2013 Greene County, Arkansas Community Health Needs Assessment

Transcription

1 2013 Greene County, Arkansas Community Health Needs Assessment Creating a Call to Action in our Community This report is available at or at Arkansas Methodist Medical Center 900 W. Kingshighway, Paragould, AR

2 Perspective ---creating a sense of health in the community The Community Health Needs Assessment (CHNA) defines opportunities for health improvement, creates a collaborative community environment to engage multiple change agents, and an open and transparent process to listen and truly understand the health needs of Greene County, Arkansas. The federal government through the Internal Revenue Service now requires that not-for-profit hospitals conduct a Community Health Needs Assessment. These census-like studies help healthcare providers build stronger relationships with their communities, identify needs and dedicate funding and other resources toward programs that clearly benefit local residents. Participants More than fifty community and healthcare organizations collaborated to implement a four-stage CHNA process focused on identifying and defining local health issues, concerns and needs. The three-month process centered on gathering and analyzing data to provide direction for the community and hospital to create a plan to improve the health of the community. Project goals and objectives To implement a formal and comprehensive community health assessment process that will allow for the identification of key health and health service issues, and a systematic review of health status in Greene County. To create infrastructure that will permit ongoing updates and easy dissemination of available data. To initiate a collaborative partnership between all stakeholders in the community. To create a health profile that will allow for prioritization of needs and resource allocation, informed decision making, and collective action that will improve health outcomes. Timeline More than fifty community and healthcare organizations collaborated AMMC contracted with Stratasan in January, 2013 to facilitate the community health needs assessment process. Stratasan and AMMC conducted a kick-off meeting to begin the process in February. On March 11-12, interviews were conducted with 20 members of the community, employers, not-for-profit organizations, clergy and government representatives. During March and April, community health data was assembled for a presentation to the community. On June 27, a community health summit was conducted with 50 community leaders. The final report was completed in August, Sourced from the County Health Rankings website: take-action We initiated the Community Health Needs Assessment with the goal of identifying public health needs, and setting goals, objectives and priorities, said Barry Davis, President and Chief Executive Officer, Arkansas Methodist Medical Center. It is our goal to use our findings as a foundation for improving and promoting the health of the whole community. The information we gathered provided the insight we need to set priorities for local public health, added Shay Willis, Director of Marketing and Public Relations, Arkansas Methodist Medical Center. The Community Health Summit was the final, critical step in the process. Now the real work improving the health of the community begins. Community Health Needs Asssessment 1

3 Who Told Us What? Data Collection and Review The health of the community was studied extensively through primary and secondary research methods. Greene County was the primary focus, however Clay County was also investigated since AMMC is the primary provider of patient care in many of the communities in Clay County. Data was gathered using several methods: 20 community members, employers, not-forprofit organizations, clergy and government representatives were interviewed one-on-one for their perspectives on community health needs and issues. Information gathering using public health sources and hospital-specific data. A Community Summit was conducted with 50 community leaders and citizens. The audience consisted of healthcare workers, business leaders, school systems, fire and police personnel, government representatives, clergy, community volunteers, and other community members. Selected Community for Assessment AMMC Patients 72% of AMMC s patients come from Greene County. AMMC is Greene County s hospital of choice with an estimated market share of 56%. Therefore, it is reasonable to select Greene County as the primary focus of the community health needs assessment. Clay County s data was also analyzed but is not the focus of the CHNA. Data was gathered using Arkansas Methodist Medical Center s (AMMC) health information. The map above shows the use of AMMC healthcare services by residents both in and outside of Greene County. Community Health Needs Asssessment 2

