2016 Community Health Needs Assessment. Carrington Area. North Dakota. Ken Hall, JD Shana L.W. Hall, MS, BSN, RN

Transcription

1 2016 Community Health Needs Assessment Carrington Area North Dakota Ken Hall, JD Shana L.W. Hall, MS, BSN, RN

2 Table of Contents Executive Summary... 3 Overview and Community Resources... 6 Assessment Process Demographic Information Health Conditions, Behaviors, and Outcomes Survey Results Findings from Focus Group and Key Informant Interviews Priority of Health Needs Appendix A Survey Instruments Appendix B County Health Rankings Model Appendix C Prioritization of Community s Health Needs Appendix D Response to Previous Assessment This project was supported, in part, by the Federal Office of Rural Health, Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS), Medicare Rural Flexibility Hospital Grant program. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS or the U.S. Government.

3 Executive Summary To help inform future decisions and strategic planning, CHI St. Alexius Health, Carrington and Foster County Public Health conducted a community health needs assessment in Foster County as well as surrounding counties. The assessment sought input from area community members and health care professionals as well as analysis of community health- related data. To gather feedback from the community, residents of the Carrington area and surrounding region were provided the opportunity to participate in a survey. Approximately 238 residents took the survey. Additional information was collected through a focus group and key informant interviews with community leaders. The input from all of these residents represented the broad interests of the area communities. Together with secondary data gathered from a wide range of sources, the information gathered presents a snapshot of health needs and concerns in the community. The demographics of the area reflect the overall makeup of North Dakota in many respects, but residents tend to be older than the state as a whole and are less likely to have completed a four- year degree, which can have workforce implications. Data compiled by County Health Rankings show that as compared to North Dakota generally, Foster County is doing considerably better on measures of health outcomes and health factors. The county ranked 3 rd of all North Dakota Counties on health outcomes and 8 th on health factors. There also is room for improvement on certain individual factors that influence health. Factors on which Foster County was performing poorly relative to the rest of the state included: Rate of diabetics Physical inactivity Alcohol- impaired driving deaths Mental health providers Preventable hospital stays Unemployment Children in single- parent households Of 74 potential community and health needs listed in the survey, residents who took the survey chose nine needs as the most important: Ability to recruit and retain primary care providers Cancer Obesity/overweight Youth alcohol use and abuse (including binge drinking) Community Health Needs Assessment 3

4 Cost of health insurance Availability of primary care providers Availability of specialists Attracting and retaining young families Affordable housing The survey also revealed that the biggest barriers to receiving health care as perceived by community members were not enough specialists, not enough medical providers, and the inability to get appointments or limited appointment hours. When asked what the good aspects of the area were, respondents indicated that the top community assets were: Safe place to live, little/no crime Family- friendly; good place to raise kids Friendly, helpful, and supportive people Active faith community Quality health care Residents are involved in community Input from community leaders provided via key informant interviews and a focus group echoed many of the concerns raised by survey respondents. Thematic concerns emerging from these sessions were: Adequate childcare services Availability of substance abuse/treatment services Ability to recruit and retain primary care providers Prevalence of obesity, overweight Cost of health insurance Adult alcohol use and abuse Youth alcohol use and abuse Political unrest Following careful consideration of the results and findings of this assessment, Community Group members determined that, in their estimation, the significant health needs or issues in the community are: Obesity/overweight Adequate childcare services Youth alcohol use and abuse Adult cyber bullying Adult alcohol use and abuse Community Health Needs Assessment 4

5 Lack of mental health providers Community Health Needs Assessment 5

6 Overview and Community Resources The purpose of conducting a community health assessment is to describe the health of local people, identify areas for health improvement, identify use of local health care services, determine factors that contribute to health issues, identify and prioritize community needs, and help health care and community leaders identify potential action to address the community s health needs. A health needs assessment benefits the community by: 1) collecting timely input from the local community; 2) providing an analysis of secondary data related to health- related behaviors, conditions, risks, and outcomes; 3) compiling and organizing information to guide decision making, education, and marketing efforts, and to facilitate the development of a strategic plan; and 4) engaging community members about the future of health care. Completion of a health assessment also is a requirement for public health departments seeking accreditation. With assistance from Prairie Health Partners and the Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences, CHI St. Alexius Health, Carrington and Foster County Public Health completed a community health assessment that focused on Foster County, but also considered population health information and survey responses from surrounding counties. Many community members and stakeholders worked together on the assessment. CHI St. Alexius Health, Carrington Medical Center is located in a frontier area and is licensed as a critical access hospital with two provider- based clinics. One clinic is attached to the Carrington hospital and the other is located 16 miles to the north in New Rockford. Carrington is located in east central North Dakota, just two hours from four major cities in North Dakota: Fargo, Minot, Grand Forks, and Bismarck. Counties served by CHI St. Alexius Health, Carrington include Foster County and Eddy County in their entirety, plus portions of Stutsman and Wells. Other hospitals are located in both Stutsman and Wells counties. This service area is defined based on the location of the medical facilities, the geographic distance to other hospitals, and the history of usage by consumers. Located in the hospital s service area are the communities of Bowdon, Community Health Needs Assessment 6

7 Carrington, Cathay, Fessenden, Glenfield, Grace City, McHenry, New Rockford, Pingree, Sykeston, and Woodworth. Figure 1: Eddy, Foster, Stutsman and Wells counties, North Dakota CHI St. Alexius Health - Carrington Medical Center CHI St. Alexius Health, Carrington began delivering its health care mission in 1916 as the Carrington Hospital. In 1941, the hospital was leased to the Presentation Sisters of the Fargo Diocese. The Presentation Sisters joined the Catholic Health Corporation of Omaha in 1980 and later became part of Catholic Health Initiatives. In 2014 and 2015, CHI St. Alexius Health, Carrington was recognized as a Health Strong Hospital by being one of the top 100 Critical Access Hospitals in the United States. Additionally, CHI St. Alexius Health, Carrington was named one of the top 20 Critical Access Hospitals in 2014 by the National Rural Health Association. CHI St. Alexius Health officially announced the formation of its regional health care system on April 19, The system is the largest health care delivery system in central and western North Dakota and is comprised of a tertiary hospital in Bismarck, and critical access hospitals (CAHs) in Carrington, Dickinson, Devils Lake, Garrison, Turtle Lake, Washburn and Williston and numerous clinics and outpatient services. CHI St. Alexius Health manages four CAHs in North Community Health Needs Assessment 7

