Randolph County Health Department - PSA Randolph County, Missouri Community Health Needs Assessment

Transcription

1 Randolph County Health Department - PSA Randolph County, Missouri Community Health Needs Assessment December 2016 VVV Consultants LLC Olathe, KS

2 Community Health Needs Assessment Table of Contents I. Executive Summary II. Methodology.. P9 a) CHNA Scope and Purpose b) Local Collaborating CHNA Parties (The identity of any and all organizations with which the organization collaborated and third parties that engaged to assist with the CHNA) c) CHNA and Town Hall Research Process (A description of the process and methods used to conduct the CHNA, a description of how the organization considered the input of persons representing the community, and an explanation of the process / criteria used in prioritizing such needs) d) Community Profile (A description of the community served by the facility and how the community was determined) III. Community Health Status.. P32 a) Historical Health Statistics (Secondary Research) b) Community Feedback Research IV. Inventory of Existing County Health Resources. P47 a) A description of the existing healthcare facilities and other resources within the community available to meet the needs identified through the CHNA V. Detail Exhibits... P67 a) Patient Origin and Access to Care b) Town Hall Attendees, Notes and Feedback (Who attended with qualifications) c) Public Notice and News 1 d) Primary Research Detail 1

3 I. Executive Summary [VVV Consultants LLC] 2

4 I. Executive Summary Randolph County Health Department (Primary Service Area) Community Health Needs Assessment (CHNA) Creating healthy communities requires a high level of mutual understanding and collaboration among community leaders. The development of this assessment brings together community health leaders and providers, along with local residents, to research and prioritize county health needs and document community health delivery successes. The Community Health Needs Assessment is not only a requirement for accreditation, but it is also a vital part of the Public Health role. This health assessment will serve as the foundation for community health improvement efforts for the next three years. The last CHNA for Randolph County Health Department (Primary Service Area) was published in June Randolph County Health Department (RCHD) completed its first formal health needs assessment in The purpose of this assessment was: (a) to provide data to public health leaders and community stakeholders in order to identify and prioritize the health needs of the tricounty area and (b) discover assets in the area available for problem solving. Through a better understanding of actual health needs, public health leaders could better serve their community. After data was gathered, stakeholders were asked to select the top priority health issues and populations to target considering the following criteria: (a) number of persons currently affected or at risk, (b) quality of life, (c) public perception and (d) preventability. RCHD performs its County Health Needs Assessment every three years. RCHD staff attend meetings with representatives from the areas of business, social service, healthcare, mental health, public schools, consumers, law and the religious community. These representatives then evaluate the most prevalent disparities between the county's current and past statistics, as well as comparing the county to Missouri's statewide figures. The new 2016 assessment was coordinated and produced by VVV Consultants LLC (Olathe, Kansas) under the direction of Vince Vandehaar, MBA. The CHNA provides benefits to local health service organizations, the hospital, the public health department, as well as the community, in the following ways: 1) Increases knowledge of community health needs and resources; 2) Creates a common understanding of the priorities of the community's health needs; 3) Enhances relationships and mutual understanding between and among stakeholders; 4) Provides a basis upon which community stakeholders can make decisions about how they can contribute to improving the health of the community; 5) Provides rationale for current and potential funders to support efforts to improve the health of the community; 6) Creates opportunities for collaboration in delivery of services to the community; and 7) Provides guidance to the hospital and local health department for how they can align their services and community benefit programs to best meet needs. 3

5 Town Hall Community Health Strengths cited for Randolph County Health Department s Primary Service Area are as follows: # Topic # Topic 1 Good park system 11 New health department building under construction 2 Health stakeholder collaboration 12 Home Health 3 Randolph County Health Department - Primary Service Area Community Health Strengths Good community partnerships (i.e. Summer Food Multiple funding sources (United Way, grants for Kids) 13 through Health Department) 4 School health 14 Hospice 5 Vaccination program at the Health Department 15 Access to healthcare 6 Availability at rural health clinics 16 Proximity to Columbia for additional services 7 Ambulance service 17 Primary Care 8 Nursing Program at MACC 18 Hospital 9 Churches 19 YMCA 10 Parents as Teachers Town Hall Community Health Changes and/or Improvements cited for Randolph County Health Department s Primary Service Area are as follows: # Focus Health Needs to Change and/or Improve Votes % Accum 1 ** 2 ** 3 ** 2016 Community Health Needs Randolph County Health Department - Moberly, MO Town Hall Priorities - 42 Attendees (122 Votes) Local Providers Collaboration; Additional Providers (OB, Peds, Psych, Pulm, Ortho, Sexual Assault Examiners); Physician Retention % 23.0% Community Health Education (Middle / High Schools); Education on Available Healthcare Resources; Nutrition % 40.2% Mental Health - Especially for Children (Access, Diagnosis, Placement) % 50.8% 4 ** Smoking % 60.7% 5 ** Dental / Vision Services for Medicaid % 68.9% 6 Healthcare Transportation 6 4.9% 73.8% 7 Drug Abuse (Meth, Prescription, Marijuana, Synthetics) 5 4.1% 77.9% 8 Local Economic Development 5 4.1% 82.0% Total Town Hall Votes 122 Other Items Noted: Expand Affordable Indoor Recreation, Daycare, Quality Nursing Homes, Affordable Quality Housing, Breastfeeding, No Local Cancer Treatment, Self-Accountability for Health Practices, Teen Pregnancy, Schools Lunches and Working Outside of the Community (Long Commute). 4

6 Key Community Health Needs Assessment Conclusions from secondary research for Randolph County Health Department s Primary Service Area are as follows: MISSOURI HEALTH RANKINGS: Per the 2016 RWJ County Health Rankings study, Randolph County Health Department s Primary Service Area (Randolph County, Missouri) had the highest State of Missouri ranking (of 115 counties) in Physical Environment. TAB 1. Demographic Profile TAB 2. Economic/Business Profile TAB 3. Educational Profile TAB 4. Maternal and Infant Health Profile TAB 5. Hospitalization / Providers Profile TAB 6. Behavioral Health Profile TAB 7. Risk Indicators & Factors TAB 8. Uninsured Profile TAB 9. Mortality Profile TAB 10. Preventative Quality Measures TAB 1: Randolph County has a population of 25,104 residents as of July 1, 2015, lower than the Missouri Rural Norm of 28,617. The percent change in population in Randolph County from April 1, 2010 to July 1, 2015 is -1.2%, higher than the Missouri Rural Norm of -0.7%. The percent of persons 65 years and over in Randolph County is 15.6%, lower than the Missouri Rural Norm of 17.9%. The percent of female persons in Randolph County is 47.7%, lower than the Missouri Rural Norm of 50.2%. The percent of white alone persons in Randolph County is 90.7%, lower than the Missouri Rural Norm of 93.2%. The percent of black or African American alone persons in Randolph County is 5.8%, higher than the Missouri Rural Norm of 3.4%. The percent of American Indian and Alaska Native alone persons in Randolph County is 0.4%, lower than the Missouri Rural Norm of 5.8%. The percent of persons 5+ years in Randolph County where a language other than English is spoken at home is 1.9%, lower than the Missouri Rural Norm of 3.4%. The population per square mile in Randolph County is 52.7, higher than the Missouri Rural Norm of Randolph County is 45.2% rural, lower than the Missouri Rural Norm of 60.9%. The percent of persons in poverty in Randolph County is 18.3%, higher than the Missouri Rural Norm of 16.3%. The percent of children in poverty in Randolph County is 26.0%, higher than the Missouri Rural Norm of 23.3%. There are 1,975 veterans in Randolph County, lower than the Missouri Rural Norm of 2,564. There are 15,739 registered voters in Randolph County, lower than the Missouri Rural Norm of 19,329. TAB 2: The median household income (in 2014 dollars) in Randolph County is $39,316, lower than the Missouri Rural Norm of $43,346. The per capita income in the past 12 months (in 2014 dollars) in Randolph County is $18,263, lower than the Missouri Rural Norm of $21,699. The number of housing units in Randolph County is 10,688, lower than the Missouri Rural Norm of 12,446. The median value of owner-occupied housing units in Randolph County is $85,500, lower than the Missouri Rural Norm of $102,113. The total number of households in Randolph County is 8,640, lower than the Missouri Rural Norm of 10,878. The total of all firms in Randolph County is 1,749, lower than the Missouri Rural Norm of 2,231. 5

7 TAB 3: The percent of children eligible for free lunch in Randolph County is 46.0%, higher than the Missouri Rural Norm of 39.4%. The percent of persons age 25 years+ in Randolph County who are a high school graduate or higher is 85.4%, lower than the Missouri Rural Norm of 87.1%. The percent of persons age 25+ years in Randolph County with a Bachelor s degree or higher is 13.9%, lower than the Missouri Rural Norm of 17.6%. TAB 4: The number of events where care began in the first trimester in Randolph County is 241.0, lower than the Missouri Rural Norm of The number of events where the mother smoked during pregnancy in Randolph County is 81.0, higher than the Missouri Rural Norm of The number of preterm births (less than 37 weeks gestation) in Randolph County is 177.0, lower than the Missouri Rural Norm of The number of teen births in Randolph County is 48.0, higher the Missouri Rural Norm of The number of out-of-wedlock births in Randolph County is 692.0, higher than the Missouri Rural Norm of The number of infants participating in WIC in Randolph County is 211.0, higher than the Missouri Rural Norm of TAB 5: The ratio of the population in Randolph County to primary care physicians is 1,780:1, lower than the Missouri Rural Norm of 1,912:1. The ratio of the population in Randolph County to dentists is 2,790:1, lower than the Missouri Rural Norm of 3,246:1. The percent of patients in Randolph County who report yes, they would definitely recommend the hospital is 56.0%, lower than the Missouri Rural Norm of 63.6%. TAB 6: The percent of children in single-parent households in Randolph County is 41.0%, higher than the Missouri Rural Norm of 29.9%. The percent of Medicare beneficiaries with Depression in Randolph County is 20.1%, higher than the Missouri Rural Norm of 17.4%. The ratio of the population in Randolph County to mental health providers is 1,1990:1, lower than the Missouri Rural Norm of 1,829:1. The violent crime rate per 100,000 in Randolph County is 151.0, lower than the Missouri Rural Norm of The percent of alcohol-impaired driving deaths in Randolph County is 14.0%, lower than the Missouri Rural Norm of 34.0%. The rate of drug overdose deaths per 100,000 in Randolph County is 13.0, lower than the Missouri Rural Norm of TAB 7: The percent of adult smoking in Randolph County is 23.0%, higher than the Missouri Rural Norm of 20.8%. The percent of physical inactivity in Randolph County is 27.0%, lower than the Missouri Rural Norm of 29.2%. The rate of sexually transmitted infections per 100,000 in Randolph County is 382.9, higher than the Missouri Rural Norm of The percent of residents in Randolph county with a long commute driving alone is 26.0%, lower than the Missouri Rural Norm of 31.1%. There are no drinking water violations in Randolph County, compared to the Missouri Rural Norm of yes. The percent of Medicare beneficiaries in Randolph County with Chronic Obstructive Pulmonary Disease (COPD) is 15.8%, higher than the Missouri Rural Norm of 13.3%. The percent of Medicare beneficiaries in Randolph County with Heart Failure is 17.2%, higher than the Missouri Rural Norm of 14.8%. The percent of Medicare beneficiaries in Randolph County with high cholesterol is 42.0%, higher than the Missouri Rural Norm of 39.8%. The percent of Medicare beneficiaries in Randolph County with Hypertension is 56.3%, higher than the Missouri Rural Norm of 53.9%. 6