4 Collaboration is Key to Good Health Community Engagement and Transparency We are pleased to share with our community the results of the Community Health Needs Assessment. The following pages highlight key findings of the assessment. We hope you will take the time to review the health needs of our community as the findings impact each and every citizen in one way or another. Implementation Plans To successfully create a sense of health in Greene County it is necessary to have a collaborative venture which brings together all of the care providers, citizens, government, schools, law enforcement and business and industry around an effective plan of action. A comprehensive plan will be coordinated across the county to help ensure adequate availability of needed and wanted services. Key Demographic Statistics: The median age of Greene County (38.1) is higher than Arkansas (37.7) and the U.S. (37.3). The median household income of Greene County ($35,115) is lower than Arkansas ($37,393) and the U.S. ($50,157). The Greene County population per year growth rate from 2012 to 2017 (0.80%) is higher than Arkansas (0.70%) and the U.S. (0.68%). The medical care index for Greene County (79) is lower than Arkansas (86) and the U.S. (100). This measures out of pocket healthcare spending of the population. This could be due to less healthcare utilization and/or less expensive healthcare costs. The racial make-up of the county is 96% white, 1% black, American Indian, some other race and two or more races and 3% Hispanic origin. The income distribution of the county is 15% high income, 48% middle income and 37% low income. Northern Paragould has the most low income households. Demographic Dashboard Category Greene County Clay County Arkansas USA Population (2012) 42,489 15,832 2,960, ,129,017 Median Age (2012) Median Household Income (2012) $35,115 $30,296 $37,393 $50,157 Annual Pop. Growth ( ) 0.80% -0.67% 0.70% 0.68% Households (2012) 16,637 6,730 1,162, ,208,713 Businesses (2011) 1, ,904 12,239,616 Employees (2011) 18,425 4,843 1,405, ,234,698 Dominant Tapestry Segment 42-Southern Satellites (22%) 50-Heartland Communities (47%) 42-Southern Satellites (11%) 12-Up and Coming Families (4%) Medical Care Index Average Health Expenditures (2011) $2,870 $2,780 $3,103 $3,611 Total Health Expenditures (2011) $47,474,917 $18,770,923 $3,583,951,934 $424,173,676,593 Community Health Needs Asssessment 3

5 In 2013, Greene County ranked 29th healthiest County in Arkansas out of 75 counties (1= the healthiest; 75 = unhealthiest). This ranking places Greene County in the second quartile. Key Findings of the Community Health Assessment Greene County was named after General Nathaniel Greene, American Revolutionary War Hero. Greene There are four broad themes which emerged in this process: County needs to lead a revolutionary Greene County needs to create a call to action for a Health change in the health of its citizens. Revolution that permeates the culture of the counties, cities, The results of the community health employers, churches, and community organizations, so everyone assessment follow. can buy into health improvement. When analyzing the health status There is a direct relationship between health outcomes and data, local results were compared affluence (income and education). Those with the lowest income to Arkansas (AR) and the top 10% and education generally have the poorest health outcomes. of counties in the U.S. Where the While any given measure may show an overall good picture of counties results differ significantly community health, there are significantly challenged subgroups. negatively from the State, we see an It will take a partnership with a wide range of organizations and opportunity for group and individual citizens pooling resources to meaningfully impact the health of the actions that results in improved community. community ratings. Greene County is the focus of the CHNA, however Clay County was also investigated and used for comparison because AMMC sees patients from Clay County. There are several lifestyle gaps that need to be closed to move Greene County up the ranking to be the healthiest community in Arkansas and eventually the Nation. For additional perspective, Arkansas is ranked the 48th healthiest state out of the 50 states. The overall demand for health services in Greene County is congruent with an aging population with higher emergency department and physician office visit rates per population. Community Health Needs Asssessment 4

6 Greene County Health Rankings Based on the County Health Rankings study performed by the Robert Wood Johnson Foundation and the University of Wisconsin, the issues needing the most attention are: Health behaviors: Smoking Obesity Clinical care: Preventable hospital stays Greene County s physical environment ranks 47th out of 75. Overall Health of Greene County Strengths Morbidity indicators: lower % reporting poor or fair health, poor physical health days and low birthweight babies Health behaviors: low excessive drinking, low rate of sexually transmitted infections Social and economics: higher high school graduation percentage, lower percentage of children in single-parent households, low violent crime rate Physical environment: drinking water safety, access to recreational facilities Opportunities Mortality, premature death Health behaviors ranked lower: smoking, obesity, physical inactivity, motor vehicle crash death rate, high teen birth rate. These lead to higher utilization of prescription drugs for high blood pressure, cholesterol, and diabetes. Greene County also has higher rates of cancer deaths. Clinical care: uninsured, primary care availability, preventable hospital stays, dentist availability, diabetic screening and mammography screening. Community Health Needs Asssessment 5