8 Dakota: Ashley, Elgin, Linton, and Wishek, as well as Mobridge Regional Medical Center in Mobridge, S.D. Catholic Health Initiatives, a nonprofit, faith- based health system formed in 1996 through the consolidation of four Catholic health systems, expresses its mission each day by creating and nurturing healthy communities in the hundreds of sites across the nation where it provides care. The nation s second- largest nonprofit health system, Englewood, Colorado- based CHI operates in 19 states and comprises 102 hospitals, including four academic health centers and major teaching hospitals as well as 30 critical- access facilities; community health- services organizations; accredited nursing colleges; home- health agencies; living communities; and other facilities and services that span the inpatient and outpatient continuum of care. In fiscal year 2015, CHI provided almost $970 million in financial assistance and community benefit an 8% increase over the previous year - - for programs and services for the poor, free clinics, education and research. Financial assistance and community benefit totaled more than $1.6 billion with the inclusion of the unpaid costs of Medicare. The health system, which generated operating revenues of $15.2 billion in fiscal year 2015, has total assets of approximately $23 billion. Mission Catholic Health Initiatives states its mission as follows: The Mission of Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education and research. Fidelity to the Gospel urges us to emphasize human dignity and social justice as we create healthier communities. To fulfill this mission, Catholic Health Initiatives, as a values- driven organization, will: Assure the integrity of the healing ministry in both current and developing organizations and activities; Develop creative responses to emerging health care challenges; Promote mission integration and leadership formation throughout the entire organization; Create a national Catholic voice that advocates for systemic change and influences health policy with specific concern for persons who are poor, alienated and underserved; and Community Health Needs Assessment 8

9 Steward resources by general oversight of the entire organization. Vision Catholic Health Initiatives states that its vision is to live up to its name as one CHI: Catholic: Living our Mission and Core Values. Health: Improving the health of the people and communities we serve. Initiatives: Pioneering models and systems of care to enhance care delivery. Specific services provided locally by CHI St. Alexius Health, Carrington are: Medical & Urgent Care Services DOT Exams Family Practice Elder Care Health Maintenance Exams Nursing Home Rounds Pediatrics and Well Child Exams Phone Nurse Prenatal Obstetrics Preoperative Exams Women's Health Inpatient Services Inpatient Care Respite Care Swing Bed Services Surgical Services Endoscopes Colonoscopies, Gastroscopies General Surgery Ophthalmology Cataract Orthopedics Vein Ablation/Varicose Vein Procedure Outpatient Services Cardiac Services - Cardiac Rehabilitation, Stress testing, Cardiac Rehab Support Group Diabetic Services - Individual and group diabetes education, Diabetic Support Group Hospice and Home Health Available by referral IV Therapy Antibiotic, PICC line cares, port cares Medical Nutrition Therapy - Dietitian services Mental Health Services - Available by referral Occupational Therapy Services Social Ministries Healthy Communities, Faith in Action Physical Therapy Services Pulmonary Rehabilitation Sleep Disorder / Apnea Testing Speech and Hearing Services Community Health Needs Assessment 9

10 Radiology - Back and Joint Injections, CT and DEXA scans, echocardiograms, EKG, fluoroscopy, general x- ray, digital mammography, MRI, cardiac stress testing with nuclear medicine, ultrasound Telemedicine Diabetes, pharmacy, sleep study Volunteer Auxiliary Services - Courtesy Cart, Gift Shop Weight Management Support Group Foster County Public Health Foster County Public Health provides public health services that encompass all residents aged birth to death. Services include environmental health, nursing services, WIC (women, infants, and children) program, health screenings and education services. Each of these programs provides a wide variety of services in order to accomplish the mission of public health, which is to assure that Foster County is a healthy place to live and each person has an equal opportunity for optimal health. To accomplish this mission, FCPH is committed to the prevention of disease and injury, promotion of healthy lifestyles, protection and enhancement of the environment, and provision of quality health care services for the people of Foster County. Specific services provided locally by Foster County Public Health are: Alcohol Prevention efforts for youth and adults Angel Tree project at Christmas Blood pressure checks Car seat program Child health (weight checks, ear checks, etc.) Blood sugar and Hemoglobin testing Emergency response and preparedness program Family Planning Services for both females and males Flu shots for children six months and older Health Tracks (child health screening) Home visits chronic disease maintenance, medication set- ups Hepatitis C/HIV testing Immunizations all ages Injections Depo Estradiol, Depo Provera, Depo Testosterone, Vit B12 Lice checks in the school, daycare or office setting Office visits and consults Preschool Screening assistance Community Health Needs Assessment 10

11 Radon testing kits School health (Safe Dates, puberty talks, school immunizations) Sewer Permit applications for county residents Tobacco Prevention and Control Tuberculosis testing and management Water Testing Kits Wellness To Businesses (flu shots, Tetanus and other immunizations, education, and health screenings) West Nile program surveillance and education (mosquitoes) WIC (Women, Infants & Children) Program Youth education programs (bike safety, etc.) Community Resources Along with health care, the economy is based on agri- business, service industries, and retail trade. Foster County is 644 square miles of land located in the center of North Dakota. It is one of the smallest of the state's 53 counties, 18 miles by 36 miles in dimension. It is bordered by Eddy, Griggs, Stutsman and Wells counties. Foster is divided into 18 townships with the seat of county government located in Carrington. Other health care facilities and services in Foster, Eddy and Wells Counties include: six dentists, four chiropractors, two massage therapists, and four optometrists. Each county has a long- term health care center with various additional levels of care and services. Foster, Eddy and Wells County Social Services also offer bathing, housekeeping, and meal preparation services through Quality Service Providers. Carrington has a number of community assets and resources that can be mobilized to address population health improvement. In terms of physical assets and features, the community includes a bike path, fitness center, facility available for winter walking, swimming pool, city park, tennis courts, golf course, movie theatre, local winery and garden, and birding drives. Foster County offers several cultural attractions such as the Foster County Museum, which pays tribute to the early history of the city and region. Community Health Needs Assessment 11

12 Carrington offers public transportation through South Central Transit and through Faith In Action an entity of CHI St. Alexius Health, Carrington. The community also has a grocery store and two pharmacies with delivery services. The Carrington school system offers a comprehensive program for students K- 12. The school system offers limited preschool options, although privately funded preschool is available in the community. Some licensed as well as unlicensed daycares are available in the area. Hospice Agencies: CHI Health at Home Home Health Agencies: CHI Health at Home Jamestown Regional Medical Center Home Health & Hospice Nursing Homes: Golden Acres Nursing Home/Assisted Living - Carrington St. Aloisius Medical Center Harvey Lutheran Home of the Good Shepherd New Rockford Evergreen Sherry Anderson New Rockford Senior Citizens Center: Carrington Senior Citizens Center (Meals on Wheels, Senior Center meals, activities) Eddy County Senior Services James River Senior Services Wells- Sheridan County Senior Services McHenry Senior Services Glenfield Senior Services Public Health Services: Foster County Public Health Eddy County Public Health Wells County Public Health Stutsman County Public Health Home and Community Based Services: Foster & Eddy County Services for the disabled and elderly Wells County Services for the disabled and elderly Stutsman County Services for the disabled and elderly Community Health Needs Assessment 12

13 County Social Service Agencies/Medicaid Providers Foster County Eddy County Wells County Stutsman County Other Community Resources: Options a resource center for Independent Living IPAT - The Interagency Program for Assistive Technology (IPAT) ND Department of Human Services and Regional Human Services Center ND Aging and Disability Resource Link Life Alert Food Assistance: Carrington s Daily Bread Food Pantry Grocery delivery in Carrington from Leevers Help with Rides to Medical Appointments: Faith In Action - rides to Medical appointments in or out of town South Central Transit - transportation within Carrington city limits and some availability within Foster County Help for the Homeless: Bismarck Homeless Coalition Fargo Salvation Army Jamestown Salvation Army Community Health Needs Assessment 13