8 TAB 8: The percent of residents uninsured in Randolph County is 16.0%, lower than the Missouri Rural Norm of 16.7%. TAB 9: The premature death years of potential life lost rate in Randolph County is 8,100.0, higher than the Missouri Rural Norm of 7, The number of Heart Disease mortalities in Randolph County is 58.0, lower than the Missouri Rural Norm of The number of Chronic Lower Respiratory Disease mortalities in Randolph County is 22.0, lower than the Missouri Rural Norm of The number of motor vehicle crash deaths per 100,000 in Randolph County is 17.0, lower than the Missouri Rural Norm of The number of injury at work deaths in Randolph County is 5.0, lower than the Missouri Rural Norm of 7.1. The number of suicides in Randolph County is 8.0, higher than the Missouri Rural Norm of 6.4. TAB 10: The percent of access to exercise opportunities in Randolph County is 60.0%, higher than the Missouri Rural Norm of 48.5%. The percent of residents in Randolph County who ate fruits and vegetables less than five times per day is 90.2%, higher than the Missouri Rural Norm of 88.4%. The percent of mammography screenings in Randolph County is 55.0%, lower than the Missouri Rural Norm of 59.0%. 7

9 Key 2016 Community Feedback Conclusions In September 2016, Randolph County Health Department collected stakeholder feedback from their primary service area consumers, community leaders and groups, public and other organizations, and other providers. These stakeholders (N=162) provided the following community feedback insights via an online perception survey: 60.5% of Randolph County stakeholders would rate the overall quality of healthcare delivery in their community as either Very Good or Good, with Very Good being the highest ranking. Randolph County stakeholders are satisfied with the following services: Ambulance, Home Health, Hospice, Pharmacy and School Nurse. Randolph County stakeholders are not satisfied with the following services: Child Care, Dentists, Emergency Room, Family Planning Services, Mental Health Services, Nursing Home and Specialists. 91.3% of Randolph County stakeholders have received healthcare services outside of their community over the past two years. Randolph County stakeholders perceive the following causes of disease or disability a problem in their community: Diabetes, Drugs / Substance Abuse, Mental Illness, Obesity, Poverty, Suicide and Wellness. As seen below, the community still senses a health need for Mental Health Access, Maternal / Child Health and Chronic Disease. Answer Options Randolph County Health Department (PSA) - Moberly, MO N= From our last CHNA (2013), a number of health needs were identified as priorities. Are any of these 2013 CHNA needs still an Ongoing Problem" in Randolph County, MO? Not a Problem Anymore Somewhat of a Problem Major Problem Problem % Response Count Mental Health Access % 158 Maternal / Child Health % 155 Chronic Disease % 155 8

10 II. Methodology [VVV Consultants LLC] 9

11 II. Methodology a)scope and Purpose For health departments that are preparing to apply for accreditation, the Public Health Accreditation Board (PHAB) recommends working diligently on a Community Health Assessment and Community Health Improvement Plan. The Community Health Needs Assessment is not only a requirement for accreditation, but it is a vital part of the Public Health role. (NOTE: The new federal Patient Protection and Affordable Care Act (ACA) also requires charitable hospitals to conduct a CHNA at least once every three years and adopt a strategy to meet community health needs). JOB #1: Report PHAB / ACA Required CHNA Documentation 1. Appoint an Accreditation Coordinator 2. Review PHAB s Online Orientation to Public Health Department Accreditation 3. Review the documentation requirements for the measures 4. Begin/refine work on the prerequisites a. Community health assessment b. Community health improvement plan c. Health department strategic plan 5. Prepare documentation ACA Detail Regulations 1. A description of the process and methods used to conduct the CHNA; 2. The identity of any and all organizations with which the organization collaborated with and third parties that it engaged to assist with the CHNA; 3. A description of how the organization considered the input of persons representing the community (e.g., through meetings, focus groups, interviews, etc.), who those persons are, and their qualifications; 4. A prioritized description of all of the community needs identified by the CHNA and an explanation of the process and criteria used in prioritizing such needs; 5. A description of the existing health care facilities and other resources within the community available to meet the needs identified through the CHNA; and 6. A prioritized description of all of the community needs identified by the CHNA and an explanation of the process and criteria used in prioritizing. JOB #2: Making a CHNA Widely Available to the Public The Notice provides that a CHNA will be considered to be conducted in the taxable year that the written report of the CHNA findings is made widely available to the public. Accordingly, an organization would make a facility s written report widely available by posting the final report on its website either in the form of (1) the report itself, in a readily accessible format, or (2) a link to another organization s website, along with instructions for accessing the report on that website. The Notice clarifies that an organization must post the CHNA for each facility until the date on which its subsequent CHNA for that facility is posted. 10

12 JOB #3: Adopt an Implementation Strategy The PHAB and the ACA both require an organization to adopt an implementation strategy to meet the needs identified through each CHNA. The Notice defines an implementation strategy as a written plan that addresses each of the needs identified in a CHNA by either (1) describing how the facility plans to meet the health need, or (2) identifying the health need as one that the facility does not intend to meet and explaining why the facility does not intend to meet it. Great emphasis has been given to work hand-in-hand with leaders from hospitals, the state health department and the local health department. A common approach has been adopted to create the CHNA, leading to aligned implementation plans and community reporting. 11

13 Domain 1: Conduct and disseminate assessments focused on population health status and public health issues facing the community. Domain 1 focuses on the assessment of the health of the population in the jurisdiction served by the health department. The domain includes: systematic monitoring of health status; collection, analysis, and dissemination of data; use of data to inform public health policies, processes, and interventions; and participation in a process for the development of a shared, comprehensive health assessment of the community. DOMAIN 1 INCLUDES FOUR STANDARDS: Standard Participate in or Conduct a Collaborative Process Resulting in a Comprehensive Community Health Assessment Standard Collect and Maintain Reliable, Comparable, and Valid Data That Provide Information on Conditions of Public Health Importance and on the Health Status of the Population Standard Analyze Public Health Data to Identify Trends in Health Problems, Environmental Public Health Hazards, and Social and Economic Factors That Affect the Public s Health Standard Provide and Use the Results of Health Data Analysis to Develop Recommendations Regarding Public Health Policy, Processes, Programs, or Interventions Seven Steps of Public Health Department Accreditation (PHAB): 1. Pre-Application 2. Application 3. Document Selection and Submission 4. Site Visit 5. Accreditation Decision 6. Reports 7. Reaccreditation 12

14 II. Methodology b) Collaborating CHNA Parties Working together to improve community health takes collaboration. Listed below is an in-depth profile of the local hospital and health department CHNA partners: Randolph County Health Department Profile 423 E Logan St, Administrator: Debra Laird The Randolph County Health Department functions with the overall philosophy of maximizing wellness and healthy lifestyles in the community. To prevent illness and the spread of disease and to serve the county as a whole to the best of its ability, the public health team consists of nursing, environmental, health education, therapies, nurse practitioners, laboratory support, clerical support, collaborative providers and all disciplines that contribute to health care. Located in Moberly, Missouri, our mission is provide quality services to protect, maintain and enhance community well-being by promoting conditions in which people can achieve their maximum level of health. About Us Mission Statement: To provide quality services to protect, maintain and enhance community well-being by promoting conditions in which people can achieve their maximum level of health. Randolph County Health Department Vision: Healthy People in a Healthy Community United for a better and brighter tomorrow. Philosophy: The Randolph County Health Department functions with the overall philosophy of maximizing wellness and healthy lifestyles in the community. It needs to be thought of as the team for public health in the community to prevent illness and the spread of disease and to serve the county as a whole to the best of its ability. The team consists of nursing, environmental, health education, therapies, nurse practitioners, laboratory support, clerical support, collaborative providers and all disciplines that contribute to health care. It is this team approach that is extremely valuable in the interfacing with other community agencies so that the three public health core functions of assessment, assurance, and policy development, are used to their fullest. That this team is able to assess the needs of the community, assure that services are available to the population, and advocate for policy development to enrich the health of the community. The team concept is of utmost importance to the welfare of the community and is the only way to effectively serve the community as a whole. As long as the Randolph County Health Department acts in good faith to prevent illness and promote wellness for the public good it will have served its purpose and fulfilled the wishes of all the citizens of Randolph County to do the best job for the most people. Most of us need medical care sometime in our lives, but we need public health all of the time. Let the health department and its purpose survive and prosper. 13

15 Board of Health: The Board of Trustees is responsible for the operation of the Randolph County Health Department and is also responsible for setting the annual public health tax levy rate. The Board is instrumental in designing the strategic plan, implementing public health programs, and adopting public health ordinances designed for the improvement of health for all who live, work, and visit Randolph County. Our Services Personal Health: The Public Health team at the Randolph County Health Department is committed to improving the health of every resident within our community. Many of the services offered provide essential health care services; from screenings and immunizations to primaryand home- care services, our primary care team is all about prevention, protection, and early detection. Walk-In Clinic Testing & Immunizations Home Health In-Home Services Health Education Nurse Practitioners STD Testing Collaborative Providers Family Health: Family members share genes, behaviors, lifestyles, and environments that together may influence their health and their risk of chronic disease. Our family health services address the health needs of vulnerable populations at all stages of life childhood, adolescence, through adulthood to older age. The Randolph County Health Department aims to enhance health across the life-course by helping families promote healthy lifestyles. Family Planning Women, Infants, Children (WIC) Child Immunizations Primary Care Services Breastfeeding Support Health Education and much more Home Care: Randolph County Health Department has been providing home care for over 30 years. Our services are designed to allow you, or your loved ones to remain at home and maintain as much independence as possible, for as long as possible. After all, home is here you want to stay and where the healing begins. Home Management: personal care, homemaker chore, respite services, advanced personal care, nursing services. Home Health Services: skilled nursing and at home therapies 14

16 Health Education: Through health education our public health team works to improve the health and well-being of individuals, groups, communities, and the environment. We have one outcome in mind more individuals educated in healthy practices will lead to better decisions and healthier practices that will work to protect and enhance the community. Breastfeeding Support Child Care Health Consultations Community Health Promotions Food Handlers/Managers Classes Quit Smoking Classes Food Safety: The Environmental Health team of Randolph County Health Department is responsible for protecting the health of the public by setting local food safety standards, conducting inspections, ensuring that standards are met, and maintaining a strong enforcement program to deal with those who are in violation of current local food ordinances and codes. Food Inspections and Violations: Restaurants in Randolph County are inspected according to their degree of risk the higher the risk, the more frequent the inspections. Food inspection violations found during an inspection are categorized into the critical or noncritical violations. Critical violations can have a direct impact on the safety of the food. Noncritical violations are usually sanitation or maintenance issues and are the violations most often observed by the public while dining. Critical Violations: Critical items can have a direct impact on the safety of the food. A repeat critical violation directly affecting the safety of the food could result in a minimum 24-hour suspension of the food establishment s permit. Examples of critical violations include: Cross contamination between raw and ready-to-eat food Touching ready-to-eat foods without gloves Food from an unapproved source Improper food temperature Improper sewage disposal Lack of food safety knowledge by the person in charge Presence of pest or animals Poor personal hygiene and employee health Noncritical Violations Noncritical items play an important role in the overall performance of the facility but alone do not directly affect food safety. 15