7 Social and economic factors ranked lower: some college, unemployment. Physical environment: limited access to healthy foods is higher and percentage of fast food restaurants is high. Health Outcomes (Mortality and Morbidity) National Benchmark 90th Greene Co Clay Co Arkansas Percentile Overall Ranking (Rank out of 75 AR Counties or 50 States) Health Outcomes (Rank out of 75) Mortality (Rank out of 75) Premature death (YPLL per 100,000 pop prior to age 75) 10,162 8,680 9,290 5,317 Morbidity (Rank out of 75) 8 32 Poor or fair health (% reporting age-adjusted) 17% 27% 19% 10% Poor physical health days (Avg # of days past 30 days) Poor mental health days (Avg # of days past 30 days) Low birthweight (% of live births with birthweight <2500 grams) 7.6% 8.0% 9.1% 6.0% Strengths The percent of adults reporting poor or fair health. The number of poor physical health days reported. The percentage of low birth weight babies. Opportunities Premature death measured in years of potential years of life lost. Greene County indexes higher for taking a prescription drug for depression than the U.S. Greene County indexes higher for taking a prescription drug for high blood pressure than the U.S. A segment of Greene County (the census tract north of Paragould up to the Clay County line) indexes higher for taking a prescription drug (insulin) for diabetes than the U.S. Greene County indexes higher than the U.S. for prescription drug use for high cholesterol. Based on cancer death rates from the National Cancer Institutes, Greene County has a rising trend and is above the U.S. cancer death rate. Community Health Needs Asssessment 6

8 Health Behaviors National Benchmark 90th Greene Co Clay Co Arkansas Percentile Health Factors (Rank out of 75) Health Behaviors (Rank out of 75) Adult smoking (smokes every day or most days) 22% 24% 23% 13% Adult obesity (BMI >=30) 34% 32% 32% 25% Physical inactivity (% 20 yo and older reporting no leisure time physical activity) 28% 35% 31% 21% Excessive drinking 12% 6% 13% 7% Motor vehicle crash death rate (crude mortality per 100,000 pop) Sexually transmitted infections (Chlamydia rate per 100,000 pop) Teen birth rate (ages per 1,000 female pop) Strengths Lower physical inactivity. Lower excessive drinking; and AR has one of the lowest excessive drinking rates in the U.S. Lower sexually transmitted infections. Opportunities Smoking- Since smoking is such a health hazard, any smoking is an opportunity to improve health status. Greene County also indexes higher than the US for smoking 9+ packs of cigarettes per week. Arkansas high school smoking has declined year over year, but is still above 15%. Chewing tobacco, snuff or dipping is not declining hovering at 12%. Smoking harms nearly every organ of the body. Smoking causes many diseases and reduces the health of smokers in general. The adverse health effects from cigarette smoking account for an estimated 443,000 deaths, or nearly one of every five deaths, each year in the United States. (CDC website) Obesity Higher percentage of adult obesity. 15.5% of AR high school students are obese. Obesity puts people at increased risk of chronic diseases: diabetes, kidney disease, joint problems, hypertension and heart disease. Obesity can cause complications in surgery and with anesthesia. It has been implicated in Alzheimer s. It often leads to metabolic syndrome and type 2 diabetes. It is a factor in cancers, such as ovarian, endometrial, postmenopausal breast cancer, colorectal, prostate, and others. A link has been found between migraine and obesity. And, of course, obesity affects an individual s general quality of life, self-esteem and self-image. Higher motor vehicle crash death. Higher teen birth rate. Community Health Needs Asssessment 7

9 Clinical Care National Benchmark 90th Greene Co Clay Co Arkansas Percentile Clinical Care (Rank out of 75) Uninsured (%<65 w/o health insurance) 20% 22% 21% 11% Primary care physicians (Pop per physician) 1,757 4,018 1,613 1,067 Dentists (Pop per dentist) 3,564 2,314 2,571 1,516 Preventable hospital stays (Hospitalization rate for ambulatorysensitive conditions per 1,000 Medicare enrollees) Diabetic screening (%diabetic Medicare enrollees receiving HbA1c screening) 79% 86% 82% 90% Mammography screening (%female Medicare enrollees receiving mammo screening) 55% 61% 61% 73% Strengths Local patients use AMMC and physicians not having to travel for healthcare. Opportunities High percent of the population without health insurance (uninsured). Higher population per physician. As part of the CHNA, a physician inventory and needs analysis was performed. The physician needs analysis indicates a shortage of primary care physicians. The community needs to work together collaboratively with the hospital and existing medical staff to attract more primary care and specialists to the community. Nurse practitioners and physician assistants help fill in the shortage areas. High population per dentist. Higher preventable hospital stays. Lower percentage of Medicare enrollees receiving blood sugar screening for diabetes. Lower percentage of Medicare enrollees receiving a mammogram. Community Health Needs Asssessment 8