14 Assessment Process Prairie Health Partners, a Grand Forks- based consulting firm, working closely with the Center for Rural Health, provided substantial support to CHI St. Alexius Health, Carrington and Foster County Public Health in conducting this needs assessment. Professionals from Prairie Health Partners have conducted dozens of comprehensive community health needs assessments and community development activities in a wide variety of communities, including many rural communities. The Center for Rural Health is one of the nation s most experienced organizations committed to providing leadership in rural health. Its mission is to connect resources and knowledge to strengthen the health of people in rural communities. As the federally designated State Office of Rural Health (SORH) for the state and the home to the North Dakota Medicare Rural Hospital Flexibility (Flex) program, the Center connects the School of Medicine and Health Sciences and the university to rural communities and their health institutions to facilitate developing and maintaining rural health delivery systems. In this capacity the Center works both at a national level and at state and community levels. The assessment process was collaborative. Professionals from both CHI St. Alexius Health, Carrington and Foster County Public Health were heavily involved in planning and implementing the process. They met regularly by telephone conference and via with representatives from Prairie Health Partners. The process closely followed a model used during the last community health needs assessment cycle. CHI St. Alexius Health, Carrington did not receive any written comments from the public on the previous community health needs assessment or its most recent implementation strategy. In response to the previous assessment findings, CHI St. Alexius Health, Carrington implemented a number of programs and initiatives, as detailed in Appendix D. Periodic updates to the implementation strategy included in Appendix D have been highlighted in blue. As part of the assessment s overall collaborative process, Prairie Health Partners spearheaded efforts to collect data for the assessment in a variety of ways: A survey solicited feedback from area residents; Community leaders representing the broad interests of the community took part in one- on- one key informant interviews; The Community Group, comprised of community leaders and area residents, was convened to discuss area health needs and inform the assessment process; and A wide range of secondary sources of data was examined, providing information on a multitude of measures including demographics; health conditions, indicators, and outcomes; rates of preventive measures; rates of disease; and at- risk behaviors. Community Health Needs Assessment 14

15 Detailed below are the methods undertaken to gather data for this assessment by convening a Community Group, conducting key informant interviews, soliciting feedback about health needs via a survey, and researching secondary data. Community Group A Community Group consisting of 18 community members was convened and first met on March 14, During this first Community Group meeting, group members were introduced to the needs assessment process, reviewed basic demographic information about Foster County, as well as Eddy, Stutsman and Wells counties, and served as a focus group. Focus group topics included community assets and challenges, the general health needs of the community, community concerns, and suggestions for improving the community s health. The Community Group met again on May 9, 2016 with 16 community members in attendance. At this second meeting the Community Group was presented with survey results, findings from key informant interviews and the focus group, and a wide range of secondary data relating to the general health of the population in Foster, Eddy, Stutsman and Wells counties. The group was then tasked with identifying and prioritizing the community s health needs. Members of the Community Group represented the broad interests of the community served by CHI SAHC and FCPH. They included representatives of the health community, business community, economic development, political bodies, law enforcement, emergency services, education, faith community, and public health. Not all members of the group were present at both meetings. Interviews One- on- one interviews with six key informants were conducted in person in Carrington on March 14, Representatives from Prairie Health Partners conducted the interviews. Interviews were held with selected members of the Community Group as well as other key informants who could provide insights into the community s health needs. Included among the informants were a public health professional with special knowledge in public health acquired through several years of direct experience in the community, including working with medically underserved, low income, and minority populations, as well as with populations with chronic diseases. Topics covered during the interviews included the general health of the community, community concerns, delivery of health care by local providers, awareness of health services offered locally, barriers to receiving health services, and suggestions for improving collaboration within the community. Survey A survey was distributed to gather feedback from the community. The survey was not intended to be a scientific or statistically valid sampling of the population. Rather, it was designed to be an additional tool for collecting qualitative data from the community at large specifically, information related to community- perceived health needs and assets. Community Health Needs Assessment 15

16 The survey was distributed to various residents of Foster County and the other counties served by CHI St. Alexius Health, Carrington. The survey tool was designed to: Learn of the good things in the community and the community s concerns; Understand perceptions and attitudes about the health of the community, and hear suggestions for improvement; and Learn more about how residents use local health services. Specifically, the survey covered the following topics: Residents perceptions about community assets Broad areas of community and health concerns Intimate partner violence Awareness of local health services Barriers to using local health care Hospital foundation awareness Basic demographic information Suggestions to improve the delivery of local health care Approximately 500 community member surveys were available for distribution. To promote awareness of the assessment process, press releases led to articles in two newspapers in Foster and Eddy counties including in the communities of Bowdon, Carrington, Fessenden, Glenfield, Grace City, Kensal, New Rockford, Pingree, and Woodworth. Additionally, information was published on CHI SAHC s website and FCPH s Facebook page. The surveys were distributed by Community Group members and at CHI SAHC, FCPH, and local churches. To help ensure anonymity, each survey included a postage- paid return envelope to the Center for Rural Health. In addition, to help make the survey as widely available as possible, residents also could request a survey by calling CHI SAHC or FCPH. Area residents also were given the option of completing an online version of the survey, which was publicized in two community newspapers, ed to at least 25 community groups, and on the websites of both CHI SAHC and FCPH. The survey period ran from February 18 to March 31, 2016, and 74 paper surveys were returned, while 164 online electronic surveys were taken. In total, counting both paper and online surveys, 238 community member surveys were submitted. The response rate is on par for this type of unsolicited survey methodology and indicates an engaged community. Secondary Data Secondary data was collected and analyzed to provide descriptions of: (1) population demographics, (2) general health issues (including any population groups with particular health issues), and (3) contributing causes of community health issues. Data were collected from a variety of sources including the U.S. Census Bureau; the Robert Wood Johnson Foundation s County Health Rankings (which pulls data from more than 20 primary data sources); the National Survey of Children s Health Data Resource Center; the Centers for Disease Control and Community Health Needs Assessment 16

17 Prevention; the North Dakota Behavioral Risk Factor Surveillance System; and the National Center for Health Statistics. Community Health Needs Assessment 17