17 Examples of noncritical violations include: Dirty floors Dirty non-food contact equipment Grease on the floor Outside trash cans not covered Repair issues Sticky tabletops Workers not wearing hair restraints, like hair nets or caps Environmental Health Services: Environmental health protects the public from disease related to physical, chemical and biological factors in the environment. It encompasses assessment and control of these factors and is targeted towards creating a healthy supportive environment. Environmental issues are addressed by: Inspecting food establishments Inspecting temporary food establishments at events Inspecting daycares Inspecting lodging facilities Inspecting sewage system installations Investigating sewage/food service complaints Investigating food borne disease outbreak Educating the community on current food/code regulations, sewage system options, food permits, etc. Observing and preventing the spread of communicable diseases Permits, Checklist, Forms, and Guidelines Food Service Forms Temporary Food Permit Application Food Handler/Food Manager class registration Randolph County on-site domestic wastewater treatment system ordinance 16

18 Moberly Regional Medical Center Profile 1515 Union Ave, COO/CFO: Tracey Matheis Director of Professional Outreach: Jaime Morgans About Us Serving the north central Missouri region. Healing begins here. Moberly Regional Medical Center is your community healthcare provider with a 101-bed facility. We believe in the power of people to create great care. We re more than 420 healthcare professionals strong. We provide essential healthcare and hospital services. We are also proud to house a Heart & Vein Center as well as a Senior Behavioral Health Unit. And we work hard every day to be a place of healing, caring and connection for patients and families in the community we call home. Our Services We're here for you and your family. Our highly skilled team of healthcare professionals is dedicated to keeping you and your family healthy. Services Topics CARDIAC CARE DIABETIC EDUCATION DIAGNOSTIC IMAGING EMERGENCY DEPARTMENT EAR, NOSE & THROAT GENERAL SURGERY INTENSIVE CARE UNIT LABORATORY SERVICES MEDICAL, SURGICAL AND PEDIATRIC UNIT NUTRITIONAL SERVICES ORTHOPAEDIC SERVICES PULMONARY MEDICINE UNIT REHABILITATION SERVICES SENIOR BEHAVIORAL HEALTH SURGICAL SERVICES UROLOGY VEIN CARE SERVICES WELLNESS CENTER WOMEN S HEALTH 17

19 Randolph County Emergency Preparedness The Environmental health division promotes and works to implement environmentally influenced public health laws and regulations. Inspections are performed to determine compliance with rules, laws and regulations. Environmental health activities also involve participation in the Emergency Preparedness Plan and other local and regional response teams. According to the Missouri Department of Natural Resources Registry Log, there is one location in Randolph County listed as a confirmed waste disposal site that contains Coal, Tar, PAHs, Semi-volatiles, and VOCs. Randolph County has been making strides in their emergency preparedness plans since Advisory meetings and LEPC meetings with local stakeholders, such as commissioners, county sheriff, police, emergency services, schools, hospital staff and the RCHD have discussed how to handle sheltering large numbers of people, organizing volunteers, communications and medical services. Some sites, including Moberly Area Community College, Moberly City Auditorium and several churches, are being considered for large shelters and were assessed for the size generator they would need and number of people they could shelter. Further discussions are needed on how to handle a large volunteer surge after an emergency and communications available without electricity, such as MOSWIN radios. A Show Me Response Medical Reserve Corp has been utilized and more health professionals are needed to register. The community should look into providing a Ready in 3 training to business owners and/or the general public. For emergency medical services, an ambulance district and the emergency room are located in the largest community on an easy-to-access junction of Hwy. 24 and Hwy. 63. The rural areas and smaller towns have trained first responders. All areas of the county can receive emergency care within 15 minutes. For access to tertiary care, there are three large hospital systems located 35 miles south on Hwy. 63 in Columbia, MO. 18

20 II. Methodology b) Collaborating CHNA Parties Continued Consultant Qualifications VVV Consultants LLC Company Profile: 601 N. Mahaffie, Olathe, KS (913) VINCE VANDEHAAR, MBA Principal Consultant and Owner of VVV Consultants LLC VVV Consultants LLC was incorporated on May 28, With over 30 years of business and faculty experience in helping providers, payors and financial service firms obtain their strategic planning and research and development needs, Vince brings in-depth health industry knowledge, research aptitude, planning expertise and energy. VVV Consultants LLC services are organized, formal processes of listening to the voice of the customer. Vince started his consulting business after working for Saint Luke s Health System (SLHS) of Kansas City for 16 years. (Note: Saint Luke s Hospital of Kansas City, SLHS s largest hospital, won the Malcolm Baldrige National Quality Award in March of The Baldrige examiners cited Vince s department as Best Practice in the areas of customer satisfaction, market research and evaluation efforts <Kansas City Star 3/10/04>). VVV Consultants LLC consultants have in-depth experience helping hospitals work with local health departments to engage community residents and leaders to identify gaps between existing health community resources and needs and construct detailed strategies to meet those needs, while still adhering to the hospital s mission and budget. Over the past 20 years, Vandehaar has completed eight comprehensive Baldrige aligned Community Health Needs Assessments for Saint Luke s of Kansas City System facilities (three campuses) and was contracted to conduct two additional independent department of health consulting projects (prior to IRS 990 regs). To date, VVV has completed 75 CHNA IRS-aligned assessments for Iowa, Kansas, Missouri and Nebraska hospitals and health departments. Vince Vandehaar, MBA is actively involved in the Kansas City community. He is a member the Greater Kansas City Employee Benefits Association, the Society for Healthcare Strategy and Market Development, the American Marketing Association Kansas City Chapter and Co-Chair of the AMA Kansas City Healthcare Special Interest Group. In addition to these roles, from 2000 to 2008, Vince served as the state chairman for MHA s Data Committee and was a member of KHA s Data Taskforce. Collaborating Consultants Alexa Backman, MBA - VVV Consultants LLC Associate Consultant Alexa supports all aspects of VVV Consultants LLC healthcare consulting services and is proficient in Microsoft Word, Surveymonkey, Excel and PowerPoint. Alexa is client focused with a special interest in quality patient health delivery to meet customer needs. Alexa graduated from the University of Kansas with a Bachelor s Degree in Community Health Education in May of After graduation, Alexa started her career at Cerner Corporation as a Delivery Consultant. In 2015, Alexa received her MBA with a Health Care Management emphasis from RU s Helzberg School of Management. 19

21 II. Methodology c) CHNA and Town Hall Research Process Randolph County Health Department s Community Health Needs Assessment (CHNA) process began in June At that time, an inquiry was made by Debra Laird, Administrator to VVV Consultants LLC to explore the possibility of conducting a comprehensive CHNA. VVV Consultants LLC then reviewed the CHNA experience, indepth PHAB CHNA requirements and regulations, CHNA development options to meet PHAB requirements and next steps after option approval. VVV CHNA Deliverables: Confirm RCHD s Primary Service Area meets the Patient Origin Rule. Uncover / document basic secondary research and health of the county, organized by 10 tabs. Conduct a Town Hall meeting to discuss secondary data and uncover / prioritize county health needs. Conduct and report CHNA primary research (with valid N). Prepare and publish CHNA report that meets PHAB requirements. To ensure proper RCHD Town Hall representation that meets the Patient Origin Rule, a patient origin three-year summary was generated and documented the zip codes below as RCHD s Primary Service Area. Randolph County Health Department - PSA Detail Demographic Profile Population Households HH Per Capita Zip Name County YR 2014 YR 2019 Chg. YR 2014 YR 2019 Avg. Size Income Cairo RANDOLPH 1,352 1, % $19, Clark RANDOLPH 3,165 3, % 971 1, $18, Clifton Hill RANDOLPH % $23, Higbee RANDOLPH 1,728 1, % $20, Huntsville RANDOLPH 2,826 2, % 1,062 1, $16, Jacksonville RANDOLPH % $20, Moberly RANDOLPH 17,552 17, % 6,338 6, $16,330 Totals 27,695 27, % 10,014 9, $19,459 20

22 Step Date (Start-Finish) Lead Task 1 7/1/2016 VVV Sent Client VVV quote for review. 2 7/15/2016 Hosp / DOH 3 8/1/2016 VVV 4 8/1/2016 VVV 5 On or before 8/15/2016 VVV 6 On or before 8/29/2016 VVV & Hosp / DOH 7 On or before 8/29/2016 VVV 8 On or before 9/19/2016 VVV 9 9/26/2016 VVV 10 9/26/ On or before 10/14/2016 All VVV & Hosp / DOH 12 10/18/2016 VVV 13 On or before 11/15/2016 VVV 14 On or before 11/30/2016 VVV Hosp / 15 12/1/2016 DOH 16 Randolph County Health Department - CHNA Work Plan Project Timeline and Roles days prior to end of hospital fiscal year Hosp / DOH Select CHNA Option A/B/C. Approve and sign VVV CHNA quote. Send out REQCommInvite Excel file. Request Hospital and DOH to enter PSA stakeholders names, addresses and s. Request hospital client to send MHA PO101, PO103 and TOT223E reports to document PSA for FFY 13, 14 and 15. In addition, request hospital to complete three year historical PSA IP/OP/ER/Clinic patient origin file (Use ZipPSA_3yrPOrigin.xls). Prepare CHNA Round #2 stakeholder feedback online link. Send test link for hospital review. Prepare and send out PR #1 story to local media announcing online CHNA Round #2 survey. Request public to participate in PR story. Place CHNA link on website, Facebook, etc. Request hospital to place PR with all PSA media. Launch online CHNA Feedback survey to stakeholders. Hospital will invite to participate to all stakeholders. Assemble and complete secondary research, organized into 10 TABS. Create Town Hall PowerPoint for presentation. Prepare and send out PR #2 story to local media announcing upcoming Town Hall. VVV will mock up PR release to media sources. Prepare and seend Town Hall reminder letter to Stakeholders and Community. Place optional local ad. Conduct conference call with hospital and health department to review Town Hall data and flow. Conduct CHNA Town Hall from 11:30-1pm at the Moberly Area YMCA. Review and discuss basic health data plus rank health needs. Complete analysis. Release draft one and seek feedback from leaders at hospital and health department. Produce and release final CHNA report. Hospital will post CHNA online. Conduct client Implementation Plan meeting with PSA leaders. Hold board meetings to discuss CHNA needs, create and adopt an Implementation Plan. Communicate CHNA plan to community. 21

23 The Community Health Needs Assessment is not only a requirement for accreditation, but it is a vital part of the Public Health role. To meet the PHAB CHNA requirements, a four-phase methodology was reviewed and approved as follows: Phase I Discovery: Conduct a 30-minute conference call with the CHNA county health department and hospital clients. Review / confirm CHNA calendar of events, explain / coach clients to complete required participant database and schedule / organize all Phase II activities. Phase II Qualify Community Need: A) Conduct secondary research to uncover the following historical community health status for the primary service area. Use Missouri Hospital Association (MHA), Vital Statistics, Robert Wood Johnson County Health Rankings, etc. to document current state of county health organized as follows: TAB 1. Demographic Profile TAB 2. Economic/Business Profile TAB 3. Educational Profile TAB 4. Maternal and Infant Health Profile TAB 5. Hospitalization / Providers Profile TAB 6. Behavioral Health Profile TAB 7. Risk Indicators & Factors TAB 8. Uninsured Profile TAB 9. Mortality Profile TAB 10. Preventative Quality Measures B) Gather historical primary research to uncover public health needs, practices and perceptions for county health department and hospital primary service areas. Phase III Quantify Community Need: Conduct a 90-minute Town Hall meeting with required county primary service area residents. At each Town Hall meeting, CHNA secondary data will be reviewed, facilitated group discussion will occur and a group ranking activity to determine the most important community health needs will be administered. Phase IV Complete Data Analysis and Create Comprehensive Community Health Needs Assessment: Post CHNA report findings to meet PHAB CHNA criteria. After consideration of CHNA stakeholders (sponsoring county health department and hospital), the CHNA Option C was selected with the following project schedule: Phase I: Discovery August 2016 Phase II: Secondary / Primary Research.. September 2016 Phase III: Town Hall Meeting.. October 18, 2016 Phase IV: Prepare / Release CHNA report... December

