Rural Maine gets mixed health care report

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BREWER – A recent study of the health status of Mainers in the northern half of the state finds some reasons to celebrate, but also underscores the challenges of providing comprehensive medical care to a small, aging population scattered across nine largely rural counties.

In the Bangor area, people with chronic illnesses such as heart disease and diabetes are being cared for more effectively, the study shows, and risk factors such as inactivity, smoking and obesity are on the decrease. On the other hand, depression in the elderly, low-birth-weight babies, and substance abuse have all increased since 2001, the study shows.

Commissioned by Eastern Maine Healthcare Systems, the study uses data from 2006 to update a similar report from 2001.

The organization says the comparison shows those aspects of health care that are working – and those that are not – and will be used to improve care throughout the region.

A series of regional meetings is planned to discuss the report and challenge community leaders and health care providers to generate ideas for improving health care in their areas.

In addition to a telephone survey of more than 2,300 households in the region, the study draws on a wealth of other information, including public birth and death records, hospital discharge data, cancer registries, unemployment records and self-reported mental health and substance abuse surveys.

The study divides northern Maine into seven regions served by 23 hospitals: Bangor, Aroostook, Penquis, Washington, Hancock, Knox-Waldo and Central Maine, which includes Waterville, Skowhegan and Pittsfield.

It compares health measures in these areas against data for the state and for “peer” communities chosen for their demographic similarity to the regions in the study.

Results vary widely among the regions.

Overall, the most positive changes since 2001 have occurred in the Bangor region. The updated study shows that the management of chronic diseases such as diabetes, heart disease and lung disease has improved, as measured by fewer hospitalizations and emergency room visits associated with those conditions.

Chronic diseases, many of which are related to smoking, poor diet and lack of exercise, account for a majority of health care spending in Maine and in the United States. Improving the prevention and management of these disorders is a major goal of health care practitioners and policymakers.

Supporting the drop in hospitalizations and emergency department visits, the Bangor region shows a 25 percent decrease in the number of adults afflicted with multiple medical problems, a 27 percent decrease in smoking, a 7 percent decrease in adults who say they are obese and a 17 percent decrease in adults who say their lifestyles are sedentary, compared to 2001.

Jerry Whalen, vice president for business development at EMHS, said the study is not designed to determine the cause of these changes. But he noted that an ambitious workplace wellness program offered through the Bangor Area Chamber of Commerce in response to the 2001 survey may be having the desired effect.

On the downside, the Bangor region shows increased rates of depression in the elderly, more children with diagnosed learning disabilities, and more drug and alcohol abuse in all ages.

Bangor also has seen an increase in low-birth-weight babies and premature births since 2001. Whalen suggested that Maine’s burgeoning population of young women addicted to opiates, and the fact that Eastern Maine Medical Center has the only neonatal intensive care unit in the nine county region, may explain the increase.

Beyond the Bangor region, the study finds that:

. Obesity rates increased in every other area covered by the survey.

. Smoking rates increased in every region except Bangor and Knox-Waldo, with an especially sharp increase in the Washington region, which also showed the highest rate of chronic lung disease.

. Adults in the Penquis region were the least likely to receive rehabilitation services following a heart attack or stroke.

. Penquis adults also had the highest rate of diabetes, but the Aroostook and Washington regions have the greatest increase in diabetes-related deaths.

. The Hancock region had the lowest rate of routine blood screening for prostate cancer, and the highest death rate related to prostate cancer.

Oral health was also measured in the survey. Compared to 2001, all regions show somewhat improved access to oral and dental care as well as improved overall oral and dental health, but the northern part of the state in general lags behind other areas on both measures.

Recommendations from the study authors include increasing access to primary care services by expanding walk-in care hours; providing dental care through small community hospitals; ramping up substance abuse treatment; doing a better job of integrating mental health services into primary care; and many other measures.

The 2007 Community Health Needs Assessment, with its price tag of $200,000, was funded by the Healthcare Charities branch of EMHS. The 2001 report it updates cost $300,000.

The initial study was conducted by the Public Health Resource Group; the same organization – now named the Center for Health Policy, Planning and Research and located at the University of New England in Portland – produced the new report.

Principal investigator Ron Deprez said Monday that the policy center has conducted similar studies in many other states as well as for the federal government.

The exercise of identifying, measuring and comparing health care strengths and weaknesses is essential to evaluating any health care system, he said.

The state of Maine, he said, “has missed the boat” on including such studies routinely in its planning process.

Although Maine is a leader among states in collecting health data, Deprez said much of the information is not readily available in any organized way for communities, providers and policymakers attempting to make the best use of scant health care dollars. That leaves it up to private institutions such as EMHS, a situation Deprez called “highly unusual.”

In response, Trish Riley, director of Gov. John Baldacci’s Office of Health Policy and Finance, said the state has access to much of the same data used in the EMHS study and has used it to good advantage.

The State Health Plan and many of the guidelines for the Maine’s Certificate of Need program, which governs big-ticket spending by hospitals, reflect the state’s own analysis of the data, Riley said. In addition, evolving plans to strengthen Maine’s public health system will also draw heavily on many sources of health information.

Private health care systems such as EMHS need to do their own planning and evaluation, independent of any public studies, Riley said. But she praised the latest study and said it will inform the state’s planning as well as the corporation’s.

In Brewer, Whalen said the 2001 study has inspired not only the Bangor Region Chamber of Commerce workplace wellness program but also the Institute for Medical Improvement at EMHS, dedicated to improving the care delivered by hospitals and other providers in the region, including those that are not EMHS affiliates.

It also helped the corporation and its affiliates attract hundreds of thousands of dollars in public and private foundation money to improve health care in northern Maine, including supporting the implementation of electronic medical records and other technologies.

Now, with two sets of data spanning six years, the health care system and the region it serves have an opportunity to reflect on what’s working and what’s not, Whalen said.

Accordingly, EMHS and its partners, St. Joseph Healthcare and Penobscot Community Healthcare, will host a series of regional meetings in seven locations around the northern part of the state in the coming weeks and months.

The first, hosted by EMHS in collaboration with St. Joseph Healthcare and Penobscot Community Healthcare, is scheduled for Aug. 6 in Bangor.

The gatherings are intended to garner community input, Whalen said, by providing invited community leaders an opportunity to discuss the findings and brainstorm ways to improve the health of their communities.

“There are lots of great ideas,” Whalen said. “We can’t do them all.”

Results of all the meetings, along with region-specific data from the study, will be posted online at www.emh.org.

Study lists priorities for health care needs

The 2007 Community Health Needs Assessment identifies a number of health care priorities for hospitals, providers and communities to consider, along with recommendations for their improvement. Below are the recommendations for expanding access to primary care services throughout the study’s seven-region area:

. Establish dental health, mental health and substance services at small local hospitals.

. Establish a low-cost or free prescription drug program in each Eastern Maine Healthcare Systems service region.

. Develop incentives to encourage primary care providers to care for their patients needing or requesting immediate care.

. Develop outpatient walk-in clinics.

. Maximize use of federal primary care program funds.

Other priority areas include expanding prevention and education services; improving care for chronic conditions; improving geriatric health care; and expanding access to mental health and substance abuse programs.

For more information, go to www.emh.org