18 Demographic Information Table 1 summarizes general demographic and geographic data about Eddy, Foster, Stutsman and Wells counties. TABLE 1: EDDY, FOSTER, STUTSMAN & WELLS COUNTIES: INFORMATION AND DEMOGRAPHICS (From 2010 Census/2014 American Community Survey; more recent estimates used where available) Eddy County Foster County Stutsman County Wells County North Dakota Population (2014 est.) 2,377 3,362 21,129 4, ,482 Population change ( ) - 0.3% 0.6% 0.1% - 0.4% 9.9% People per square mile (2010) Persons 65 years or older (2014 est.) 23.8% 22.0% 17.6% 27.1% 14.2% Persons under 18 years (2014 est.) 22.2% 21.4% 20.4% 19.2% 22.8% Median age (2014 est.) White persons (2014 est.) 93.0% 97.4% 95.1% 97.7% 89.1% Non- English speaking (2014 est.) 2.2% 4.4% 4.9% 2.6% 5.4% High school graduates (2014 est.) 86.6% 88.1% 87.3% 84.1% 91.3% Bachelor s degree or higher (2014 est.) 19.9% 20.0% 22.3% 19.7% 27.3% Live below poverty line 10.7% 8.0% 11.6% 10.9% 11.5% Children under 18 in poverty (2013) 20.9% 10.1% 18.7% 9.0% 14.1% While the population of North Dakota has grown in recent years, the populations of the four counties studied were stable with modest changes between 2010 and The data show that the area is rural and that its residents are older than the state as a whole and are less likely to have completed a four- year degree, which can have workforce implications. Eddy and Stutsman counties had higher levels of children in poverty than North Dakota overall, while Foster and Wells counties experienced lower rates of children in poverty. Community Health Needs Assessment 18

19 Health Conditions, Behaviors, and Outcomes As noted above, several sources of secondary data were reviewed to inform this assessment. The data are presented below in two categories: County Health Rankings and children s health. County Health Rankings The Robert Wood Johnson Foundation, in collaboration with the University of Wisconsin Population Health Institute, has developed County Health Rankings to illustrate community health needs and provide guidance for actions toward improved health. In this report, Eddy, Foster, Stutsman and Wells counties are compared to North Dakota rates and national benchmarks on various topics ranging from individual health behaviors to the quality of health care. The data used in the 2016 County Health Rankings are pulled from more than 20 data sources and then are compiled to create county rankings. Counties in each of the 50 states are ranked according to summaries of a variety of health measures. Those having high ranks, such as 1 or 2, are considered to be the healthiest. Counties are ranked on both health outcomes and health factors. As shown in Table 2 below, for example, Foster County ranks 3 rd out of 49 ranked counties in North Dakota on health outcomes and 8 th on health factors. Below is a breakdown of the variables that influence a county s rank. A model of the 2016 County Health Rankings a flow chart of how a county s rank is determined may be found in Appendix B. For further information, visit the County Health Rankings website at Community Health Needs Assessment 19

20 Table 2 summarizes the pertinent information gathered by County Health Rankings as it relates to the counties in the assessment area. It is important to note that these statistics describe the population of a county regardless of where county residents choose to receive their medical care. In other words, all of the following statistics are based on the health behaviors and conditions of the county s residents, not necessarily the patients and clients of CHI St. Alexius Health, Carrington and Foster County Public Health or of particular medical facilities. For most of the measures included in the rankings, the County Health Rankings authors have calculated the Top U.S. Performers for The Top Performer number marks the point at which only 10% of counties in the nation do better, i.e., the 90th percentile or 10th percentile, depending on whether the measure is framed positively (such as high school graduation) or negatively (such as adult smoking). As shown in the key below, the measures listed in Table 2 marked with a red checkmark (ü ) are those where a county is not measuring up to the state rate/percentage; a blue checkmark (ü ) indicates that the county may be faring better than the North Dakota average, but is not meeting the U.S. Top 10% rate on that measure. Measures marked with a smiling icon (J ) indicate that the county is in the U.S. Top 10% of counties on that measure. ü = County is worse than the state average ü = County is not meeting the Top 10% nationally J = County in Top 10% nationally Community Health Needs Assessment 20

21 TABLE 2: SELECTED MEASURES FROM 2016 COUNTY HEALTH RANKINGS Eddy County Foster County Stutsman County Wells County U.S. Top 10% North Dakota Ranking: Outcomes 41 st 3 rd 36 th 28 th (of 49) Premature death - 5,200 J 7,400 ü ü 8,100 ü ü 5,200 6,600 Poor or fair health 14% ü 11% J 11% J 12% J 12% 14% Poor physical health days (in past 30 days) 3.0 ü ü 2.5 J 2.4 J 2.6 J Poor mental health days (in past 30 days) 2.9 ü 2.5 J 2.5 J 2.6 J Low birth weight - 4% J 9% ü ü - 6% 6% % Diabetic 12% ü ü 10% ü ü 8% J 10% ü ü 9% 8% Ranking: Factors 39 th 8 th 27 th 37 th (of 49) Health Behaviors Adult smoking 19% ü 16% ü 17% ü 16% ü 14% 20% Adult obesity 32% ü ü 29% ü 30% ü 32% ü ü 25% 30% Food environment index 8.1 ü ü 8.9 J 8.4 J 8.1 ü ü Physical inactivity 29% ü ü 34% ü ü 29% ü ü 33% ü ü 20% 25% Access to exercise opportunities 62% ü ü 68% ü 79% ü 1% ü ü 91% 66% Excessive drinking 19% ü 21% ü 22% ü 19% ü 12% 25% Alcohol- impaired driving deaths 75% ü ü 67% ü ü 43% ü 40% ü 14% 47% Sexually transmitted infections ü 93.7 J Teen birth rate 23 ü 22 ü 23 ü 27 ü Clinical Care Uninsured 15% ü ü 12% ü 12% ü 13%ü ü 11% 12% Primary care physicians :1ü 1320:1ü ü 4210:1ü ü 1040:1 1260:1 Dentists 790:1 J 1680:1ü 1510:1 ü 1400:1 ü 1340:1 1690:1 Mental health providers :1ü ü 350:1 J - 370:1 610:1 Preventable hospital stays 71 ü ü 64 ü ü 45 ü 87 ü ü Diabetic monitoring 80% ü ü 87% ü 86% ü 72% ü ü 90% 86% Mammography screening 71% J 79% J 73% J 71% J 71% 68% Social and Economic Factors Unemployment 5.9% ü ü 3.2% ü 2.9% ü 4.8% ü ü 3.5% 2.8% Children in poverty 14% ü 10% J 14% ü 14% ü 13% 14% Income inequality 4.4 ü 4.3 ü 4.1 ü 4.3 ü Children in single- parent households 41% ü ü 36% ü ü 42% ü ü 16% J 21% 27% Violent crime 55 J 11 J 186 ü 140 ü Injury deaths 126 ü ü 60 ü 66 ü ü 95 ü ü Physical Environment Air pollution particulate matter 9.8 ü 9.9 ü 10.0 ü 9.6 ü Drinking water violations No No Yes Yes No Severe housing problems 8% J 11% ü 7% J 8% J 9% 11% Community Health Needs Assessment 21

22 Foster County Summary The data from County Health Rankings show that Foster County is in top 10% of counties nationally on a number of studied measures: Premature death Self- reported poor or fair health Self- reported poor physical health days Self- reported poor mental health days Low birth weight Food environment index Mammography screening Children in poverty Violent crime The data revealed, however, that Foster County is faring worse than North Dakota averages on the following measures: Rate of diabetics Physical inactivity Alcohol- impaired driving deaths Mental health providers Preventable hospital stays Unemployment Children in single- parent households Other measures where Foster County tended to do better than the state overall, but was not performing in the top 10% of counties nationally were: Rate of diabetics Adult smoking Adult obesity Physical inactivity Access to exercise opportunities Excessive drinking Alcohol- impaired driving deaths Teen birth rate Uninsured residents Primary care physicians Dentists Mental health providers Preventable hospital stays Diabetic monitoring Income inequality Children in single- parent households Injury deaths Air pollution particulate matter Severe housing problems Eddy County Summary The data from County Health Rankings show that Eddy County is in top 10% of counties nationally on a few studied measures: Dentists Mammography screening Severe housing problems Violent crime Community Health Needs Assessment 22

