Area served by Paducah hospitals was among nation’s most improved health regions from 2011 to 2014, data indicate

By Danielle Ray
Kentucky Health News

The health of the region served by Paducah hospitals is among the nation’s most improved in the last few years, according to data compiled by the Commonwealth Fund, a foundation that aims to promote a high-performing health-care system.

Out of 306 hospital-referral regions in the U.S., Paducah is one of only 14 to improve on most measurements of health and the efficacy of the health-care system. Of the five regions based in Kentucky, it was the only one to earn that distinction. However, its ranking remains lower than the national average.

Cape Girardeau, Mo., also made the list of the most improved 14 regions in the Scorecard on Local Health System Performance, after ranking near the bottom three years earlier. Both regions include parts of Southern Illinois.

Lourdes Hospital (Photo from West Kentucky Star)

Hospital referral regions represent regional health-care markets. The Commonwealth Fund recognizes 306 HRRs with at least one hospital in which complex surgeries are performed, such as Baptist Health Paducah and Lourdes Hospital.

Such hospitals are at the apex of a regional health system, which includes smaller hospitals, doctor’s offices and so on. HRRs, developed by the Dartmouth Atlas of Health Care, are widely used in health-services research and policy analysis.

The overall rankings are divided into four dimensions: access, prevention and treatment, healthy lives and avoidable trips to the hospital (including hospital costs). Paducah improved in all but one dimension, avoidable hospital trips; it fell from 277th in 2011 to 286th in 2014.

Baptist Health Paducah (Photo from WKMS)

Paducah ranks 225th of 306 regions in overall performance, up from 279th in 2011. Changes in underlying data sources and definitions of measure required researchers to make some changes to their measurements, so the new scorecard shouldn’t be viewed as a precise update to the last version. Also, because there is relatively little difference between closely ranked regions, the rankings are perhaps better expressed in groups. For example, Paducah ranked in the lowest fifth in 2011 and now ranks in the next-highest fifth. Cape Girardeau, at 281st overall, remains in the lowest fifth.

The Paducah region jumped to 109th from 203rd in access and to 229th from 266th in prevention and treatment. It also improved to 215th from 259th in healthy lives.

Factors that affect access include uninsured children and adults, adults who went without care because of cost in the past year, and adults without routine doctor or dental visits. Prevention and treatment factors include instructions given to hospital patients about home recovery, adults with a regular source of care, and adults with age-appropriate vaccines. Factors that influence avoidable hospital visits include Medicare hospital readmissions and potentially avoidable emergency-room visits by Medicare patients. Finally, the healthy lives dimension is influenced by factors such as obesity, smoking and deaths from certain types of cancers, including breast and colorectal.

Paducah leaders have been fighting poverty and social inequality for years, which could be one factor responsible for the gains in the complex web of community health. For example, St. Nicholas Family Clinic, a free clinic that serves low-income individuals, was one Paducah institution involved in the Impact Poverty Task Force, which was introduced in 2010 and sought to reduce poverty in the area.

Adapted Dartmouth Atlas map shows hospital referral regions

The group brought in KentuckyCare, a federally qualified health center (a designation that gets extra reimbursement from Medicare and Medicaid), when Kentucky expanded Medicaid eligibility in 2014. KentuckyCare offers health-care assistance programs and discounts to low-income residents in eight West Kentucky counties.

Brandi Harless, director of the St. Nicholas clinic at the time, said KentuckyCare helped many of their patients who had never been insured before transition to Medicaid. She said she believes the shift to a Federally Qualified Health Center has had a direct impact on Paducah’s health improvements.

St. Nicholas Family Clinic has since become St. Nicholas Family Clinic Foundation, a transition that has allowed the clinic to expand its services to provide payment assistance for dental care, doctor visits, prescriptions, eyeglasses and hearing aids to uninsured and under-insured working adults.

Meanwhile, Purchase Area Health Connections began as an informal health coalition in late 2013 with the goal of consolidating efforts to improve local health.

“There were a lot of conversations about health initiatives happening simultaneously,” Harless said. “We wanted to bring those conversations together.”
The coalition has helped secure $600,000 in grants from multiple private foundations and federal entities to help implement health initiatives in several West Kentucky communities.

Among individual health factors, the Paducah region improved on 17 of 33 total indicators, including adults who smoke, adults who went without care because of cost in the past year, and uninsured adults aged 19-64.

The share of adults in the Paducah region without health insurance dropped 8 percentage points from 2011, down to 12 percent in 2014. Kentucky led the nation in getting uninsured people covered.

Sara Collins, vice president of health-care coverage and access for The Commonwealth Fund, attributes the improvement in Kentucky’s uninsured numbers to Medicaid expansion and Kynect, the state health insurance marketplace where Kentuckians could enroll in Medicaid or buy federally subsidized private insurance.

“I do think the decline we’re seeing [in the uninsured] is a direct result of both of those programs,” she said. “Medicaid has been a very important source of coverage for the state.”

Paducah worsened from 2011 to 2014 on two indicators: colorectal cancer deaths and total reimbursements per adult enrollees with employer-sponsored insurance. Marks in the other 14 categories changed little.

Honolulu ranks first in the nation in performance. Owensboro has the highest ranking in Kentucky at 173rd overall. Covington ranks just behind Paducah at 227th. Louisville makes the list at 233rd overall, followed by Lexington at 268th. Much of Southern Kentucky, including Trigg County, is in the Nashville region, which ranks 245th. The entire interactive scorecard is available here.

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