24 Detail CHNA Development Steps Include: Steps to Conduct Community Health Needs Assessment Development Steps Step #1 Commitment Determine interest level of area healthcare leaders (Health Department, Hospital, Mental Health Centers, Schools, Churches and Physicians, etc.) and hold community meeting. Step #2 Planning Prepare brief Community Health Needs Assessment plan. List goals, objectives, purpose, outcome, roles, community involvement, etc. Hold community kick-off meeting. Step #3 Secondary Research Collect and report community health published facts. Gather health practice data from published secondary research sources (i.e. census, county health records, behavioral risk factors surveillance, etc.). Step #4a Primary Research Conduct Community Roundtable (qualitative research). Review secondary research (Step #3) with community stakeholders. Gather current opinions and identify health needs. Step #4b Primary Research <Optional> Collect community opinions (quantitative research). Gather current opinions (valid sample size) regarding community health needs and healthcare practices. If appropriate, conduct Physician Manpower Assessment to determine FTE physician need by specialty. Steps #5 Reporting Prepare / present comprehensive Community Health Needs Assessment report to community leaders with recommended actions to improve health. (Note: Formal report will follow PHAB regulations). VVV Consultants LLC (913)

25 Overview of Town Hall Community Priority Setting Process Each community has a wealth of expertise to be tapped for CHNA development. For this reason, a Town Hall is the perfect forum to gather community insight and provide an atmosphere to objectively consensus build and prioritize county health issues. All Town Hall priority-setting and scoring processes involve the input of key stakeholders in attendance. Individuals and organizations attending the Town Halls were critically important to the success of the CHNA. The following list outlines partners invited to the Town Hall: local hospital, public health community, mental health community, free clinics, community-based clinics, service providers, local residents, community leaders, opinion leaders, school leaders, business leaders, local government, f aith-based organizations and persons (or organizations serving them), people with chronic conditions, uninsured community members, low income residents and minority groups. Randolph County Health Department s Town Hall was held on Tuesday, October 18, 2016 at the Moberly Area YMCA. Vince Vandehaar and Alexa Backman facilitated this 1½ hour session with 42 attendees. (Note: a detailed roster of all Town Hall attendees is listed in Section V.) The following Town Hall agenda was conducted: 1. W elcome and introductions. 2. Review purpose for the CHNA Town Hall and roles in the process. 3. Presentation / review of historical county health indicators (10 Tabs). 4. Facilitate Town Hall participant discussion of data by probing health strengths / concerns. Reflect on size and seriousness of any health concerns sited and discuss current community health strengths. 5. Engage Town Hall participants to rank health needs using four dots to cast votes on priority issues. Tally and rank top community health concerns cited. 6. Close meeting by reflecting on the health needs / community voting results. Inform participants on next steps. At the end of the Town Hall session, VVV encouraged all community members to continue to contribute ideas to both hospital and health department leaders via or personal conversations. (NOTE: To review detail Town Hall discussion content, please turn to Section V for detailed notes of session and activity card content reporting of open-end comments.) 24

26 Community Health Needs Assessment Town Hall Meeting Randolph County Health Department (Moberly MO) Vince Vandehaar, MBA VVV Consultants LLC Principal / Adjunct Professor Olathe, Kansas VVV@VandehaarMarketing.com Community Health Needs Assessment (CHNA) Town Hall Discussion Agenda I. Opening / Introductions (10 mins) II. Review CHNA Purpose and Process (10 mins) III. Review Current County Health Status -Secondary Data by 10 TAB Categories -Review Community Feedback Research (35 mins) IV. Collect Community Health Perspectives -Hold Community Voting Activity: Determine Most Important Health Areas (30 mins) I. Close / Next Steps (5 mins) I. Introduction: Background and Experience Town Hall Participation (You) Vince Vandehaar, MBA VVV Consultants LLC - Principal Consultant Olathe, KS Professional Consulting Services: Strategic Planning, Marketing Management, Business Research & Development Focus : Strategy, Research, Deployment 25+ years of experience with Tillinghast, BCBSKC, Saint Luke s Adjunct Professor - Marketing / Health Admin, 26 years + Webster University (1988 present) Rockhurst University (2010 present) ALL attendees welcome to share Parking Lot There are no right or wrong answers Only one person speaks at a time Please give truthful responses Have a little fun along the way Alexa Backman, MBA, Associate Consultant 25

27 I. Introductions: A Conversation with the Community Community members and organizations invited to CHNA Town Hall Consumers: Uninsured/underinsured people, Members of at-risk populations, Parents, caregivers and other consumers of health care in the community, and Consumer advocates. Community leaders and groups: The hospital organization s board members, Local clergy and congregational leaders, Presidents or chairs of civic or service clubs -- Chamber of Commerce, veterans' organizations, Lions, Rotary, etc., Representatives from businesses owners/ceo's of large businesses (local or large corporations with local branches.),business people & merchants (e.g., who sell tobacco, alcohol, or other drugs), Representatives from organized labor, Political, appointed and elected officials., Foundations.,United Way organizations. And other "community leaders." Public and other organizations: Public health officials, Directors or staff of health and human service organizations, City/Community planners and development officials, Individuals with business and economic development experience,welfare and social service agency staff,housing advocates - administrators of housing programs: homeless shelters, low-income-family housing and senior housing,education officials and staff - school superintendents, principals and teachers, Public safety officials, Staff from state and area agencies on aging,law enforcement agencies - Chiefs of police, Local colleges and universities, Coalitions working on health or other issues. Other providers: Physicians, Leaders in other not-for-profit health care organizations, such as hospitals, clinics, nursing homes and home-based and community-based services, Leaders from Catholic Charities and other faith-based service providers, Mental health providers, Oral health providers, Health insurers, Parish and congregational nursing programs, Other health professionals II. Purpose Why Conduct a CHNA? To determine health-related trends and issues of the community To understand / evaluate health delivery programs in place. To develop strategies to address unmet health needs To meet Federal requirements both local hospital and health department II. Review CHNA Definition A Community Health Needs Assessment (CHNA) is a systematic collection, assembly, analysis, and dissemination of information about the health of the community. (NOTE: Some the data has already been collected / published by Local, State and Federal public health organizations. Some data will be collected today.) A CHNA s role is to identify factors that affect the health of a population and determine the availability of resources to adequately address those factors. Future System of Care Sg2 Acuity Community-Based Care Home Health Dept./ Pharmacy Wellness and Fitness Center Physician Clinics Ambulatory Procedure Center Diagnostic/ Imaging Center Urgent Care Center Hospital IP Rehab SNF Recovery & Rehab Care Home Care Hospice Acute Care OP Rehab IP = inpatient; SNF = skilled nursing facility; OP = outpatient. 26

28 Community Health Needs Assessment Joint Process: Local Health Department & Hospital Seven Steps of Public Health Department Accreditation (PHAB) 1. Pre-application, 2. Application, 3. Document Selection and Submission, 4. Site Visit 5. Accreditation Decision, 6. Reports, 7. Reaccreditation Domain 1: Conduct and disseminate assessments focused on population health status and public health issues facing the community Domain1 focuseson theassessmentof the healthof thepopulationin thejurisdictionserved by the health department. The domain includes: systematic monitoring of health status; collection, analysis,and disseminationof data; use of data toinformpublichealthpolicies, processes, and interventions; and participation in a process for the development of a shared, comprehensive health assessment of the community. DOMAIN 1 INCLUDES FOUR STANDARDS: Standard 1.1 Participate in or Conduct a Collaborative Process Resulting in a Comprehensive Community Health Assessment Standard 1.2 Collectand Maintain Reliable, Comparable, and Valid Data That Provide Informationon Conditions of Public HealthImportanceand On the HealthStatus of the Population Standard 1.3 Analyze Public Health Data to Identify Trends in Health Problems, Environmental Public Health Hazards, and Social and Economic Factors That Affect the Public s Health Standard 1.4 Provide and Use the Results of HealthData Analysis to Develop Recommendations RegardingPublic Health Policy, Processes, Programs, or Interventions Public Health Accreditation Board Standards & Measures Version 1.0 Approved May 2011 II. CHNA Written Report Documentation a description of the community served a description of the CHNA process the identity of any and all organizations and third parties which collaborated to assist with the CHNA a description of how the organization considered the input of persons representing the community (e.g., through meetings, focus groups, interviews, etc.), who those persons are, and their qualifications a prioritized description of all of the community needs identified by the CHNA and a description of the existing health care facilities and other resources within the community available to meet the needs identified through the CHNA 27

29 III. Review Current County Health Status: Secondary Data by 10 Tab Categories, plus MO State Rankings County Health Rankings - Robert Wood Johnson Foundation and University of WI Health Institute TAB 1. Demographic Profile TAB 2. Economic/Business Profile TAB 3. Educational Profile TAB 4. Maternal and Infant Health Profile TAB 5. Hospitalization / Providers Profile TAB 6. Behavioral Health Profile TAB 7. Risk Indicators & Factors TAB 8. Uninsured Profile TAB 9. Mortality Profile TAB 10. Preventative Quality Measures Physical Environment (10%) 1 2b Social and Economic Environment (40%) Measure Description Focus Area Measure Description Focus Area Air and water Air pollution - particulate The average daily measure of fine particulate matter Community Violent crime Violent crime rate per 100,000 population quality (5%) matter in micrograms per cubic meter (PM2.5) in a county safety (5%) Drinking water violations Percent of population potentially exposed to water Injury deaths Injury mortality per 100,000 exceeding a violation limit during the past year Housing and Severe housing problems Percent of households with at least 1 of 4 housing transit (5%) problems: overcrowding, high housing costs, or lack of kitchen or plumbing facilities Driving alone to work Percent of the workforce that drives alone to work 3 Health Outcomes (30%) Long commute - driving Among workers who commute in their car alone, the 3a Health Behaviors alone percent that commute more than 30 minutes 2a Clinical Care (20%) Focus Area Measure Description Focus Area Measure Description Tobacco use Adult smoking Percent of adults that report smoking >= 100 Access to care Uninsured Percent of population under age 65 without health Diet and Adult obesity Percent of adults that report a BMI >= 30 (10%) insurance exercise (10%) Primary care Ratio of population to primary care physicians Food Index of factors that contribute to a healthy physicians environment food environment index Dentists Ratio of population to dentists Physical inactivity Percent of adults aged 20 and over reporting Mental health Ratio of population to mental health providers Access to exercise Percent of the population with adequate providers opportunities access to locations for physical activity Quality of care Preventable hospital Hospitalization rate for ambulatory-care sensitive Alcohol and Excessive drinking Binge plus heavy drinking (10%) stays conditions per 1,000 Medicare enrollees drug use (5%) Diabetic screening Percent of diabetic Medicare enrollees that receive Alcohol-impaired Percent of driving deaths with alcohol HbA1c screening driving deaths involvement Mammography Percent of female Medicare enrollees that receive Sexual activity Sexually Chlamydia rate per 100,000 population screening mammography screening (5%) transmitted infections Social and Economic Environment (40%) 2b Teen births Teen birth rate per 1,000 female population, ages Focus Morbidity / Mortality Area Measure Description 3b / 3c Education High school Percent of ninth grade cohort that graduates in 4 Focus Area Measure Description (10%) graduation years Some college Percent of adults aged years with some postsecondary Quality of life Poor or fair Percent of adults reporting fair or poor health education (50%) health (age-adjusted) Employment Unemployment Percent of population age 16+ unemployed but Poor physical Average number of physically unhealthy days (10%) seeking work health days reported in past 30 days (age-adjusted) Average number of mentally unhealthy days Income (10%) Children in poverty Percent of children under age 18 in poverty Poor mental health days reported in past 30 days (age-adjusted) Family and Inadequate social Percent of adults without social/emotional support Low birthweight Percent of live births with low birthweight (< social support support 2500 grams) (5%) Children in singleparent Percent of children that live in household headed by Length of life Premature death Years of potential life lost before age 75 per households single parent (50%) 100,000 population (age-adjusted) IV. Collect Community Health Perspectives Ask your opinion. Your thoughts? 1) Tomorrow: What is occurring or might occur that would affect the health of our community? 2) Today: What are the strengths of our community that contribute to health? 3) Today: Are there healthcare services in your community / neighborhood that you feel need to be improved and / or changed? 28