10 Social & Economic Factors Greene Co Clay Co Social & Economic Factors (Rank out of 75) Arkansas National Benchmark 90th Percentile High school graduation (% of 9th grade cohort graduating in 4 yrs) 83% 84% 81% N/A Some college (% of adults w/ some postsecondary ed) 48% 42% 53% 70% Unemployment 10.0% 13.7% 8.0% 5.0% Children in poverty (% under age 18 in poverty) 26% 29% 28% 14% Inadequate social support (% of adults w/o social/emotional support) 19% 23% 21% 14% Children in single-parent households (% of HH headed by a single parent) 27% 31% 36% 20% Violent crime rate (violent crime per 100,000 pop) Strengths Higher high school graduation percentage. Lower percentage of children in poverty. Lower percentage of inadequate social support. Lower percentage of children in single-parent households. Lower violent crime rate. Opportunities Lower post-secondary education percentage. Higher unemployment rate. Lower median household income. Physical Environment Strengths Drinking water safety is good. Higher access to recreational facilities. Opportunities Higher daily fine particulate matter in the air. Higher limited access to healthy foods. Higher percentage of fast food restaurants. Greene Co Clay Co Arkansas National Benchmark 90th Percentile Physical Environment (Rank out of 75) Daily fine particulate matter (Avg daily measure of matter in micrograms per cubic meter) Drinking water safety (% of pop exposed to wager exceeding a violation limit during the past year) 0% 21% 9% 0% Access to recreational facilities (Recreational facilities per 100,000 pop) Limited access to healthy foods (% of pop who are low income and do not live close to a grocery store) 8% 5% 8% 1% Fast food restaurants (% of all restaurants that are fast food) 54% 58% 50% 27% Community Health Needs Asssessment 9

11 Results of the Community Health Summit The Summit attendees listed the three most important health issues in Greene County on Post-it notes and placed them on the wall, the results of the exercise are below with the number of Post-it notes related to the issue. 1. Obesity Access to Care and Insurance Lifestyle (Diet and Exercise) Drug Abuse and Mental Health Diabetes Cancer, HBP and Heart Disease-9 7. Tobacco/Smoking-9 8. Teen Pregnancy and Birth Issues-9 9. Education-7 Based on the Community Summit, the following goals and actions were created by the table groups and form the foundation Greene County s health initiatives. The work in the next months will determine the ideas to be implemented. The table groups brainstormed goals and actions around the most important health issues. These goals and actions have been organized below. Obesity Goal 1: Stabilize the obesity trend Action 1: Encourage business and industry to provide incentives for healthy employees Action 2: Conduct community health fairs to monitor blood pressure, BMI, diabetes Goal 3: Promote activity Action 1: Initiate city-wide fitness programs, walk offs, contests Action 2: Promote parks, walking trails Responsible Partners: Fitness Centers, Churches, Chamber of Commerce, Employers Responsible Partners: Businesses and Industries, Chamber of Commerce, Clinics, AMMC Goal 2: Education on nutrition and side effects of obesity Action 1: Encourage healthy food options and health education regarding how to make healthier choices Action 2: Educate people on the side effects of obesity Responsible Partners: AMMC, Schools, Health Department, Physicians/Providers Community Health Needs Asssessment 10

