Medical CenterBeverly Mahler, University of Eau Claire Student NurseHeidi Massey, Western Regional Office, Public HealthChar Mlejnek, Lakeview Medical CenterKaren Morris, Western Regional Office, Public HealthDanessa Sandmann, AmeriCorps, Lakeview Medical CenterLaura Sauve, Barron County Public HealthRita Sullivan, Mayo Clinic Health SystemPage 9 of 24

Sarah Turner, Safe and Stable Family CoalitionBobbi Wyss, Cumberland Health CareJoe Willger, Marshfield ClinicThe steering committee sought guidance on the process from the Wisconsin State Department ofHealth (Karen Morris and Heidi Massey.)The group researched best practices for conductingcommunity assessments by reviewing materials and talking to representatives from other counties thathad completed the task. A planning timeline and outline for the assessment was developed to keep theproject moving forward.Data for Barron County was compiled by the committee for the following three areas to use in theCHNA process: DemographicsCommunity perception surveyHealthy Wisconsin 2020 Health PrioritiesCommunity perception surveyThe county CHNA included a random household survey. The objective was to increase theunderstanding of the community’s health needs and its perception of the main challenges facing theresidents of Barron County. Surveys were distributed to libraries, hospitals, clinics, the free clinic, foodpantries and senior centers. A press release was sent to area newspapers announcing the initiative andasking for community participation. The survey process also was explained and promoted on themorning talk radio show on WJMC in Rice Lake.The survey was translated into both the Spanish and Somali languages (prevalent populations in BarronCounty) to ensure that the opinions of those populations were included. The committee received 13Somali surveys and 12 Spanish surveys.More than 1,100 surveys were completed both online and on paper. The results were tabulated andweighted. Based on the surveys returned, community members felt the health issues in Barron Countywere:1. Alcohol and drugs 23.0 percent2. Chronic disease 12.0 percent3. Nutrition 10.8 percent3. Physical activity 10.8 percent5. Tobacco 8.6 percent6. Mental health 7.4 percent7. Injury and violence 6.5 percent8. Oral health 4.6 percent9. Growth and development 4.2 percent10. Reproductive health 4.1 percentPage 10 of 24

11. Communicable disease 3.2 percent12. Environment 2.2 percentNo answer 0.4 percentThe steering committee used Healthiest Wisconsin 2020 as a foundation to conduct the datacollection. Healthiest Wisconsin 2020 encompasses two main focus areas: 1) cross cutting, whichincludes eliminating health disparities and socio-economic and educational determinants; and 2)health, which includes 12 focus areas: Alcohol and drug useChronic disease prevention and managementCommunicable diseasesEnvironmental and occupational healthHealthy growth and developmentInjury and violence preventionMental healthNutrition and healthy foodsOral healthPhysical activityReproductive and sexual healthTobacco use and exposureThe complete Healthiest Wisconsin 2020 plan can be found e committee hosted a Community Planning Day on September 12, 2012, inviting business leaders,health experts and the general community to select the top three health priorities for Barron County.Community experts on each of the 12 areas also were invited to ensure that along with communitymembers, people who have a working understanding of the issues were included in the process.Small group sessions on each priority area were charged with giving three reasons why that priorityshould be chosen as a Barron County health priority. These small groups then made their case to thelarge group. After the presentations were made, and community input from the March 2012 surveyswas considered, a vote was taken to determine the top three priorities, which were:1. Alcohol and drugs2. Mental health3. Chronic diseaseThe CHNAC also reviewed a wide range of secondary data sources including health, demographic andsocio-economic qualitative data. A full citation of data sources is included in Appendix B.Page 11 of 24

One of the main data sources was County Health Rankings provided by the Centers for Disease Control.Launched in 2010, the program aimed to produce county level health rankings for all 50 states. TheCounty Health Rankings identify the multiple factors that determine a county’s health status, includingenvironment, education and jobs, individual behaviors, access to services and health care quality.County Health Ranking Data for Barron County has been included as Appendix C.Prioritization processThe CHNAC used these data sources and the county CHNA to compile a thorough listing of communityhealth needs. Identified needs were evaluated using a matrix called the CHNA Process to Identify &Prioritize Needs. Each need was measured on a set of criteria, which then was given a ranking of high,medium or low for each criteria. The criteria used were: comparison to state and national goals,community impact, the organization’s ability to impact change, community readiness for change, gapsin community resources, and the voice of local customer. The prioritization matrix is included asAppendix D.Page 12 of 24