30 Have We Forgotten Anything? A.Aging Services M.Hospice B.Chronic Pain Management N.Hospital Services C.Dental Care/Oral Health O.Maternal, Infant & Child Health D.Developmental Disabilities P.Nutrition E.Domestic Violence, R.Pharmacy Services F.Early Detection & Screening S.Primary Health Care G.Environmental Health T.Public Health Q.Exercise U.School Health H.Family Planning V.Social Services I.Food Safety W.Specialty Medical Care Clinics J.Health Care Coverage X.Substance Abuse K.Health Education Y.Transportation L.Home Health z. Other Community Health Needs Assessment Questions Next Steps? VVV Consultants LLC

31 II. Methodology d) Community Profile (A Description of Community Served) Randolph County, Missouri Community Profile Demographics The population of Randolph County was estimated to be 25,104 on July 1, 2015, and had a -1.2% change in population from April 1, 2010 July 1, According to the United States Census Bureau, its county seat is Huntsville. The county has a total area of 488 square miles, of which 483 square miles is land and 5.1 square miles is water. 2 Randolph County s population density is 52 persons per square mile and its industries providing employment are Educational (health and social services) (19.5%), Agriculture (forestry, fishing and hunting, and mining) (13.3%), Construction (11.9%), Manufacturing (11.5%) and Professional (scientific, management, administrative, and waste management services) (10.9%). 3 The major highway transportation is by U.S. Route 24, U.S. Route 63 and Route U.S. Census Bureaus U.S. Census Bureaus 30

32 Randolph County Health Department - PSA Detail Demographic Profile Population Households HH Per Capita Zip Name County YR 2014 YR 2019 Chg. YR 2014 YR 2019 Avg. Size Income Cairo RANDOLPH 1,352 1, % $19, Clark RANDOLPH 3,165 3, % 971 1, $18, Clifton Hill RANDOLPH % $23, Higbee RANDOLPH 1,728 1, % $20, Huntsville RANDOLPH 2,826 2, % 1,062 1, $16, Jacksonville RANDOLPH % $20, Moberly RANDOLPH 17,552 17, % 6,338 6, $16,330 Totals 27,695 27, % 10,014 9, $19,459 Population YR 2014 Females Zip Name County YR 2014 Pop. 65+ Kids <18 Gen. Y Males Females Age 20_ Cairo RANDOLPH 1, Clark RANDOLPH 3, , ,663 1, Clifton Hill RANDOLPH Higbee RANDOLPH 1, Huntsville RANDOLPH 2, ,444 1, Jacksonville RANDOLPH Moberly RANDOLPH 17,552 2,607 4,330 6,212 9,290 8,262 1,607 Totals 27,695 4,075 7,157 9,181 14,516 13,179 2,407 Population Aver HH Zip Name County White Black Amer. Ind. Hisp. HH Inc. 14 YR 2014 HH $50K Cairo RANDOLPH 1, $52, Clark RANDOLPH 3, $60, Clifton Hill RANDOLPH $53, Higbee RANDOLPH 1, $50, Huntsville RANDOLPH 2, $43,791 1, Jacksonville RANDOLPH $53, Moberly RANDOLPH 15,418 1, $43,270 6,338 2,078 Totals 25,124 1, $51,098 10,014 3,618 Source: ERSA Demographics 31

33 III. Community Health Status [VVV Consultants LLC] 32

34 III. Community Health Status a) Historical Health Statistics Health Status Profile This section of the CHNA reviews published quantitative community health indicators and results of our recent CHNA Town Hall. To produce this profile, VVV Consultants LLC staff analyzed data from multiple sources. This analysis focuses on a set of published health indicators organized by 10 areas of focus (10 Tabs), results from the 2015 County Health Rankings and conversations from Town Hall primary research. Each table reflects a trend column, with Green denoting growing / high performance indicators, Yellow denoting minimal change / average performance indicators and Red denoting declining / low performance indicators. (Note: The Robert Wood Johnson Foundation collaborates with the University of Wisconsin Population Health Institute to release annual County Health Rankings. As seen below in model, these rankings are based on a number of health factors.) 33

35 Secondary Research 2016 State Health Rankings for Randolph County, Missouri Missouri Rank of 115 Counties (including St. Louis City) Randolph County MO RURAL NORM (15) # Definitions TREND 1 Health Outcomes Length of Life, Quality of Life a Length of Life Premature Death b Quality of Life 2 Health Factors Poor / Fair Health, Poor Physical / Mental Health Days, Low Birthweight 78 Health Behaviors, Clinical Care, Social / Economic Factors, Physical Environment 73 Tobacco Use, Diet / Exercise, Alcohol / Drug Use, Sexual 54 2a Health Behaviors Activitiy 80 2b Clinical Care Access to Care, Quality of Care c 2d Social and Economic Factors Physical Environment released 2016 Education, Employment, Income, Family / Social Support, Community Safety 73 Air / Water Quality, Housing / Transit 31 Missouri Rural Norm (N=15) includes the following counties: Marion, Henry, Chariton, Cass, Audrain, Bates, Clinton, Howard, Johnson, Macon, Monroe, Pettis, Phelps, Randolph and Shelby Counties

36 When considering the state of community health, it s important to review published health data by topic area. Below is a summary of key tabs of information collected: Tab 1a Demographic Profile Tab Health Indicator Randolph County Trend State of MO MO Rural Norm (15) Source 1a a Population estimates, July 1, ,104 6,083,672 28,617 People Quick Facts 1a b Population, Census, April 1, ,414 5,988,927 28,531 People Quick Facts 1a c Population, percent change - April 1, 2010 (estimates base) to July 1, % 1.6% -0.7% People Quick Facts 1a d Persons under 5 years, percent, July 1, % 6.2% 6.0% People Quick Facts 1a e Persons under 18 years, percent, July 1, % 22.9% 23.0% People Quick Facts 1a f Persons 65 years and over, percent, July 1, % 15.7% 17.9% People Quick Facts 1a g Female persons, percent, July 1, % 50.9% 50.2% People Quick Facts 1a h White alone, percent, July 1, % 83.3% 93.2% People Quick Facts 1a i Black or African American alone, percent, July 1, % 11.8% 3.4% People Quick Facts 1a j Hispanic or Latino, percent, July 1, % 4.1% 2.6% People Quick Facts 1a k American Indian and Alaska Native alone, percent, July 1, % 0.6% 5.8% People Quick Facts 1a l Asian alone, percent, July 1, % 2.0% 0.8% People Quick Facts 1a m Two or More Races, percent, July 1, % 2.2% 1.9% People Quick Facts Tab 1b Demographic Profile Tab Health Indicator Randolph County Trend State of MO MO Rural Norm (15) Source 1b a Foreign born persons, percent, % 3.9% 1.7% People Quick Facts 1b b Language other than English spoken at home, percent of persons age 5 years+, % 6.1% 3.4% People Quick Facts 1b c Population per square mile, Geography Quick Facts 1b d % Rural 45.2% 29.6% 60.9% Census Population Estimates 1b e Persons in poverty, percent 18.3% 14.8% 16.3% People Quick Facts 1b f Children in poverty, percent, % 21.0% 23.3% Small Area Income and Poverty Estimates 1b g Veterans, , ,762 2,564 People Quick Facts 1b h Registered Voters in Missouri, ,739 4,190,936 19,329 Missouri Centralized Voter Registration 35

37 Tab 2a Economic / Business Profile Tab Health Indicator Randolph County Trend State of MO MO Rural Norm (15) Source 2a a Median household income (in 2014 dollars), $39,316 $47,764 $43,346 People Quick Facts 2a b Per capita income in past 12 months (in 2014 dollars), $18,263 $26,006 $21,699 People Quick Facts 2a c Housing units, July 1, ,648 2,746,599 12,446 People Quick Facts 2a d Owner-occupied housing unit rate, People Quick Facts 2a e Median value of owner-occupied housing units, $85,500 $136,700 $102,113 People Quick Facts 2a f Households, ,640 2,361,232 10,878 People Quick Facts 2a g Persons per household, People Quick Facts 2a h Severe housing problems, percent, % 15.0% 11.9% 2a i Comprehensive Housing Affordability Strategy (CHAS) data Living in same house 1 year ago, percent of persons age 1 year+, % 83.9% 85.2% People Quick Facts Tab 2b Economic / Business Profile Tab Health Indicator Randolph County Trend State of MO MO Rural Norm (15) 2b a Grocery stores/1,000 pop, NA 0.2 2b b Low income and low access to store, percent, % NA 7.1% 2b c Seniors, low access to store, percent, % NA 3.3% 2b d SNAP participants (% pop), % NA 14.2% Source U.S. Department of Agriculture - Food Environment Atlas U.S. Department of Agriculture - Food Environment Atlas U.S. Department of Agriculture - Food Environment Atlas U.S. Department of Agriculture - Food Environment Atlas 2b e All firms, , ,606 2,231 Business Quick Facts 2b f Unemployment, percent, % 6.1% 6.1% Bureau of Labor Statistics Tab 3 Educational Profile Currently, school districts are providing on-site primary health screenings and basic care. Tab Health Indicator Randolph County Trend State of MO MO Rural Norm (15) Source 3 a Children eligible for free lunch, percent, % 38.0% 39.4% National Center for Education Statistics 3 b 3 c High school graduate or higher, percent of persons age 25 years+, % 88.0% 87.1% People Quick Facts Bachelor's degree or higher, percent of persons age 25 years+, % 26.7% 17.6% People Quick Facts 36

38 Tab 3 Educational Profile # Health Indictors Higbee R-VIII School District Moberly School District Northeast Randolph County R-IV School District Renick R-V School District Westran R-I 1 Total Public School Nurses School Nurse Part of IEP 2 Team Yes Yes Yes Yes No 3 Active School Wellness Plan Yes Yes Yes Yes No VISION: # Screened / Referred to Prof / Seen by 4 Professional 57/2/? Do Not Track 224/3/? 89/6/2 624/45/18 5 HEARING: # Screened / Referred to Prof / Seen by Professional 57/2/? 750/75/25 224/1/? 89/0/0 624/0/0 6 7 ORAL HEALTH: # Screened / Referred to Prof / Seen by Professional 18/?/? 800/75/? NA SCOLIOSIS: # Screened / Referred to Prof / Seen by Professional 24/0/? Students Served with No Identified Chronic Health Screening on 9/30/16 No No Screening Last Year NA 16/0/0 68/0/? 8 Concerns 3,000 1,800 NA School has Suicide 9 Prevention Program Unsure Yes Yes No Yes Compliance on Required 10 Vaccinations Yes 99% 98% 100% NA TAB 4 Maternal / Infant Health Profile Tracking maternal and infant care patterns are vital in understanding the foundation of family health. Tab Health Indicator Randolph County Trend State of MO MO Rural Norm (15) Source 4 a Care Began First Trimester, number of events, , b Mother Smoked During Pregnancy, number of events, , c Preterm Births (less than 37 Weeks Gestation), number of events, , d Low Birth Weight, percent, % 8.0% 7.5% 4 e Teen births, number of events, f Out-of-Wedlock Births, number of events, , g Infants Participating in WIC, number of events, , Missouri Department of Health and Senior Services Missouri Department of Health and Senior Services Missouri Department of Health and Senior Services National Center for Health Statistics - Natality files National Center for Health Statistics - Natality files Missouri Department of Health and Senior Services Missouri Department of Health and Senior Services 37