23 The data revealed, however, that Eddy County is faring worse than North Dakota averages on the following measures: Self- reported poor physical health days Rate of diabetics Adult obesity Food environment index Physical inactivity Access to exercise opportunities Alcohol- impaired driving deaths Uninsured residents Preventable hospital stays Diabetic monitoring Unemployment Children in single- parent households Injury deaths Other measures where Eddy County tended to do better than the state overall, but was not performing in the top 10% of counties nationally were: Self- reported poor or fair health Self- reported poor mental health days Adult smoking Excessive drinking Teen birth rate Children in poverty Income inequality Air pollution particulate matter Community Health Needs Assessment 23

24 Children s Health The National Survey of Children s Health touches on multiple intersecting aspects of children s lives. Data are not available at the county level; listed below is information about children s health in North Dakota. The full survey includes physical and mental health status, access to quality health care, and information on the child s family, neighborhood, and social context. Data are from More information about the survey may be found at: Key measures of the statewide data are summarized below. The rates highlighted in red signify that the state is faring worse on that measure than the national average. TABLE 3: SELECTED MEASURES REGARDING CHILDREN S HEALTH (For children aged 0-17 unless noted otherwise) Health Status North Dakota National Children born premature (3 or more weeks early) 10.8% 11.6% Children overweight or obese 35.8% 31.3% Children 0-5 who were ever breastfed 79.4% 79.2% Children 6-17 who missed 11 or more days of school 4.6% 6.2% Health Care Children currently insured 93.5% 94.5% Children who had preventive medical visit in past year 78.6% 84.4% Children who had preventive dental visit in past year 74.6% 77.2% Young children (10 mos.- 5 yrs.) receiving standardized screening for developmental or behavioral problems 20.7% 30.8% Children aged 2-17 with problems requiring counseling who received needed mental health care 86.3% 61.0% Family Life Children whose families eat meals together 4 or more times per week 83.0% 78.4% Children who live in households where someone smokes 29.8% 24.1% Neighborhood Children who live in neighborhood with a park, sidewalks, a library, and a community center 58.9% 54.1% Children living in neighborhoods with poorly kept or rundown housing 12.7% 16.2% Children living in neighborhood that s usually or always safe 94.0% 86.6% The data on children s health and conditions reveal that while North Dakota is doing better than the national averages on some measures, it is not measuring up to the national averages with respect to: Obese or overweight children Children with health insurance Preventive primary care and dentist visits Developmental/behavioral screening Children in smoking households Community Health Needs Assessment 24

25 Table 4 includes selected county- level measures regarding children s health in North Dakota. The data come from North Dakota KIDS COUNT, a national and state- by- state effort to track the status of children, sponsored by the Annie E. Casey Foundation. KIDS COUNT data focus on main components of children s well being; more information about KIDS COUNT is available at The measures highlighted in red in the table are those in which that county is doing worse than the state average. The year of the most recent data is noted. The data show that the area suffers from higher rates of uninsured children and a lack of licensed childcare services. Notably, the number of children that can be served by licensed childcare providers in Foster County is less than half the state rate. TABLE 4: SELECTED COUNTY- LEVEL MEASURES REGARDING CHILDREN S HEALTH Uninsured children (% of population age 0-18), 2013 Uninsured children below 200% of poverty (% of population), 2013 Medicaid recipient (% of population age 0-20), 2015 Children enrolled in Healthy Steps (% of population age 0-18), 2013 Supplemental Nutrition Assistance Program (SNAP) recipients (% of population age 0-18), 2015 Licensed childcare capacity (% of population age 0-13), 2016 High school dropouts (% of grade 9-12 enrollment), 2014 Eddy County Foster County Stutsman County Wells County North Dakota 11.5% 10.4% 8.7% 10.4% 8.7% 54.0% 57.7% 49.1% 56.5% 47.8% 29.5% 26.7% 26.8% 25.7% 27.9% 4.8% 2.4% 3.0% 2.4% 2.5% 15.7% 14.5% 18.2% 15.6% 20.7% 27.9% 22.1% 36.5% 32.8% 44.5% 0% 0% 3.1% 1.3% 2.8% Community Health Needs Assessment 25

26 Survey Results As noted previously, 238 community members took the survey in communities throughout the assessment area. Survey results are reported below in six categories: Demographics Health insurance status Community assets Community concerns Delivery of health care CHI Carrington Health Foundation Demographics To better understand the perspectives being offered by survey respondents, survey- takers were asked a few demographic questions. Throughout this report, numbers (N) instead of percentages (%) are reported because percentages can be misleading with smaller numbers. Survey respondents were not required to answer all survey questions; they were free to skip any questions they wished. With respect to demographics of those who chose to take the survey: The survey attracted a fairly even distribution of ages. The most represented groups were those aged 35 to 44 and 45 to 54, with 46 and 45 respondents, respectively. The large majority were female, with a ratio of female- to- male of more than three- to- one. Slightly more than half of respondents (N=99) had bachelor s degrees or higher, with a plurality of respondents (N=67) having bachelor s degrees. A large majority (N=129) worked full- time, with retirees (N=32) being the next largest group. A plurality (N=44) of respondents who chose to provide household income reported income in the range of $100,000 to $149,999. Figure 2 shows these demographic characteristics. It illustrates the wide range of community members household income and indicates how this assessment took into account input from parties who represent the varied interests of the community served, including wide age ranges, those in diverse work situations, and lower- income community members. Of those who provided a household income, 12 community members reported a household income of less than $25,000, with seven of those indicating a household income of less than $15,000. Of survey- takers who chose to identify their race or ethnicity, 190 were white, one was Hispanic/Latino and three were American Indian. Community Health Needs Assessment 26

27 Figure 2: Demographics of Survey Respondents Age to 24 years 25 to 34 years 35 to 44 years Gender 46 Female to 54 years 55 to 64 years 65 to 74 years 153 Male 75 years and older Highest Educaqon Less than high school High school diploma or GED Some college/ technical degree Associate's degree Bachelor's degree Graduate or professional degree Employment Status 13 1 Full qme 32 Part qme Homemaker Mulqple job holder Unemployed Reqred Prefer not to answer $150,000 and over Household Income $100,000 to $149, $75,000 to $99, $50,000 to $74, $25,000 to $49, $15,000 to $24,999 5 Less than $15, Community Health Needs Assessment 27