Addressing the Needs of the CommunityOverviewAfter completing an extensive analysis of the county CHNA, Healthiest Wisconsin 2020, County HealthRankings and other quantitative and qualitative data, the top community health needs identified asMayo Clinic Health System – Northland in Barron priorities are: Chronic disease prevention and managementPhysical activityAdequate, Appropriate and Safe Food and NutritionChronic disease prevention & managementAccording to Healthiest Wisconsin 2020, the goals of chronic disease prevention and management are“to prevent disease occurrence, delay the onset of disease and disability, lessen the severity of diseaseand improve the health-related quality and duration of the individual's life.”Four modifiable health risk behaviors— unhealthy diet, insufficient physical activity, tobacco use andsecondhand smoke exposure, and excessive alcohol use — are responsible for much of the illness,suffering and early death related to chronic diseases. Prevention is not always possible, so it isimportant that effective management of chronic disease be part of the health care system.Although chronic diseases usually become clinically apparent in adulthood, the exposures and riskfactors that precede disease onset occur at every stage of life. Childhood and adolescence are criticaltimes to deliver and reinforce health education messages.Data HighlightsChronic diseases, such as heart disease, stroke, cancer, diabetes, asthma and arthritis, are among themost common and costly of all health problems in the United States. Currently, seven of the 10 leadingcauses of death in Wisconsin and the U.S. are due to chronic diseases, accounting for approximatelytwo out of every three deaths annually. Cardiovascular disease is consistently the leading cause of mortality for Wisconsin residents,accounting for more than 16,000 deaths annually, or 35 percent of all deaths.Each year from 2002 through 2006, an annual average of 27,256 cancers were diagnosedamong Wisconsin residents. The average age-adjusted incidence rate for all cancers was 470.3per 100,000 Wisconsin residents.From 2004 to 2007, diabetes-related hospitalizations increased nearly 11 percent, from 85,113to 94,331. Diabetes prevalence among adults increased more than 27 percent, from 329,460 to419,870.In 2005, more than 5,500 Wisconsin residents were hospitalized for asthma and more than22,000 sought emergency room care for asthma.Page 13 of 24

More than 27 percent of Wisconsin adults aged 18 years and older (1.1 million) reported theyhad some form of arthritis during 2003–2007.Chronic diseases are several of the leading causes of death in Barron County, Wisconsin and thenation.Annually, on average 63 percent of deaths in Barron County are due to chronic disease.In 2009, 12.8 percent of hospitalizations in the county were chronic disease related, while only6.5 percent were injury-related.In Barron County, an estimated 9 percent of the population (over 4,100 residents) is living withdiabetes. However, only 6.6 percent of that number has been officially diagnosed with thedisease, and even fewer are successfully managing their blood sugars.Consistently, heart disease is the leading cause of death in Barron County, accounting for nearlya quarter of deaths annually.In 2009, an estimated 9.1 million was spent on coronary heart disease hospitalizations inBarron County, with nearly 5 million incurred by patients over 65.Additional information included in the Healthiest Wisconsin 2020 Health Focus Areas report can befound here: pdfPhysical activityLimited physical activity is closely linked to obesity (a major risk factor for cardiovascular disease,certain types of cancer, type 2 diabetes and other chronic diseases.) Obesity is defined by the Centersfor Disease Control and Prevention as “a body mass index (BMI) of 30 or greater. BMI is calculatedfrom a person's weight and height and provides a reasonable indicator of body fatness and weightcategories that may lead to health problems.” U.S. and Wisconsin rates of obesity have risen steadilyover the past 20 years, with a leveling off in recent years. The Behavioral Risk Factor SurveillanceSystem results for 2008 indicate that 26.7 percent of the U.S. population and 26.1 percent of theWisconsin population were obese.Data highlightsObesity, the second leading cause of death in the U.S., has increased significantly from 2000 to 2010.This increase has occurred nationally, as well as in Minnesota, Wisconsin and Barron County. Levels of physical activity trends in Wisconsin have shown a slight increase since 2001. Theproportion of residents meeting the minimum physical activity recommendations rose from 52percent (2001) to 55 percent (2007.) Nearly half the population of Wisconsin does not meet therecommendations for physical activity. Twenty-six percent of Wisconsin adults are obese and 64 percent are overweight or obese. Twenty-three percent of high school students are overweight or obese. According to Behavioral Risk Factor Surveillance System Survey data, 59 percent of adult womenand 77 percent of adult men in Barron County are overweight or obese. Approximately 27percent of adults in the county report their rate of physical activity as “inactive.” In one Barron County high school, 37 percent of students in grades 9 through 12 wereoverweight or obese, according to BMI data obtained from the Be Well Barron County program.Page 14 of 24