12 Access to Care and Insurance Goal 1: Educate citizens on new options to purchase health insurance through the PPACA Action 1: Assist in making third party payors available to the public through health fairs, charitable clinics, churches and advertising Action 2: Enroll individuals into health insurance programs Responsible Partners: AMMC, Physicians/Providers, Health Department Goal 2: Continue to be proactive in recruiting specialists and primary care physicians Action 1: Continue an active recruiting process for physicians Action 2: Solicit information from the public concerning their needs Responsible Partners: Chamber of Commerce, City of Paragould, AMMC Goal 3: Increase median household income Action 1: Recruit higher wage jobs to the community Action 2: Increase post-secondary education Responsible Partners: Chamber of Commerce, Adult Education Center, Schools, DHS Lifestyle (Diet, Exercise and Health Screenings) to reduce chronic diseases such as obesity, high blood pressure, cancer and heart disease Goal 1: Educate the community on healthy lifestyles Action 1: Involve industries, churches, schools and civic organizations in educating the community Action 2: Train peer educators in the community to expand education programs Action 3: Hold seminars and lectures on health Action 4: Provide health fairs Responsible Partners: AMMC, Physicians/Providers, Health Department, Churches, Schools, Community Centers, Coaches, Civic Leaders, Industry Leaders Goal 2: Provide opportunities for activities that promote healthier lifestyles Action 1: Support local Farmer s Market and community gardens Action 2: Teach classes on growing individual family gardens and hold a day for giving away seeds Responsible Partners: AMMC, Home Extension, Chamber of Commerce Goal 3: Provide safe environments for participation in healthier living activities Action 1: Add more sidewalks, extra lighting and bike trails Action 2: Establish neighborhood watch programs Responsible Partners: Local Government Leaders, Civic Organizations, Police Department Goal 4: Reduce high blood pressure by 20% Action 1: Improve diet Action 2: Increase exercise Responsible Partners: AMMC, Physicians/Providers Goal 5: Reduce cancer rate Action 1: Increase annual physicals and screenings Community Health Needs Asssessment 11

13 Action 2: Increase health fair participation Responsible Partners: Physicians/ Providers, AMMC Goal 6: Reduce heart disease Action 1: Increase education re: nutrition, check-ups, exercise, baby aspirin Responsible Partners: Physicians/ Providers, AMMC Drug Abuse and Behavioral Health Diabetes Goal 1: Reduce the progression from gestational diabetes to Type 2 diabetes by 50% Action 1: Educate and promote life change habits for mothers with gestational diabetes Action 2: Teach healthy eating Responsible Partners: Arkansas Obstetrics Association, AMMC, Health Department Goal 2: Increase exercise decreasing % inactivity from 28% to 20% Goal 1: Reduce illegal and inappropriate access to prescription drugs Action 1: Educate youth, adults and physicians on the dangers and prevalence of prescription drug abuse Action 2: Improve drug security and utilization of drug take-back program Responsible Partners: Community Leaders, Law Enforcement Action 1: Promote and teach the positive effects of exercise in schools; Mandatory exercise programs in schools Action 2: Promote exercise through the workplaces, churches and neighborhoods Responsible Partners: Communities, Neighborhoods, Churches, Employers, Schools Goal 3: Increase blood sugar monitoring frequency to prevent damage Action 1: Provide blood sugar checks at Walmart Goal 2: Increase availability of mental health treatment Action 1: Increase treatment facilities Action 2: Educate on resources available Action 2: Provide free blood sugar checks at the flu clinic Action 3: Increase knowledge about the resources available at AMMC Responsible Partners: AMMC, Health Department Responsible: Governments, Mental Health Providers, Community Groups Goal 3: Decrease utilization of illegal drugs Action 1: Improve enforcement of penalties to become a deterrent Action 2: Increase education in schools 5th Grade D.A.R.E. increase time, and repeat in 9th or 10th grade Responsible Partners: Government, Legislators, Law Enforcement, Community Groups, Schools Community Health Needs Asssessment 12