28 Survey takers were asked whether they worked for the hospital, clinic, or public health unit. As shown in Figure 3, 145 responded they did not work for these health organizations, while 38 said they did and 18 indicated they worked for another health care facility in the community. Figure 3: Work for Hospital, Clinic or Public Health? Yes No I work for another healthcare facility in the community Health Insurance Status Community members were asked about their health insurance status. Health insurance status often is associated with whether people have access to health care. A large majority of respondents (N=168) reported having insurance that was self- purchased or through their employer. Thirty- seven reported having Medicare. Four respondents said they had no insurance, while an additional four said they were underinsured. Figure 4: Insurance Status Insurance through employer or self- purchased 168 Medicare 37 Other. Please specify: Medicaid No insurance Veteran s Health Care Benefits Not enough insurance Indian Health Service (IHS) Community Health Needs Assessment 28

29 Community Assets Survey- takers were asked what they perceived as the best things about their community in four categories: people, services and resources, quality of life, and activities. In each category, respondents were given a list of choices and asked to pick the three best things. Respondents occasionally chose less than three or more than three choices within each category. The results indicate there is consensus (with 140 or more respondents agreeing) that community assets include: Safe place to live, little/no crime (N=184) Family- friendly; good place to raise kids (N=177) Friendly, helpful, and supportive people (N=156) Active faith community (N=146) Quality health care (N=141) Residents are involved in community (N=141) Figures 5 to 8 illustrate the results of these questions. Figure 5: Best Things about the PEOPLE in Your Community People are friendly, helpful, supporqve 156 People who live here are involved in their community 141 Feeling connected to people who live here Sense that you can make a difference through civic engagement Community is socially and culturally diverse or becoming more diverse Government is accessible People are tolerant, inclusive and open- minded Other Community Health Needs Assessment 29

30 Figure 6: Best Things about the SERVICES AND RESOURCES in Your Community Acqve faith community Health care Quality school systems Access to healthy food Community groups and organizaqons Programs for youth Business district (restaurants, availability of goods) Public transportaqon Opportuniqes for advanced educaqon Other Figure 7: Best Things about the QUALITY OF LIFE in Your Community Safe place to live, litle/no crime Family- friendly; good place to raise kids Closeness to work and acqviqes 113 Informal, simple, laidback lifestyle 86 Job opportuniqes or economic opportuniqes 29 Other Figure 8: Best Thing about the ACTIVITIES in Your Community Recreaqonal and sports acqviqes 139 Acqviqes for families and youth Local events and fesqvals Year- round access to fitness opportuniqes Arts and cultural acqviqes Other Community Health Needs Assessment 30

31 Community Concerns At the heart of this community health assessment was a section on the survey asking survey- takers to review a wide array of potential community and health concerns in seven categories and asked to pick the top three concerns. The seven categories of potential concerns were: Community health Availability of health services Safety/environmental health Delivery of health services Physical health Mental health and substance abuse Senior population The two most highly voiced concerns, chosen by at least 120 respondents, were: Ability to recruit and retain primary care providers (N=142) Cancer (N=122) The other issues that were chosen by at least 100 survey- takers were: Obesity/overweight (N=112) Youth alcohol use and abuse (including binge drinking) (N=111) Cost of health insurance (N=110) Availability of primary care providers (N=106) Availability of specialists (N=105) Attracting and retaining young families (N=102) Affordable housing (N=100) Examining the survey responses from those who indicated they worked for a health care facility reveals that health care professionals generally share the same concerns as community members. Consistent with the overall survey results, health care professionals rated the top concern as the ability to recruit and retain primary care providers. They differed in that they judged the availablity of specialists as the second- highest concern, and also included as a top concern the inadequate number of jobs with livable wages. Top concerns of health care professionals (those chosen by at least 35 health care professionals) were: Ability to recruit and retain primary care providers (N=50) Availability of specialists (N=43) Cancer (N=41) Obesity/overweight (N=41) Cost of health insurance (N=40) Attracting and retaining young families (N=37) Community Health Needs Assessment 31

32 Jobs with livable wages (N=35) Figures 9 through 15 illustrate these results. Figure 9: Community Health Concerns All Respondents Atracqng and retaining young families Affordable housing Adequate childcare services Jobs with livable wages Adequate school resources Access to exercise and wellness acqviqes Adequate youth acqviqes Poverty Change in populaqon size Other Figure 9A: Community Health Concerns Health Care Professionals Only Atracqng and retaining young families Jobs with livable wages Adequate childcare services Affordable housing Adequate school resources Access to exercise and wellness acqviqes Adequate youth acqviqes Poverty Change in populaqon size Other Community Health Needs Assessment 32

33 Figure 10: Availability of Health Services Concerns All Respondents Availability of primary care providers Availability of specialists Ability to get appointments 76 Availability of substance abuse/treatment services Availability of mental health services Availability of wellness/disease prevenqon services Availability of dental care Availability of vision care Availability of public health professionals Other Figure 10A: Availability of Health Services Concerns Health Care Professionals Only Availability of specialists 43 Availability of primary care providers 33 Ability to get appointments Availability of substance abuse/treatment services Availability of mental health services Availability of wellness/disease prevenqon services Availability of public health professionals Availability of dental care Availability of vision care Other Community Health Needs Assessment 33

34 Figure 11: Safety/Environmental Health Concerns All Respondents Adult cyber bullying Emergency services available 24/7 Youth cyber bullying Traffic safety Prejudice, discriminaqon Public transportaqon (opqons and cost) Crime and safety Water quality (well water, lakes, rivers) Physical violence, domesqc violence Other Air quality Land quality (liter, illegal dumping) Low graduaqon rates Figure 11A: Safety/Environmental Health Concerns Health Care Professionals Only Adult cyber bullying Emergency services available 24/7 Youth cyber bullying Prejudice, discriminaqon Public transportaqon (opqons and cost) Crime and safety Traffic safety Water quality (well water, lakes, rivers) Physical violence, domesqc violence Other Air quality Land quality (liter, illegal dumping) Low graduaqon rates Community Health Needs Assessment 34

35 Figure 12: Delivery of Health Services Concerns All Respondents Ability to recruit and retain primary care providers Cost of health insurance Cost of health care services 88 Cost of prescripqon drugs Extra hours for appointments, such as evenings and weekends Quality of care Paqent confidenqality Providers using electronic health records Sharing of informaqon between healthcare providers Other Adequacy of Indian Health or Tribal Health services Figure 12A: Delivery of Health Services Concerns Health Care Professionals Only Ability to recruit and retain primary care providers Cost of health insurance Cost of health care services 28 Cost of prescripqon drugs Extra hours for appointments, such as evenings and weekends Paqent confidenqality Quality of care Sharing of informaqon between healthcare providers Providers using electronic health records Other Adequacy of Indian Health or Tribal Health services Community Health Needs Assessment 35

36 Figure 13: Physical Health Concerns All Respondents Cancer Obesity/overweight Diabetes Poor nutriqon, poor eaqng habits Sedentary lifestyles Youth obesity Heart disease Youth hunger and poor nutriqon Lung disease (Emphysema, COPD, Asthma, etc.) Youth sexual health (including sexually transmited infecqons) Wellness and disease prevenqon, including vaccine- preventable diseases Other Teen pregnancy Sexual health (including sexually transmited diseases/aids Community Health Needs Assessment 36

