Health Care for All- Dubuque, IA

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Health Care for All 

Rationale:
The Crescent Community Health Center in Dubuque identified the need for additional health services in their Community Health Needs Assessment. From the assessment, Crescent sought to expand services to lower income residents, uninsured residents, Marshallese residents and residents experiencing mental health crisis. 

Goal:
To provide quality health services for all residents by realizing Crescent Health Center’s vision of creating a health care campus with one building housing other health agencies that will provide a wide range of specialty services to patients.

Project Summary:
Crescent Health Center provides primary health and dental care for people with little to no access to care and, often, no way to pay for that care. Approximately 20% of the patients are uninsured and likely to remain so, which leaves nowhere for them to go for their health care. Even Medicaid patients have limited choices based upon the managed care insurance company to which they have been assigned.

As federal healthcare funding becomes more precarious, Dubuque has been responding to the urgent, growing need for healthcare by adding health services for its population to address needs identified in the Community Health Needs Assessment (CHNA). The CHNA was updated through a public engagement process led by a steering committee of stakeholders.

Current and planned service enhancements include: 

Planned Expansion
By partnering with other health and community-based organizations in Dubuque, Crescent has expanded to provide access to additional quality services to over 6,500 patients. From 2008-2017, that number has grown by 38%.  By 2020, the Health Resources and Services Administration (HRSA) expects Crescent to increase its patients to 8,057, a 20% increase.   To continue the mission, Crescent has begun to develop and move to larger space within the Washington Neighborhood. This move will almost double its current space, combining three locations into one and increasing health care access for the community.

The expansion will facilitate the care of an estimated 20% more patients and provide mental health and substance abuse services through collaboration with community partners.

Establishment of The Patient/Family Advisory Council
In 2017, the Patient/Family Advisory Council was formed to create a connection between patients, the Crescent Board, and the surrounding community.  Patients can provide input directly to the Board about social determinants of health and health care needs in their community and are mentored to prepare them for eventual Board membership.  The Council also serves as a venue to conduct proactive healthy behaviors educational sessions.

Pacific Islander Health Project
Dubuque has 600 to 800 Marshallese residents, the largest Marshallese population in Iowa.  The Marshallese have high rates of cancer, and diabetes prevalence is estimated at 25-50% of Marshallese adults. A local survey of 82 Marshallese adult residents in Dubuque revealed that 61% have diabetes, 28% have heart disease, 5% have cancer, and 5% have hypertension.  Seventy-three percent of those interviewed lack health insurance.  Among those surveyed, 58% have not seen a doctor within the last year, 65% of those because they lack health insurance, and 23% because of cost.

To address this high community need, a community-based committee was established by Mercy Medical Center to develop an engagement strategy and accessible health care for the Marshallese and Pacific Islander population. Crescent hired a Marshallese individual as a community health worker, a nurse, and a social worker.  The community health worker trains service organizations regarding Marshallese cultures and systems, translates documents and case manages 86 Marshallese patients, helping them to navigate the healthcare system.  The Dubuque Pacific Island Health Project’s (DPIHP) mission is to engage, educate, and empower the Pacific Islander community in achieving and maintaining health.

In addition to improvement in diabetes and other chronic disease management in the Pacific Island Health Project, patient results of the project include a 38% decrease in hospital emergency room visits and a 60% decrease in missed appointments at Crescent. Specific diabetic classes for the project, which incorporate foods more relevant to the Marshallese population, have improved the diabetic A1c marker in the majority of class participants.

Brain Health Task Force
Crescent has expanded its on-site services to include mental health counseling because of high community need and participation in the community-based Brain Health Task Force.

Based on community feedback received through the Project HOPE initiative, the CFGD facilitated a community needs assessment specific to mental health services in the fall of 2016.

To address the needs identified in the assessment, a 34-member stakeholder group was formed.  This group of community stakeholders has formed the Brain Health Task Force and is focusing on three main areas:

• Review of the Strengths, Weaknesses, Opportunities and Threats (SWOT) that need to be addressed;
• Education for medical staff, providers and volunteers; and
• Advocacy, bringing community awareness to Brain Health.

Besides these three main focus areas, the Brain Health Task Force is working to establish an access center in Dubuque for individuals with urgent mental health — brain health — needs. 

Engagement Strategies:

• A Community Health Needs Assessment was updated in 2018 through a process led by a steering committee of private health care providers, the Dubuque County Board of Health, City, and Crescent. Additionally, the assessment included a public engagement process to confirm trends and needs identified through data analysis.
• An advisory council of patients, the Crescent Board, and the surrounding community was created to allow patients to provide input directly to the board about social determinants of health and health care needs.
• A community-based committee was established to improve the accessibility to health care by the Marshallese and Pacific Islander populations.
• A Brain Health Task Force was created to provide education to providers while increasing community awareness of brain health.

Outcomes:

• Expansion of the Crescent Community Health Center’s Location that will provide services to 20% more patients and provide mental health and substance abuse services.
• The Brain Health Task Force enacted a community-wide billboard and social media awareness campaign that had over 122,000 impressions.
• Patients in the Pacific Island Health Project saw a 38% decrease in hospital emergency room visits and a 60% decrease in missed appointments at Crescent.
• Crescent has seen an increase of patients with over 6,500 residents served.

Local Contact:
Nancy Van Milligen
Community Foundation of Greater Dubuque
nancy@dbqfoundation.org
(563) 588-2700

Additional Resources:
Dubuque, IA- 2019 AAC Winner: Presentation