Running Head: Medina Care Plan: Improving Transportation for the People of Medina 1

Medina Care Plan: Improving Transportation Availability for the People of Medina to Access

Settings with Positive Health Promotion and Outcomes

William Erskine, Paige Hawkins, Alexis Hertz

Youngstown State University

December 9th, 2016

Running Head: Medina Care Plan: Improving Transportation for the People of Medina 2

Healthy People 2020 Goal

A goal of Healthy People 2020 is to improve access to comprehensive, quality health

services. According to Healthy People 2020, Access to comprehensive, quality health care

services is important for the achievement of health equity and for increasing the quality of a

healthy life for everyone (Office of Disease Prevention and Health Promotion, 2016). Another

related focus of Healthy People 2020 is to Achieve health equity, eliminate disparities, and

improve the health of all groups (Office of Disease Prevention and Health Promotion, 2016).

Short Term Goal

Medina as a community will acknowledge the results of the 2013 Community Health

Needs Assessment- Medina Hospital identifying the necessity to further expand and

improve currently offered public transportation services. Following this

acknowledgement, the community, including government officials, will devise a plan for

a potential partnership with other public transit services to meet the increasing needs for

readily available transportation in Medina.

Long Term Goal

The city of Medina will internally expand their current transit system and a partnership

with an external transit service will be established. In doing so, the limitations expressed

in the 2013 Community Health Needs Assessment- Medina Hospital will be addressed

and corrected. According to the Cleveland Clinic, the Medina Hospital community is the

only Cleveland Clinic community hospital with projected population growth (Cleveland

Clinic). This expanded transit service will provide transportation for a variety of purposes
Running Head: Medina Care Plan: Improving Transportation for the People of Medina 3

including recreational, employment, healthcare, and nutritional/household needs to the

current population as well as the projected growth population.

Outcome Criteria

Within three months, funding avenues for the kick-start of the expansion project of the

Medina County Public Transit will be identified and cost estimates will be provided.

Local government officials will procure cost projection regarding expansion while

reaching out to other public transit groups to gauge partnership interest. Meetings which

will be open to the entire medina population take place bi-weekly directly after city

council on Monday evenings with at least 10% of the population in attendance. The

limitations that stakeholders referred to reported in the 2013 Community Health Needs

Assessment- Medina Hospital will be discussed. The persistence of the residents voicing

their concerns about the current system, including limited availability and reliability,

leads to the formulation of the expansion plan. Community members who feel

passionately about providing expanded transportation, whether it directly affects their

situation or not, are invited to aid in the efforts. Roles of the community members

involved will be identified based on background/prior knowledge and desire to be

involved in a specific subset. Community volunteers involved in the meetings will begin

addressing the options for collecting revenue to jumpstart the expansion project through

fundraising, local business sponsorship/donation, and grants at the local, state and federal

levels. These funds will also be utilized to expand the existing curb-to-curb services the

Medina County Office for Older Adults offers to include disabled members of the

community.
Within the first 6 months, the city of Medina will have an earmarked account with funds

collected for the expansion project to occur. All applicable local, state, and federal grants
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have been identified with the deadlines prioritized. A team including community

professionals and officials has been assigned the writing process. Surveys have also been

distributed to current users of the Medina County Public Transit to gauge how many of

them currently depend on the transit as the only mode of transportation available to them.

Basic demographic information such as age sex and race will be obtained as well. These

figures will serve as a baseline to compare after the transit has been expanded. The city

will also have data collected to maintain a baseline of how many riders are currently

utilizing the transit. The bus driver will hit a button every time a rider comes on the bus to

maintain the count which will be time stamped. Within the first 6 months the country

transit will have a new bus being staffed full time. It will run 6am-6pm M-F and 7:00am-

3:00pm on the weekends. This bus will not run one of the established loops that are

currently available; rather it will provide a customized loop based on riders needs. The

general route direction will be maintained but the transit will provide more opportunity

for the citizens who are attending work, routine/preventative health visits, and common

household needs such as grocery and cleaning supplies trips. The counting system will be

implemented on the new bus as well as maintained on the previously running transits.
After eighteen months of generating funds and data collection two buses from an external

source called Healthline, a Bus Rapid Transit (BRT) provider for the greater Cleveland