37 Figure 13A: Physical Health Concerns Health Care Professionals Only Obesity/overweight Cancer Diabetes 23 Heart disease Poor nutriqon, poor eaqng habits Sedentary lifestyles Youth obesity Lung disease (Emphysema, COPD, Asthma, etc.) Youth sexual health Wellness and disease prevenqon, including vaccine- preventable diseases Youth hunger and poor nutriqon Teen pregnancy Other Sexual health (including sexually transmited diseases/aids Community Health Needs Assessment 37

38 Figure 14: Mental Health and Substance Abuse Concerns All Respondents Youth alcohol use and abuse 111 Adult alcohol use and abuse Youth drug use and abuse Adult drug use and abuse 57 Depression Stress Adult mental health Youth suicide Youth mental health Youth tobacco use Adult suicide Adult tobacco use Other Community Health Needs Assessment 38

39 Figure 14A: Mental Health and Substance Abuse Concerns Health Care Professionals Only Adult alcohol use and abuse Youth alcohol use and abuse Youth drug use and abuse Adult drug use and abuse Depression Stress Adult mental health Youth suicide Youth mental health Youth tobacco use Adult suicide Adult tobacco use Other Figure 15: Senior Population Concerns All Respondents Availability of resources to help the elderly stay in their homes Assisted living opqons Ability to meet needs of older populaqon Long- term/nursing home care opqons Demenqa/Alzheimer s disease Availability of acqviqes for seniors Availability of resources for family and friends caring for elders Cost of acqviqes for seniors Other Elder abuse Community Health Needs Assessment 39

40 Figure 15A: Senior Population Concerns Health Care Professionals Only Availability of resources to help the elderly stay in their homes Assisted living opqons Ability to meet needs of older populaqon Availability of resources for family and friends caring for elders Demenqa/Alzheimer s disease Long- term/nursing home care opqons 16 Availability of acqviqes for seniors 13 Cost of acqviqes for seniors Elder abuse 3 4 Other The survey posed two questions about intimate partner violence. First, respondents were asked if they were aware of any incidents of intimate partner violence in their community. Second, they were asked whether they would report any known incidents of intimate partner violence to city or county law enforcement. A large majority of survey respondents said they were not aware of such incidencts of violence, but that they would be willing to report incidents if they were aware of them. Figure 16 shows these results. Figure 16: Intimate Partner Violence Aware of inqmate partner violence incidents in your community? Willing to report to law enforcement incidents of inqmate partner violence? Yes No Yes No In an open- ended question, residents were asked to share other concerns and challenges, as well as suggestions to improve the delivery of local health care. Forty survey- takers provided Community Health Needs Assessment 40

41 responses to this question. By far, the concern voiced most related to the ability to recruit and retain providers, specifically physicians. Specific comments provide some insights into residents perception of this issue: Must recruit and retain local doctors and make working conditions favorable so the doctors have a quality of life that makes them willing to stay. CHI needs to get some Drs. in there. We are sick of hearing that nobody wants to work in Carrington. Challenges bringing quality physicians to a smaller town and then when we get good ones not to overload them. Having a local physician on call for ER would be wonderful as well, but I understand they need their time off as well. Need to recruit good local doctors who have a connection to the community. That gives them family ties to the community and hopefully makes it more likely for them to enjoy a long career here. We can't miss any of these local recruitment opportunities when they come up. Not enough doctors. Those that are here are great but are over worked and run down. Burn out is very likely. Have had instances with nurses and front desk staff being rude, short with others, or crabby. Concern about administration not being able to secure another medical doctor, won't be long until there will only be one here! We need an additional physician. We are seriously over working those we have. Other concerns noted by multiple respondents were: (1) the lack of adequate ambulance personnel and concerns that emergency services will not be available when needed, (2) the lack of community plans to attract and retain young families, as evidenced by the recent vote against funding for a new school, and (3) costs of insurance (including high deductibles and co- pays), health care services, and prescription drugs. Community Health Needs Assessment 41

42 Delivery of Health Care The survey asked residents what they see as preventing them or others from receiving health care locally. The most prevalent barrier perceived by residents was not enough specialists (N=63), followed by not enough medical providers (N=58) and the inability to get appointments or limited appointment hours (N=34). Figure 17 illustrates these results. Figure 17: Perceptions about Barriers to Care Not enough specialists Not enough medical providers Not able to get appointment/limited hours Concerns about confidenqality Not enough evening or weekend hours Not able to see same provider over qme Not affordable No insurance or limited insurance Other Don t know about local services Distance from health facility Poor quality of care Can t get transportaqon services Limited access to telehealth technology Don t speak language or understand culture Lack of services through Indian Health Service Lack of disability access Community Health Needs Assessment 42

43 The survey revealed that, by a large margin, residents turned to a primary care provider (doctor, nurse practitioner, physician assistant) for trusted health information. Other common sources of trusted health information are other health care professionals (nurses, chiropractors, dentists, etc.) and web searches/internet (WebMD, Mayo Clinic, Healthline, etc.). Figure 18: Sources of Trusted Health Information Primary care provider (doctor, nurse pracqqoner, physician assistant) 169 Other health care professionals (nurses, chiropractors, denqsts, etc.) Web searches/internet (WebMD, Mayo Clinic, Healthline, etc.) Word of mouth, from others (friends, neighbors, co- workers, etc.) 70 Public health professional 45 Other When asked whether they would appreciate having a trained paramedic make visits to their home following an illness, the majority of respondents replied no. Figure 19: Appreciate Visit from Trained Paramedic Following Illness? 68 Yes 114 No Services Provided by CHI St. Alexius Health, Carrington The survey asked community members whether they were aware of (or have used) services offered locally by CHI St. Alexius Health, Carrington and by Foster County Public Health. Among services offered by the hospital, community members were most aware of: Family practice (N=163) Physical therapy services (N=140) Community Health Needs Assessment 43

44 Inpatient care (N=137) Endoscopes colonoscopies, gastroscopies (N=133) Radiology (N=133) Phone nurse (N=127) Community members were least aware of the following services: Respite Care (N=53) Prenatal obstetrics (N=53) Ophthalmology cataract (N=54) Orthopedics (N=62) Pulmonary rehabilitation (N=62) Telemedicine - diabetes, pharmacy, sleep study (N=62) These services with lower levels of awareness may present opportunities for further marketing, greater utilization, and increased revenue. Figures 20 to 23 illustrate community members awareness of services. Figure 20: Awareness of Inpatient Services Inpaqent Care 137 Swing Bed Services 106 Respite Care Figure 21: Awareness of Surgery Services Endoscopes Colonoscopies, Gastroscopies 133 Vein Ablaqon/Varicose Vein Procedure 85 General Surgery 73 Orthopedics Ophthalmology Cataract Community Health Needs Assessment 44