Additional information included in the Healthiest Wisconsin 2020 Health Focus Areas report can befound here: pdfAdequate, appropriate and safe food and nutritionAccording to Healthiest Wisconsin 2020, adequate, appropriate and safe food and nutrition means theregular and sufficient consumption of nutritious foods across the life span, including breastfeeding, tosupport normal growth and development of children and promote physical, emotional and social wellbeing for all people. Good nutritional practices also can reduce the risk for a number of chronicdiseases, which are major public health problems, including chronic conditions such as obesity, type 2diabetes, cancer, heart disease and stroke.Data highlightsObesity is one of the most critical health issues of our time. Overweight and obesity describe ranges ofweight for a certain height that are higher than that considered healthy. Obesity is a paramount healthconcern for Wisconsin and the nation because of its strong relationship to many negative healthconditions and outcomes, such as type 2 diabetes, cardiovascular disease, certain cancers, arthritis,asthma, depression and negative pregnancy and birth outcomes. Obese youth are also much morelikely to become obese adults, putting them at risk for having lifelong health consequences.Poverty in Wisconsin rose substantially during the 2000s. In 2009, 12.4 percent of the state’spopulation was living in poverty, increasing to 13.2 percent in 2010. Poverty puts households at a muchgreater risk of experiencing food insecurity and hunger. Households that are food insecure haveuncertain access to food.Data about the prevalence of obesity have been included under physical activity. Along with thosestatistics, about 14 percent of adults and 7 percent of high school students eat fruit at least twice perday and vegetables at least three times per day.Additional information included in the Healthiest Wisconsin 2020 Health Focus Areas report can befound here: pdfHealth needs not addressedThrough our assessment process, the CHNAC identified other community health needs that have notbeen addressed in this community health improvement plan. In prioritizing community health needs,the CHNAC took into consideration other community organizations addressing the need in question,the core competencies of Mayo Clinic Health System and our ability to impact change, as well as thereadiness of the community for interventions. Access to dental care: This is outside the expertise and resources available at the hospital.Alcohol and drug use/abuse: Other agencies in the county are addressing these issues, andthey are generally out of scope for Mayo Clinic Health System.Tobacco: We will continue to support the decrease in tobacco use through patient education.Page 15 of 24

Mental health: This is a core service of Mayo Clinic Health System, which we will continue toaddress to meet the needs of our patients. Lack of medical providers in the county wasidentified during the assessment, and in July 2013, a full- time psychiatrist was added to MayoClinic Health System – Northland in Rice Lake.Page 16 of 24

Appendix A: Additional DemographicsBarron CountyPopulation: 45,707Population in poverty: 11.4%*Unemployment rate: 8.4%**Uninsured ages 18-64: 8.5%Uninsured under 18: 0.9%Adults 25 years with high school education or less: 53.5%Page 17 of 24

Appendix B: Individuals Involved in CHNABarron County CHNA Steering Committee Jolene Anderson, Marshfield Clinic Deb Dietrich, Mayo Clinic Health System Kelli Engen, Barron County Public Health Laura Johnson, Be Well Barron County Coalition Jenny Jorgenson, Mayo Clinic Health System Lisa Laatsch, Lakeview Medical Center Beverly Mahler, University of Eau Claire Student Nurse Heidi Massey, Western Regional Office, Public Health Char Mlejnek, Lakeview Medical Center Karen Morris, Western Regional Office, Public Health Danessa Sandmann, AmeriCorps, Lakeview Medical Center Laura Sauve, Barron County Public Health Rita Sullivan, Mayo Clinic Health System Sarah Turner, Safe and Stable Family Coalition Bobbi Wyss, Cumberland Health Care Joe Willger, Marshfield ClinicPersons with special knowledge and expertise in public health Judy Demars, HHS Director Kelli Engen, RN Health Officer Laura Sauve, RN, Public Health Nurse Marla Pritz, WIC Nancy Drake, Wisconsin Women Well ProgramGovernment agencies with knowledge of relevant health needs of the community Health and Human Services UW Extension office Veteran's Affairs Aging and Disability office Birth to Three ProgramMedically underserved representatives Judy Demars, HHS Director Kelli Engen, RN Health officer Laura Sauve, RN Public Health nurse Marla Pritz, WIC Nancy Drake, Wisconsin Women Well Program Clare Janty, Rice Lake Free Clinic Charlene Oftadahl, Office on Aging, Marshfield Dental ClinicPage 18 of 24

Minority populations Workforce Development Barron County International Center, Nasra Xashi Health and Human Services Veteran's ServicesLow income representatives Judy Demars, HHS director Kelli Engen, RN Health officer Laura Sauve, RN Public Health nurse Marla Pritz, WIC Nancy Drake, Wisconsin Women Well Program Clare Janty, Rice Lake Free Clinic Charlene Oftadahl, Office on Aging Workforce Development Area food pantries Heart Island Family Enrichment Center Benjamin's HouseHealth care consumer advoca

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