14 Tobacco Goal 1: Decrease smoking by 25% by 2016 Action 1: Encourage employers to stop hiring smokers Action 2: Charge more for insurance for smokers (increased insurance premiums) Responsible Partners: Businesses and Industries, Employers, Insurance Companies Goal 2: Increase education, communication and awareness 80% by 2016 Action 1: Show kids the results of tobacco use (cancerous mouth, trach, lungs) Action 2: Increase the availability of prenatal care Responsible Partners: AMMC, Schools, Churches, Community, Health Department, Physicians/Providers Goal 3: Decrease infant mortality by 25% per year Action 1: Provide monthly parenting classes Action 2: Hold a yearly community drive in memory of all the infants that have passed throughout the year for baby products, prenatal care Responsible Partners: AMMC, Schools, Churches, Community Groups, Health Department, Physicians/ Providers Action 2: Implement a public service campaign with local cancer victims who were former smokers Responsible Partners: Schools, Media, AMMC Goal 3: Reduce underage tobacco use 50% by 2016 Action 1: Stronger penalties for underage usage for kids and the businesses who sell the tobacco Responsible Partners: Law enforcement, Schools, Businesses, Parents Teen Pregnancy and Birth Issues Goal 1: Reduce teen pregnancy by 10% per year over the next 5 years Action 1: Increase linkages between teen pregnancy prevention programs and community-based clinical services Action 2: Implement sex education programs for students and parents by a knowledgeable facilitator by the 7th grade Responsible Partners: Schools, Health Department, LifeHouse Ministries, Parents/Teens, AMMC Educators, Churches Goal 2: Decrease premature births by 5% over the next 5 years Action 1: Educate reproductive age women what to expect and what to do and what NOT to do Community Health Needs Asssessment 12

15 Education and Miscellaneous Goal 1: Increase post-secondary education to 53% by 2017 Action 1: Increase college career days at high schools Action 2: Provide information on available scholarships Responsible Partners: High Schools, ASU, Black River Technical College, Crowley s Ridge College, School Counselors Arkansas Methodist Medical Center s Selected Initiatives Based on input from the Community Summit, Arkansas Methodist Medical Center (AMMC) will select goals and will implement action plans for these identified goals over the next few months. AMMC will monitor the progress through the Hospital s Strategic Planning Committee and will annually report the progress to their Executive Board of Directors and the community. Goal 2: Reduce fear of outcome of medical testing Action 1: Hold seminars on specific diseases Action 2: Share individual testimonials from people who are living with the disease or had the disease Responsible Partners: AMMC, Health Department, Physicians/Providers, Churches, Community Groups Community Health Needs Asssessment 13

16 Giving credit where credit is due Acknowledgements We would like to acknowledge the efforts of this collaborative group. It is energizing when a diverse group of citizens comes together to work toward a common cause. Funding for this project has been provided by: Arkansas Methodist Medical Center. Participation in the interviews and in creating the Greene County Community Health Improvement Plan: Arkansas Methodist Medical Center Board of Directors, Medical Staff and Members of Management; AMMC Ambulance Service; AMMC Auxiliary; AMMC Women s Council; Marmaduke/ Paragould Medical Clinic; Woman to Woman Cancer Support Group; Stratasan; Greene County Health Department; Arkansas Department of Health; Paragould Fire Chief; Paragould Chief of Police; Paragould Fire Fighters; Paragould Police Officers; Mayors of Paragould and Marmaduke; Paragould Regional Chamber of Commerce; Paragould Light Water and Cable; Paragould, Greene County Tech and Marmaduke School Districts; Mission Outreach of Northeast Arkansas; Mid-South Health Systems; American Cancer Society-Relay for Life; American Railcar Industries; Hitt Family Healthcare; Senior BEES; BanCorp South; 7th and Mueller Church of Christ and Absolute Care Management. The report is not the end of the process. Several small groups will form to begin implementation on several fronts related to the goals and actions identified in the Community Summit. Please contact Shay Willis at Arkansas Methodist Medical Center for information regarding ongoing efforts and how you may get involved. The primary and secondary research is the basis of the Community Health Needs Assessment report for Greene County, Arkansas. The health information contained in these reports can be utilized to further refine community health priorities, develop an updated community plan and guide collaboration and resource allocation. Meet the people who have brought this important information together. As a community, we are appreciative of their work, their time and their talents. Arkansas Methodist Medical Center Executive Board of Directors Barry Davis, President/Chief Executive Officer, Arkansas Methodist Medical Center Brad Bloemer, Chief Financial Officer, Arkansas Methodist Medical Center Lana Williams, Chief Nursing Officer, Arkansas Methodist Medical Center Shay Willis, Director of Marketing and Public Relations, Arkansas Methodist Medical Center Funding for this project was provided by Arkansas Methodist Medical Center Community Health Needs Asssessment 14

17 Engagement Notes Ways I see myself getting involved Goals for my personal health Community Health Needs Asssessment 15

18 2013 Greene County, Arkansas Community Health Needs Assessment