45 Figure 22: Awareness of Outpatient Services Physical Therapy Services Radiology - Back and Joint Injecqons, CT and DEXA Hospice and Home Health - Available by referral Cardiac Services - Cardiac Rehabilitaqon, stress Diabeqc Services - Individual and group diabetes Volunteer Auxiliary Services - Courtesy Cart, Gix Shop Social Ministries - Health Communiqes, Faith In Acqon Occupaqonal Therapy Services Speech and Hearing Services Weight Management Support Group Mental Health Services - Available by referral IV Therapy - Anqbioqc, PICC line cares, port cares Sleep Disorder / Apnea Tesqng Medical Nutriqon Therapy - Dieqqan services Telemedicine - Diabetes, pharmacy, sleep study Pulmonary Rehabilitaqon Figure 23: Awareness of Clinical Services Family Pracqce 163 Phone Nurse 127 Health Maintenance Exams 112 Pediatrics and Well Child Exams Nursing Home Rounds Preoperaqve Exams Women's Health DOT Exams Elder Care Prenatal Obstetrics Community Health Needs Assessment 45

46 Services Provided by Foster County Public Health With respect to public health services, respondents were generally aware of some services, such as immunizations and public health care, but most survey- takers were unaware of several of public health s other offerings, as shown in Figure 24: Figure 24: Awareness of Public Health Services Immunizaqons 162 Public Health Care 123 Car Seat Safety Foot Care WIC Home Visits (chronic disease management, medicaqon set- up) Tobacco Educaqon Maintenance Injecqons (Depo Provera, Depo Testosterone, Vitamin B12) Wellness Clinics Family Planning Health Tracks School Nursing Environmental Health Community Health Needs Assessment 46

47 Hospital Foundation The survey asked residents whether (1) they were aware of the hospital s foundation, and (2) they have supported the foundation. The majority of respondents were aware of the foundation. A relatively small number of respondents indicated they had supported the foundation, with cash and stock gifts being the most common form of support. Figures 25 and 26 show these results. Figure 25: Aware of Hospital Foundation? Yes No Figure 26: Supported Hospital Foundation? Cash or stock gix 33 Memorial/Honorarium CHI Carrington Health employee payroll donaqons Other Endowment gixs Planned gixs through wills, trusts or life insurance policies Community Health Needs Assessment 47

48 Findings from Focus Group and Key Informant Interviews Questions about the health and well- being of the community, similar to those posed in the survey, were explored during key informant interviews with community leaders and health professionals. The themes that emerged from these sources were wide- ranging, with some directly associated with health care and others more rooted in broader community matters. Some issues were similar to those that emerged from the survey, while others were not reflected in survey responses. Eight issues were raised: Adequate childcare services Availability of substance abuse/treatment services Ability to recruit and retain primary care providers Prevalence of obesity, overweight Cost of health insurance Adult alcohol use and abuse Youth alcohol use and abuse Political unrest To provide context for these expressed needs, below are some of the comments that interviewees made about these issues: Adequate childcare services Younger families are moving back and need childcare services This will help to free up parents who want to work Lack of services makes economic development a struggle Options are limited; many daycares not licensed Problem is getting worse Availability of substance abuse/treatment services People don t know where to go for help We need these services locally These problems are becoming more prevalent Counselors are overworked Community Health Needs Assessment 48

49 Ability to recruit and retain primary care providers After loss of physician, I would have liked to have seen a bigger recruiting initiative We need a more focused attention to recruiting We have no relationship with locums who are there on weekends Getting harder to see same provider over time Prevalence of obesity, overweight It starts in grade school People don t get out enough More desk jobs; kids in front of cell phones and videogames Cost of health insurance High deductibles lead to people foregoing visit to provider There is confusion over insurance marketplaces For some people a co- pay is a burden This is a huge concern all over Adult alcohol use and abuse The bars in this town do well We need for law enforcement to enforce all drug and alcohol laws, not selective enforcement Youth alcohol use and abuse Parents enable kids drinking by hosting parties This has always been an issue; adults look the other way Because of rural nature of area, there aren t as many activities for kids Political unrest Some citizens are against everything, and they make the most noise Certain agitators get their way by making the most noise Creates tension in community Bullying is taking place among the adults Some county commission meetings have become uncivil and unprofessional Community Health Needs Assessment 49

50 Focus group participants and key informants also were asked to weigh in on community engagement and collaboration of various organizations and stakeholders in the community. Specifically, participants were asked, On a scale of 1 to 5, with 1 being no collaboration/community engagement and 5 being excellent collaboration/community engagement, how would you rate the collaboration/engagement in the community among these various organizations? They were then presented with a list of 13 organizations or community segments to rank. According to these participants, public health and faith- based organizations are the most engaged in the community, while human services and social services are viewed as having the most room for improvement. The averages of these rankings (with 5 being excellent engagement or collaboration) were: Public Health Faith- based Emergency services, including ambulance and fire Other local health providers, such as dentists and chiropractors Pharmacies Schools Law enforcement Economic development organizations Hospital (health care system) Long term care, including nursing homes and assisted living Business and industry Human services Social Services Community Health Needs Assessment 50

51 Priority of Health Needs The Community Group met on May 9, Sixteen community members of the group attended the meeting. A representative from Prairie Health Partners presented the group with a summary of this report s findings, including background and explanation about the secondary data, highlights from the survey results (including perceived community assets and concerns, and barriers to care), and findings from the focus group and key informant interviews. Following the presentation of the assessment findings, and after consideration of and discussion about the findings, all members of the group were asked to identify what they perceived as the top four community health needs. All of the potential needs were listed on large poster boards, and each member was given four stickers so they could place a sticker next to each of the four needs they considered the most significant. The results were totaled, and the concerns most often cited were: Obesity/overweight (12 votes) Adequate childcare services (10 votes) Youth alcohol use and abuse (8 votes) Adult cyber bullying (6 votes) Adult alcohol use and abuse (5 votes) Lack of mental health providers (5 votes) In a second round of voting, each member of the group was then given an additional red sticker to place next to the concern they believed was the most important priority of the top six highest ranked priorities. The group chose obesity/overweight as the most important concern, garnering nine votes, followed by youth alcohol use and abuse, with seven votes. A summary of this prioritization may be found in Appendix C. Table 5 shows the currently prioritized needs along with those prioritized by the community in the previous community health needs assessment. TABLE 5: COMPARISON OF PRIORITIZED NEEDS FROM PREVIOUS ASSESSMENT CURRENT CHNA Obesity/overweight Adequate childcare services Youth alcohol use and abuse Adult cyber bullying Adult alcohol use and abuse Lack of mental health providers PREVIOUS CHNA Cancer Chronic disease management Higher costs of health care for consumers Maintaining EMS Obesity and physical inactivity Community Health Needs Assessment 51

52 Appendix A1 Paper Survey Instrument Community Health Needs Assessment 52

53 Community Health Needs Assessment 53

54 Community Health Needs Assessment 54

55 Community Health Needs Assessment 55

56 Community Health Needs Assessment 56

57 Community Health Needs Assessment 57

58 Appendix A2 Online Survey Instrument Community Health Needs Assessment 58

59 Community Health Needs Assessment 59

60 Community Health Needs Assessment 60

61 Community Health Needs Assessment 61

62 Community Health Needs Assessment 62

63 Community Health Needs Assessment 63

64 Community Health Needs Assessment 64

65 Community Health Needs Assessment 65

66 Appendix B County Health Rankings Model Community Health Needs Assessment 66