Regional Transit Authority. The data collection thus far has provided support for the

citys movement by showing the need does exist. The original county transits have shown

no decline from their baseline numbers. The new transits have provided enough revenue

to self-maintain even while continuing discount programs for children and families of

low socioeconomic status (those who are eligible for the free and reduced lunch

programs), the elderly, and the disabled. Meetings now occur monthly and currently
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focus on gauging public perception on the current system and how it has affected their

previous inability to make routine health appointments and attend work regularly. These

categories directly affect the community health and wellness. The grant writing team is

re-evaluated and members wishing to step-down are replaced. Grant writing is slowed,

however, continues to ensure financial stability for the program when replacement is

necessary.
By 24 months the 2018 Community Needs Health Assessment will reveal a changed

community perception regarding the public transportation system. The transportation

needs of most residents in the city of Medina have been addressed; however, the outreach

and promotion will continue to maintain the level of business that has incurred since the

induction of new transit busses. In the community needs assessment residents express

they feel they are better equipped with the tools necessary to maintain a higher level of

overall wellness and provide for themselves/families. As a result of the growing

population and increasing availability of transportation the preventative health facilities

and family health practitioners will see an increase in patients seeking preventative and

routine care. This can be tracked via electronic records in these facilities and data can be

analyzed to detect the effectiveness of improved transportation on the number of people

seeking routine medical care.

Nursing Diagnosis

Ineffective health maintenance among the people of Medina, Ohio related to the

limitations in transportation services for the residents of Medina.

As Evidenced By

A statement made in the Community Health Needs Assessment of Medina The

transportation system within the community is limited and not user-friendly.

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Additionally, stakeholders mentioned that transportation for older adults may not be

adequate (2013).
According to the Office of Disease Prevention and Health Promotion Social

determinants of health reflect the social factors and physical conditions of the

environment in which people are born, live, learn, play, work, and age. Also known as

social and physical determinants of health, they impact a wide range of health,

functioning, and quality-of-life outcomes. Afterward, transportation options was

listed as an example of a social determinant.

According to the Cleveland Clinic, The Medina Hospital community is the only

Cleveland Clinic hospital community with projected population growth. Often,

population growth will necessitate future development of the infrastructure of a

community (i.e., public utilities, public transit system and housing) (2013).
According to the Medina Regional Transportation Study Population growth: while

Ohios population increased 1.6 percent between 2000 and 2010, Medina Countys

population increased 12.3 percent, and Montville Townships population alone

increased 52 percent (Ohio Department of Transportation, 2015).

Interventions and Rationales

Intervention: Surveying individuals whom are using the existing County transit to

understand the demographics and reasons for use of the transit. Collect and analyze data

reflecting usage of Medina County transit.

Rationale: In order for the changes being made to the current system to be evaluated

statistically baseline numbers must be established regarding users and their patterns. In

doing so, data can continue to be compared as the program grows to ensure the new

additions and purchases being made are having the desired impact on the community by

expanding the transportation services and reaching people who were not previously able
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to find adequate transportation. Not only does this allow for the usage rates to be

displayed, but also allows for usage trends specific to time and day of the week to be

identified. As a result, running hours of operation and location of routes may be altered

appropriately.
Intervention: An addition transit bus will be purchased and operate full time. This transit

will focus specifically on populations with a low socioeconomic status, elderly, disabled,

and those needing assistance with a work commute.

Rationale: Expanding the number of people in the city who have access to quality

transportation benefits the community in a number of ways. According to the ODPHP

Poor health outcomes are often made worse by the interaction between individuals and

their social and physical environment (2016). As previously stated, lack of

transportation options has been cited as a social determinant that can cause poor health

outcomes to become worse. As stated in The Transportation Barrior, low-income

neighborhoods are hit particularly hard by shoddy transportation infrastructuresubways

may not service areas on the fringes of a city, buses may be unreliable, and both are

vulnerable to strikes or service suspensions. And for those who are disabled, obese, or

chronically ill, riding the bus or the subway can be a difficult undertaking (Cronk,

2015).
Intervention: Composing a 2018 Community Needs Health Assessment- Medina Hospital

and assessing electronic records regarding the number of patients served by family

practitioners and preventative care facilities.

Rational: The community needs health assessment will be used to detect an alteration in

perception by the people of Medina to ensure continued effectiveness of the program and

its outreach capabilities. This feedback from the community would determine if the

increased transportation had a positive effect on the perceptions of the residents.

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Surveying electronic records would provide the data needed to determine if the improved

transportation has a direct impact on the health status of Medina, and their access to

routine medical care.