39 TAB 4 Maternal / Infant Health Profile Tab Missouri Department of Health and Senior Services, Vital Statistics Randolph County Trend State of MO 4 a Total Live Births, ,718 4 b Total Live Births, ,069 4 c Total Live Births, ,400 4 d Total Live Births, ,244 4 e Total Live Births, ,104 TAB 5 Hospitalization / Providers Profile Understanding provider access and disease patterns are fundamental in healthcare delivery. Listed below are several vital county statistics. Tab Health Indicator Randolph County Trend State of MO MO Rural Norm (15) 5 a Ratio of Primary Care physicians to population, ,780:1 1,420:1 1,912:1 5 a Ratio of Dentists to population, ,790:1 1,870:1 3,246:1 5 b Preventable hospital stays per 1,000, c 5 d 5 e Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest) 68.0% 71.0% 68.8% Patients who reported YES, they would definitely recommend the hospital 56.0% 69.0% 63.6% Average Time Patients Spent in the Emergency Department Before They Were Seen by a Healthcare Professional, minutes Source Area Health Resource File/American Medical Association Area Health Resource File/National Provider Identification file Dartmouth Atlas of Health Care CMS Hospital Compare, 10/1/2014-9/30/2015 CMS Hospital Compare, 10/1/2014-9/30/2015 CMS Hospital Compare, 10/1/2014-9/30/2015 # MHA HIDI PO103 Randolph County, MO FFY13 FFY14 FFY15 Trend 1 Total Discharges 3,869 3,682 3,531 2 Total IP Discharges-Age 0-17 Ped Total IP Discharges-Age Total IP Discharges-Age Total IP Discharges-Age Total IP Discharges-Age Psychiatric Obstetric MRMC Only # MHA HIDI PO103 FFY13 FFY14 FFY15 Trend 1 Total Discharges 1, % of County 34.3% 26.3% 21.1% 2 Total IP Discharges-Age 0-17 Ped Total IP Discharges-Age Total IP Discharges-Age Total IP Discharges-Age Total IP Discharges-Age Psychiatric Obstetric # MHA TOT223E FFY13 FFY14 FFY15 Trend 1 Emergency Market Share 76.1% 72.1% 68.1% 2 Surgery Market Share 36.4% 32.2% 25.0% 38

40 TAB 6 Behavioral Health Profile The following mental health services are currently available in Randolph County: Burrell Behavioral Health-Crisis Intervention, Safe passage Domestic Violence Crisis Intervention center, the Division of Family Services (DFS) and the Department of Health & Senior Services, Lighthouse Counseling Center, Moberly Community Counseling Center, Preferred Family Healthcare Inc., Randolph County Health Department and private practitioners. Abuse: The elderly make up a large portion of the county s population, giving elder abuse the potential to reach many people in the county. Domestic abuse does not seem to be a problem when ER visits, hospitalizations and deaths are examined, but child abuse is a problem. Survivors are at increased risk for smoking, alcoholism, drug abuse, depression, suicide and other negative health outcomes. It should also be considered that many episodes of abuse may go unreported. Behavioral healthcare provides another important indicator of community health status. Tab Health Indicator Randolph County Trend State of MO MO Rural Norm (15) Source 6 a Children in single-parent households, percent, % 33.0% 29.9% 6 b Poor mental health days, American Community Survey, 5-year estimates Behavioral Risk Factor Surveillance System 6 c Depression Medicare beneficiaries, percent, % 19.1% 17.4% CCW (CMS) 6 d Ratio of Mental Health providers to population, ,190:1 600:1 1,829:1 6 e Violent crime rate per 100,000, f Alcohol-impaired driving deaths, % 33.0% 34.0% CMS, National Provider Identification Uniform Crime Reporting - FBI Fatality Analysis Reporting System 6 g Drug overdose deaths per 100,000, CDC WONDER mortality data Tab Individuals who received psychiatric services had the following types of disorders. The total number of diagnoses is larger than the number served because some individuals had more than one type of disorder. Randolph County Trend Source Diagnosis Category a Adjustment Disorder b Anxiety Disorder c Dementia NA NA 0 6 d Developmental Disorder e Impulse Control Disorder f Mood Disorder g Personality Disorder h Psychotic Disorder i Sexual Disorder NA NA NA Missouri Department of Mental Health Missouri Department of Mental Health Missouri Department of Mental Health Missouri Department of Mental Health Missouri Department of Mental Health Missouri Department of Mental Health Missouri Department of Mental Health Missouri Department of Mental Health Missouri Department of Mental Health 39

41 TAB 7a Risk Indicators / Factors Profile Lead: All Medicaid eligible children are blood tested for lead at 12 and 24 months of age. It is recommended that all children (regardless of Medicaid eligibility) be tested for lead at these ages. A re-evaluation of all children less than six years of age shall be made for risk of lead poisoning at health care visits (at least annually) and conducting a blood test for those found to be at risk. Water Supply: Randolph County has five fluorinated water sources in Clark, Higbee, Huntsville and two in Moberly. Knowing community health risk factors and disease patterns can aid in the understanding of next steps to improve health. Being overweight / obese, smoking, drinking in excess, not exercising, etc. can lead to poor health. Tab Health Indicator Randolph County Trend State of MO MO Rural Norm (15) Source 7a a Adult smoking, percent, % 21.0% 20.8% 7a b Physical inactivity, percent, % 26.0% 29.2% 7a c Poor physical health days, a d Adult obesity, percent, % 31.0% 32.8% 7a e Diabetes prevalence, percent, % 10.0% 10.9% 7a f Excessive drinking, percent, % 16.0% 15.5% 7a g Sexually transmitted infections per 100,000, Behavioral Risk Factor Surveillance System CDC Diabetes Interactive Atlas Behavioral Risk Factor Surveillance System CDC Diabetes Interactive Atlas CDC Diabetes Interactive Atlas Behavioral Risk Factor Surveillance System National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention 7a h Mean travel time to work, workers age 16 years+, minutes, People Quick Facts 7a i Long commute - driving alone, percent, % 30.0% 31.1% American Community Survey 7a 7a j k Estimated Number and Percentage of workers over 16 years that Walked, % 2.0% 2.7% Estimated Annual Total Number of Work-Related Injuries and Illnesses Involving Days Away from Work, , United States Department of Labor, Bureau of Labor Statistics United States Department of Labor, Bureau of Labor Statistics 7a l Food Insecurity Rate, percent, % 16.8% 15.6% Feeding America 7a Air pollution - particulate matter, average daily density in micrograms m per cubic meter, CDC WONDER environmental data 7a n Drinking water violations, FY2013-FY2014 No Yes Yes Safe Drinking Water Information System 40

42 TAB 7b Risk Indicators / Factors Profile Tab Health Indicator Randolph County Trend State of MO MO Rural Norm (15) Source 7b a Asthma Medicare beneficiaries, percent, % 4.7% 3.9% CCW (CMS) 7b b Atrial fibrillation Medicare beneficiaries, percent, % 8.0% 8.5% CCW (CMS) 7b d Chronic kidney disease Medicare beneficiaries, percent, % 16.4% 13.5% CCW (CMS) 7b e Chronic obstructive pulmonary disease (COPD) Medicare beneficiaries, percent, % 13.1% 13.3% CCW (CMS) 7b f Heart failure Medicare beneficiaries, percent, % 13.9% 14.8% CCW (CMS) 7b g High cholesterol Medicare beneficiaries, percent, % 42.6% 39.8% CCW (CMS) 7b h Hypertension Medicare beneficiaries, percent, % 55.0% 53.9% CCW (CMS) 7b i Osteoporosis Medicare beneficiaries, percent, % 6.0% 5.2% CCW (CMS) 7b k Stroke Medicare beneficiaries, percent, % 3.7% 3.4% CCW (CMS) TAB 8 Uninsured Profile Based on state estimations, the number of insured is documented below. Also, the amount of charity care from area providers is trended below. Tab Health Indicator Randolph County Trend State of MO MO Rural Norm (15) Source 8 a Uninsured, percent, % 15.0% 16.7% 8 b Uninsured adults, percent, % 18.0% 20.0% 8 c Uninsured children, percent, % 7.0% 8.5% Small Area Health Insurance Estimates Small Area Health Insurance Estimates Small Area Health Insurance Estimates Source: Internal Hospital Records Moberly Regional Medical Center YR 2013 YR 2014 YR 2015 Trend 1 Charity and Uncompensated Care $10,359,583 $9,975,906 $9,450,868 2 Donations to the Community $20,449 $115,350 $65,856 3 Property and Sales Taxes $4,833,181 $5,093,485 $4,448,971 41

43 TAB 8 Uninsured Profile Source: Internal Health Department Records Randolph County Health Department YR 2013 YR 2014 YR 2015 Trend Tax dollars used for services such as blood pressure screenings or STD testing and treatment Tax dollars used for Primary Care, lab testing, various shots and procedures Tax dollars used for other programs, such as communicable disease and other clinic services $18,509 $12,365 $9,467 $71,039 $107,770 $65,257 $132,778 $103,933 $149,943 4 Vaccine (Received from State) $81,688 $81,409 $81,118 5 WIC $41,240 $41,240 $42,089 6 Environmental Services $94,586 $94,586 $93,737 7 Community Health $84,400 $84,400 $84,400 8 Home Management $75,575 $75,575 $75,575 9 Home Health $23,428 $23,428 $23, Healthy Families America $29,902 $35,263 $35,263 TAB 9 Mortality Profile The leading causes of county deaths are listed below. Areas of higher than expected are so noted. Tab Health Indicator Randolph County Trend State of MO MO Rural Norm (15) Source 9 a Life Expectancy for Males, b Life Expectancy for Females, c Premature death, Years of Potential Life Lost Rate, , , , d Heart Disease Mortality, number of events, , e Chronic Lower Respiratory Disease Mortality, number of events, , Missouri Department of Health and Senior Services Missouri Department of Health and Senior Services National Center for Health Statistics - Mortality Files Missouri Department of Health and Senior Services Missouri Department of Health and Senior Services 9 f Motor vehicle crash deaths per 100,000, CDC WONDER mortality data 9 g Injury deaths per 100,000, CDC WONDER mortality data 7a h Injury at Work - Deaths, number of events, , i Suicides, number of events, , Missouri Department of Health and Senior Services Missouri Department of Health and Senior Services 42

44 TAB 9 Mortality Profile # Causes of Death by County of Residence, Missouri Department of Health and Senior Services, 2014 Randolph County % Trend State of MO All Causes % 58, % 1 Heart disease % -3.8% 14, % 2 Cancer % -2.4% 13, % 3 Other diseases (residual) % 1.2% 6, % 4 Chronic lower respiratory diseases % 1.4% 3, % 5 Cerebrovascular disease (Stroke) % -0.2% 3, % 6 Diabetes % 1.8% 1, % 7 All other accidents and adverse effects % -0.2% 2, % 8 Other respiratory diseases % 2.5% % 9 Other digestive diseases 9 3.2% 0.9% 1, % 10 Kidney disease (nephritis/nephrotic syndrome/nephrosis) 8 2.8% 0.4% 1, % 11 Suicide 8 2.8% 1.1% 1, % % TAB 10 Preventive Quality Measures Profile Infectious Diseases: Randolph County employs a Communicable Disease Coordinator who performs passive surveillance of reportable diseases. As diseases are reported, conditions are put into a state system under the proper county. The cases are then investigated and reports are forwarded to the regional epidemiologist. Vaccines Preventable: RCHD currently utilizes the Vaccine Information Statements (VIS) for each vaccine provided and follows ACIP / CDC guidelines for administration of vaccines. RCHD updates their information anytime it is updated by the CDC. RCHD provides pamphlets regarding the importance of Prevnar13 and Pneumovax23 vaccination (provided by the manufacturers) for better protection against pneumococcal infections. RCHD also promotes influenza vaccines, both regular and High Dose, to the public and at flu clinics that are set up with the RCHD clinic. Anytime a patient comes in for a flu shot, RCHD staff asks if the patient is up-to-date on their pneumonia vaccine and then proceeds to assess which pneumonia vaccine the patient needs, as well as provides the VIS / pamphlets. RCHD provides influenza vaccines for insurance pay, self-pay and 317 for adults that are unable to afford them. RCHD is able to provide Prevnar13 and Pneumovax23 through the 317 program to those that are uninsured / unable to afford the vaccine(s). Randolph County has providers at the Rural Health Clinic and RCHD who administer vaccines. Local pharmacies also provide Influenza, Tdap and Meningitis. Child Immunizations: Only 74% of two-year-olds served in Randolph County Health Department s clinic were considered properly immunized. At this age, children should receive four Diphtheria-Tetanus and Pertussis (DTaP), three Injectable Polio Virus (IPV), one Measles- Mumps- Rubella (MMR), one Varicella, two Hepatitis A, four Prevnar (PCV13), two Rota Virus, three Hepatitis, four Hepatitis B and four HIB vaccinations. 43

45 TAB 10 Preventive Quality Measures Profile The following table reflects the future health of the county. This information also is an indicator of community awareness of preventative measures. Tab Health Indicator Randolph County Trend State of MO MO Rural Norm (15) 10 a Access to exercise opportunities, percent, % 76.0% 48.5% Source Business Analyst, Delorme map data, ESRI, & US Census Tigerline Files 10 b Ate fruits and vegetables less than 5 times per day, percent, % 87.5% 88.4% 10 b Limited access to healthy foods, percent, % 6.0% 7.1% 10 c Diabetic monitoring, percent, % 86.0% 84.2% Missouri Department of Health and Senior Services USDA Food Environment Atlas Dartmouth Atlas of Health Care 10 d Mammography screening, percent, % 62.0% 59.0% 10 e 10 f No pap test in last 3 years - among women age 18 and older, percent, % 26.4% 33.1% Had no sigmoidoscopy or colonoscopy in last 10 years - among men and women age 50 and older, percent, % 38.0% 41.1% 10 g U.S.-acquired cases of measles, number of events, 2014 NA 27.0 NA 10 h Children receiving the recommended doses of DTaP, polio, MMR, Hib, HepB, varicella and PCV vaccines by age months, percent, 2014 NA 70.0% NA Dartmouth Atlas of Health Care Missouri Department of Health and Senior Services Missouri Department of Health and Senior Services National Notifiable Diseases Surveillance System (NNDSS), CDC/PHSIPO National Immunization Survey (NIS), CDC/NCIRD and CDC/NCHS 10 i Percent Annual Check-Up Visit with PCP NA NA TBD 10 j Percent Annual Check-Up Visit with Dentist NA NA TBD 10 k Percent Annual Check-Up Visit with Eye Doctor NA NA TBD 44

46 Community Feedback Research For a CHNA, it s also important to gather community perspective from key stakeholders on their views of progress to address the baseline CHNA needs documented three years ago. Below are findings of this online community primary research: Question 1 Overall Quality of Healthcare Delivery Randolph County Health Department (PSA) - Moberly, MO N= Three years ago, Randolph County Health Department completed a Community Health Needs Assessment (CHNA). This assessment identified a number of health needs for our community. Today, we are updating this assessment and would like to know how you rate the "Overall Quality" of healthcare delivery in our community? Answer Options Very Good Good Fair Poor Very Poor Valid N Randolph County Health Department Only N= Top 2 Boxes (Very Good / Good) 60.5% 23.1% 3.8% 0.0% Randolph County Health Department PSA N= Top 2 Boxes (Very Good / Good) 60.5% 33.2% 6.3% 0.0% Option C Stakeholders Round #2 1,108 2, ,662 Top 2 Boxes (Very Good / Good) 75.1% 21.1% 3.2% 0.7% Question 8 Requested Discussion Items for Town Hall Agenda Randolph County Health Department (PSA) - Moberly, MO N= Are there any other health needs from the list below that need to be discussed at our upcoming CHNA Town Hall meeting? Option C Stakeholders Round #2 Bottom 2 Boxes Randolph County N=162 Mental Illness 9.0% 10.0% Drugs / Substance Abuse 8.5% 9.4% Poverty 5.6% 6.9% Obesity 7.8% 6.8% Wellness 5.9% 6.0% Diabetes 4.9% 5.0% Suicide 5.0% 5.0% Abuse / Violence 4.7% 4.9% Teen Pregnancy 3.7% 4.8% Physical Exercise 5.5% 4.7% Tobacco Use 4.0% 4.6% Nutrition 5.0% 4.4% Alcohol 4.8% 4.0% Family Planning 2.9% 3.7% Heart Disease 3.7% 3.3% Cancer 4.7% 3.2% Vaccinations 3.7% 3.1% Respiratory Disease 2.2% 2.9% Water Quality 3.1% 2.6% Sexual Transmitted Diseases 2.3% 2.2% Other (please specify) 1.5% 1.5% Ozone 0.7% 0.7% Lead Exposure 0.7% 0.5% TOTAL 100.0% 100.0% TREND 45

47 Questions 4-5 Rating of Healthcare Services Randolph County Health Department (PSA) - Moberly, MO N= How would you rate each of the following services offered in Randolph County, MO? Option C Stakeholders Round #2 Bottom 2 Boxes Randolph County N=162 Mental Health Services 33.6% 38.1% Nursing Home 12.1% 25.0% Specialists 9.3% 19.0% Emergency Room 8.4% 15.8% Family Planning Services 16.3% 14.6% Dentists 11.6% 11.3% Child Care 13.8% 11.1% Eye Doctor / Optometrist 6.3% 9.0% Inpatient Services 4.4% 8.2% Outpatient Services 3.5% 7.8% Public Health Department 5.0% 6.5% Primary Care 4.9% 6.2% Chiropractors 5.3% 6.1% Hospice 5.9% 3.8% Home Health 9.0% 3.6% Ambulance Services 3.2% 2.6% Pharmacy 2.5% 2.5% School Nurse 6.1% 2.3% TREND Question 7 Healthcare Services Outside of PSA Randolph County Health Department (PSA) - Moberly, MO N= Throughout the past two years, did you or someone you know receive healthcare services outside of Randolph County, MO? Option C Stakeholders Round #2 Bottom 2 Boxes Randolph County N=162 Yes 78.4% 91.3% No 14.9% 8.1% Don't know 6.7% 0.6% TOTALS 100.0% 100.0% TREND 46

48 IV. Inventory of Community Health Resources [VVV Consultants LLC] 47

49 Inventory of Healthcare Services - Randolph County, MO Cat Healthcare Services Offered in County: Yes / No Hospital Health Dept Other Clinic Primary Care yes yes yes Hosp Alzheimer Center no no yes Hosp Ambulatory Surgery Centers no no no Hosp Arthritis Treatment Center no no no Hosp Bariatric / Weight Control Services (Wellness Center Only) yes no yes Hosp Birthing / LDR / LDRP Room no no no Hosp Breast Cancer (Lump Removal Only) yes no no Hosp Burn Care no no no Hosp Cardiac Rehabilitation yes no no Hosp Cardiac Surgery no no no Hosp Cardiology Services yes no no Hosp Case Management yes no no Hosp Chaplaincy / Pastoral Care Services yes no yes Hosp Chemotherapy no no no Hosp Colonoscopy yes no no Hosp Crisis Prevention yes no yes Hosp CT Scanner yes no no Hosp Diagnostic Radioisotope Facility yes no no Hosp Diagnostic / Invasive Catheterization yes no no Hosp Electron Beam Computed Tomography (EBCT) no no no Hosp Enrollment Assistance Services yes no yes Hosp Extracorporeal Shock Wave Lithotripter (ESWL) yes no no Hosp Fertility Clinic no no no Hosp Full Field Digital Mammography (FFDM) yes no no Hosp Genetic Testing / Counseling no yes no Hosp Geriatric Services yes no yes Hosp Heart Services yes no no Hosp Hemodialysis no no yes Hosp HIV / AIDS Services no yes no Hosp Image-Guided Radiation Therapy (IGRT) no no no Hosp Inpatient Acute Care - Hospital Services yes no no Hosp Intensity-Modulated Radiation Therapy (IMRT) 161 no no no Hosp Intensive Care Unit yes no no Hosp Intermediate Care Unit no no no Hosp Interventional Cardiac Catheterization yes no no Hosp Isolation Room yes no no Hosp Kidney Services no no yes Hosp Liver Services no no no Hosp Lung Services yes no no Hosp Magnetic Resonance Imaging (MRI) yes no no Hosp Mammograms yes no yes Hosp Mobile Health Services no no no Hosp Multislice Spiral Computed Tomography (<64 Slice CT) yes no no Hosp Multislice Spiral Computed Tomography (64+ Slice CT) yes no no Hosp Neonatal Services no no no Hosp Neurological Services yes no yes Hosp Obstetrics (Prenatal Only) yes no yes Hosp Occupational Health Services yes yes yes Hosp Oncology Services no no no Hosp Orthopedic Services yes yes yes Hosp Outpatient Surgery yes no no Hosp Pain Management yes no yes Hosp Palliative Care Program yes no yes Hosp Pediatric Services yes yes yes Hosp Physical Rehabilitation yes yes yes Hosp Positron Emission Tomography (PET) yes no no Hosp Positron Emission Tomography / CT (PET / CT) yes no no 48

50 Inventory of Healthcare Services - Randolph County, MO Cat Healthcare Services Offered in County: Yes / No Hospital Health Dept Other Hosp Psychiatric Services yes no yes Hosp Radiology, Diagnostic yes no yes Hosp Radiology, Therapeutic yes no no Hosp Reproductive Health yes no no Hosp Robotic Surgery yes no no Hosp Shaped Beam Radiation System 161 no no no Hosp Single Photon Emission Computerized Tomography no no no Hosp Sleep Center yes no no Hosp Social Work Services yes no yes Hosp Sports Medicine yes no yes Hosp Stereotactic Radiosurgery no no no Hosp Swing Bed Services yes no yes Hosp Transplant Services no no no Hosp Trauma Center - Level III no no no Hosp Ultrasound yes no yes Hosp Women's Health Services yes yes yes Hosp Wound Care yes no no SR Adult Day Care Program no np yes SR Assisted Living no no yes SR Home Health Services no yes yes SR Hospice no no yes SR Long-Term Care no no yes SR Nursing Home Services no no yes SR Retirement Housing no no yes SR Skilled Nursing Care yes yes yes ER Emergency Services yes no no ER Urgent Care Center no no yes ER Ambulance Services no no yes SERV Alcoholism-Drug Abuse no no yes SERV Blood Donor Center no no no SERV Chiropractic Services no no yes SERV Complementary Medicine Services no no yes SERV Dental Services no yes yes SERV Fitness Center yes no yes SERV Health Education Classes yes yes yes SERV Health Fair yes yes yes SERV Health Information Center yes no yes SERV Health Screenings yes yes yes SERV Meals-on-Wheels no no yes SERV Nutrition Programs yes yes yes SERV Patient Education Center yes yes no SERV Support Groups no no yes SERV Teen Outreach Services no no yes SERV Tobacco Treatment / Cessation Program yes yes yes SERV Transportation to Health Facilities no no yes SERV Wellness Program yes yes yes 49