Intervention: To procure funds for an improved transit system through fundraising, local

business sponsorship/donation, and grants at the local, state, and federal levels.
Rational: Most of the funding for public transportation comes from the federal

government and is then trickled down to the state and local government. This funding is

short-term based, meaning no long-term agreements for money allocations to public

transportation are made by Congress. This creates a stop-and-go situation for local

transit (tapsbus.com). Given the uncertainty of funding from the federal government,

expansion of the Medina County Public Transit may need to come from an aggressive

program of governmental and private partnerships with businesses, hospitals, local

universities, and fundraising (tapsbus.com).

Evaluation

Three-Month Evaluation

Funding avenues for the kick-start of the expansion project of the Medina County

Public Transit are identified and cost estimates have been provided. Local government

officials have successfully reached out to public transit groups to gauge partnerships in

expanding the transportation and services of transportation. Community advocates were

present at the meeting, which included at least 10% of the population of Medina. Roles of

the community members involved are established and a committee to head lobbying for

better and more accessible transportation is created. Community volunteers procure

options for collecting revenue to jumpstart the expansion project through fundraising,

local business sponsorship/donation, and grants at the local, state and federal levels.
Six Month Evaluation
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The city of Medina has created an earmarked account with funds collected for the

expansion project. All applicable local, state, and federal grants have been identified with

the deadlines prioritized to begin allocating funds to the transportation improvement

effort. Surveys have also been distributed to current users of the Medina County Public

Transit to gauge how many of them currently depend on the transit as the only mode of

transportation available to them. Basic demographic information such as age sex and race

was also obtained to identify the greatest population using the public transit. A baseline of

how many riders are currently utilizing the transit was established using the bus drivers as

resource. The transit now has a new bus staffed full time, running for 6am-6pm M-F and

7am-3pm on the weekends, running on a customized loop to accommodate citizens

coming to and from work, routine/preventative health visits, and common household

needs such as grocery and cleaning supplies trips.

Eight Month Evaluation

After eighteen months, Medina generated funds and data collection from two

buss from an external source called Healthline, a Bus Rapid Transit (BRT) provider for

the greater Cleveland Regional Transit Authority. A post survey was sent out to the public

gauging public perception on the current system and how it has affected their previous

inability to make routine health appointments and attend work regularly. The post surveys

concluded that the residents of Medina have been able to make their routine health

appointments and are able to attend work regularly. These drastic changes greatly

increased the community health and wellness of Medina.

Twenty-Four Month Evaluation
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By 24 months, the 2018 Community Needs Health Assessment was reevaluated

and looked at if there was a change in the communitys perception regarding the public

transportation system. In the community needs assessment, due to the increasing

availability of transportation, residents expressed that they felt they are better equipped

with the tools necessary to maintain a higher level of overall wellness and can better

provide for themselves/families. Electronic records were looked at in facilities that

residents of Medina would use for health care. The records showed effectiveness of

improved transportation due to an increased number of people seeking routine medical

care. As a result of the growing population and increasing availability of transportation

the preventative health facilities and family health practitioners are seeing an increase in

patients seeking preventative and routine care.

References
Cleveland Clinic. 2013 Community Health Needs Assessment Medina Hospital. (2012, March
30).
Retrieved From: https://my.clevelandclinic.org/ccf/media/Files/About-Cleveland-
Clinic/chna/2013-Medina-CHNA-and-ISR.pdf?la=en

Cronk, I. (2015, August 09). The Transportation Barrier. Retrieved from:

http://www.theatlantic.com/health/archive/2015/08/the-transportation-barrier/399728/

Office of Disease Prevention and Health Promotion. (2016). Healthy People 2020: Access to
Health Services. Retrieved from: https://www.healthypeople.gov/2020/topics-
objectives/topic/Access-to-Health-Services

Office of Disease Prevention and Health Promotion. (2016). Healthy People 2020: Determinants
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of Health. Retrieved from: https://www.healthypeople.gov/2020/about/foundation-health-

measures/Determinants-of-Health

Ohio Department of Transportation. (2015, June). Medina Regional Transportation Study

Existing and Future Conditions Report. Retrieved From:
https://www.dot.state.oh.us/districts/D03/DDD/PIO/Documents/Medina%20Regional
%20Transportation%20Plan%20Existing%20and%20Future%20Condition%20Report
%20Final%20Submittal%208-21-2015.pdf