51 RCHD - Health Education Schedule 2016 Date Event 1/4/2016 CPR Class for Westran School Staff 1/27/2016 Nutrition Education at Westran Elementary Learn Burn and Earn Group 2/20/2016 Pediatric CPR and First Aid 2/17/2016 Nutrition Education at Westran Elementary Learn Burn and Earn Group 3/17/2016 Basic Life Support CPR 3/24/2016 STI Presentation Preferred Family Healthcare 3/29/2016 Nutrition Education at Cardinal Health, Health Fair 4/11/2016 Nutrition Education at Week of the Young Child Event 4/12/2016 Handwashing presentation at I Can 4/16/2016 Pediatric CPR 4/20/2016 Nutrition Information at Orcehlens Health Fair 5/11/2016 Nutrition Education at Ican 6/6/2016 Basic Life Support CPR 6/9/2016 Dental Hygiene Presentation at Gratz Brown Elementary 6/16/2016 Summer Safety Presentation at Gratz Brown Elementary School 6/17/2016 Nutrition Education at Associate Electric Health Fair 7/21/2016 Basic Life Support CPR 7/29/2016 Nutrition Education at Summer Bash at Tannehill Park 7/22/2016 Personal Hygiene Presentation at Safe Passage 8/9/2016 Nutrition Education at Smart Start Back to School Event 8/11/2016 Nutrition Education at Freshman Academy 8/20/2016 Pediatric First Aid and CPR 9/10/2016 Nutrition Education at Old Settler s Event 9/15/2016 Nutrition Education Presentation at Country Villa Apartments 9/15/2016 Basic Life Support CPR 10/15/2016 Pediatric CPR and First Aid 10/17/2016 Heart saver CPR and First Aid 10/19/2016 Nutrition Education at MACC Health Fair 10/20/2016 Smoking Prevention Education at St. Pius Red Ribbon Week Event 1/1-9/20/ Hour Training for 88 Daycare Providers 12 Half-Hour Health Promotions for 7 Daycares with 18 Daycare Providers and 1/1-9/20/ Children 32 Half-Hour Obesity Prevention Health Promotions for 14 Daycares with 89 1/1-9/20/2016 Daycare Providers and 465 Children 50

52 MRMC - Health Education Schedule 2016 Date Event Host 1/12/2016 Dr.'s Office Radio Show Dwight Jones, FNP 1/13/2016 Paris Cancer Reconstruction Talk Dr. Hagan, ENT & Plastic Surgery 1/14/2016 Doc Talk, Retired Railroaders Dr. Hagan, ENT & Plastic Surgery 1/19/2016 Dr.'s Office Radio Show CEO & DPO 2/2/2016 Dr.'s Office Radio Show Dr. Chan, Cardiology 2/5/2016 Rotary - Huntsville ER Director - Stroke Talk 2/9/2016 Dr.'s Office Radio Show ER Director - Stroke Talk 2/10/2016 Orscheln Blood Pressure Clinic 2/11/2016 Orscheln Blood Pressure Clinic 2/16/2016 Dr.'s Office Radio Show Viruses in the News 2/23/2016 Dr.'s Office Radio Show Dr. Anees, Gastroenterology 3/5/2016 Blow Cancer Away Event Moberly ENT & Plastic Surgery 3/22/2016 Dr.'s Office Radio Show Dr. Ardhanari, Cardiology 3/29/2016 Dr.'s Office Radio Show ER Director - High Fever 4/7/2016 Lunch and Learn - Cardiology Dr. Ardhanari and Dr. Kumar 4/12/2016 Dr.'s Office Radio Show Jump with Jill Show 4/14/2016 Jump with Jill Nutrition Show Westran Elementary 4/14/2016 Jump with Jill Nutrition Show South Park Elementary 4/15/2016 Jump with Jill Nutrition Show Gratz Brown Elementary 4/15/2016 Jump with Jill Nutrition Show North Park Elementary 4/16/2016 Jump with Jill Nutrition Show Community Event - MACC 4/18/2016 Jump with Jill Nutrition Show St. Pius X School 4/19/2016 Dr.'s Office Radio Show John Dawes, CEO 4/20/2016 Orscheln Health Fair 4/30/2016 Healthy Community Day YMCA 5/8/2016 Run for Her Life 5K 5/10/2016 Ucan2 Dr. Holyoak, Urologist and DPO 5/13/2016 Hannibal LaGrange Senior Event SBHU 5/17/2016 Dr.'s Office Radio Show Cardiac Cath Lab 5/19/2016 Chariton County Senior Health Fair SBHU 5/25/2016 Orscheln Blood Pressure Clinic 5/26/2016 Orscheln Blood Pressure Clinic 5/31/2016 Dr.'s Office Radio Show ER Director - Broken 6/1/2016 Orscheln Blood Pressure Clinic 6/4/2016 Relay for Life Moberly ENT & Plastic Surgery 6/9/2016 NARVRE Dr. McCoy, OB/Gyn and CEO 6/9/2016 Rotary Dr. Kumar, Cardiology 6/14/2016 Dr.'s Office Radio Show Nuclear Medicine 6/16/2016 Lunch and Learn - Ophthalmology Dr. Nizam 6/17/2016 AECI Employee Health Fair 6/21/2016 Dr.'s Office Radio Show Diabetes Education 51

53 MRMC - Health Education Schedule 2016 Date Event Host 7/12/2016 Dr.'s Office Radio Show Infection Control 7/19/2016 Dr.'s Office Radio Show Courtney Ramsey, FNP 7/26/2016 Dr.'s Office Radio Show Dr. McCoy, OB/Gyn 7/27/2016 Back to School Fair Chariton Valley Family Medicine 8/2/2016 Dr.'s Office Radio Show Dr. Bostick, Cardiology 8/4/2016 Cardiology Health Talk Dr. Bostick, Cardiology 8/16/2016 Dr.'s Office Radio Show ER Director - Tick Borne Illnesses 8/23/2016 Dr.'s Office Radio Show 8/30/2016 Dr.'s Office Radio Show ER Director 9/6/2016 Dr.'s Office Radio Show 9/8/2016 Macon Health Care Veteran's Celebration 9/13/2016 Dr.'s Office Radio Show 9/15/2016 Lunch and Learn - Podiatry Dr. Fallis 9/20/2016 Dr.'s Office Radio Show 9/21/2016 Orscheln Blood Pressure Clinic 9/22/2016 Orscheln Blood Pressure Clinic 9/27/2016 Dr.'s Office Radio Show ER Director 10/4/2016 Dr.'s Office Radio Show 10/6/2016 Moberly CIT Pre-Council Meeting SBHU 10/7/2016 City of Moberly Health Fair 10/11/2016 Dr.'s Office Radio Show 10/12/2016 Lunch and Learn - Sr. Behavioral Health 10/18/2016 Women's Health Event Dr. McCoy and Dr. Williams 10/18/2016 Dr.'s Office Radio Show 10/19/2016 MACC Fall Activities Fair 10/25/2016 Dr.'s Office Radio Show ER Director 11/1/2016 Dr.'s Office Radio Show 11/3/2016 Moberly CIT Pre-Council Meeting SBHU 11/8/2016 Dr.'s Office Radio Show 11/15/2016 Dr.'s Office Radio Show 11/17/2016 November Men's Health Event Dr. Holyoak and Dr. Stitzer 11/22/2016 Dr.'s Office Radio Show 11/29/2016 Dr.'s Office Radio Show ER Director 12/1/2016 Living Windows 12/6/2016 Dr.'s Office Radio Show 12/13/2016 Dr.'s Office Radio Show 12/14/2016 Orscheln Blood Pressure Clinic 12/15/2016 Orscheln Blood Pressure Clinic 12/20/2016 Dr.'s Office Radio Show 12/27/2016 Dr.'s Office Radio Show ER Director 52

54 Randolph County, Missouri Area Healthcare Services Emergency Numbers Police/Sheriff 911 Fire 911 Ambulance 911 Non-Emergency Numbers Randolph County Sheriff Randolph County Ambulance

55 BANKING FINANCIAL Bank Midwest 420 N. Morley St. Phone: Bank of Cairo & Moberly 207 E. Rollins 700 Hwy. 24 E. Phone: / Website: Citizens Bank & Trust 801 N. Morley Phone: Website: Central Bank of Moberly 500 W. Coates St. Phone: S. Main Huntsville, MO Phone: Website: Commerce Bank 1415 N. Morley Phone: Website: County Bank 1615 N. Morley Phone: Website: First State Community Bank 100 S. Fourth St. Phone: Website: GE Capital 1961 Hirst Drive Phone: Website: Leaf Commercial Capital, Inc Crete St. Phone: Website: United Credit Union 1791 E. Outer Road Phone: Website: CHILDREN AND YOUTH SERVICES Project Jumpstart Mailing Address: 517 Wicker Location: Allendale (Outreach Building) 17 Kehoe Phone: / Randolph Area YMCA 1600 N. Morley Phone: Fax: Randolph County Family Support and Children s Division 1715B South Morley Phone: Fax: Toll Free: Stubbins Regional Youth Center 811 South 5th Street Phone: (24-Hours) Fax: CHURCH Coates Street Presbyterian Church 601 W. Coates Phone: Website: Family Life Fellowship 339 N. Williams Phone: Website: 54

56 First Baptist Church 514 W. Rollins Street Phone: Website: Timber Lake Christian Church 1624 Gratz Brown Phone: Website: Trinity United Methodist Church 101 S. Fourth St. Phone: Website: Zion Lutheran Church 1075 E. Urbandale Phone: DENTIST Michael W Berry, DDS 110 E. Rollins St. Phone: Website: Long Branch Dental Group 1013 Hwy. 24 West Phone: Website: O Loughlin Dental, LLC 1710 Gratz Brown Phone: Website: Smile Dental 1620 E. Rollins Phone: Website: DAYCARE CENTERS / PRESCHOOLS Central Christian Preschool 201 South Fourth Street Phone: Community Day Care Learning Center 1416 East McKinsey, P.O. Box 674 Phone: Fax: Douglass Community Center Head Start 707 Sinnock Phone: Fax: Family Life Fellowship Preschool Destiny Dome Highway 24 East Phone: Zion Lutheran Preschool 1075 East Urbandale Drive Phone: EDUCATION AND JOB TRAINING Central Christian College of the Bible 911 E. Urbandale Dr. Phone: Website: Columbia College-Moberly 101 College Ave., Rm 231 Phone: x Website: Experience Works P.O. Box 414 Buffalo, MO Phone: Toll Free: Fax: Website: Caring for Kids, Too 1800 Dolphin Court Phone:

57 Gamm, Inc. Workforce Investment Act (WIA) 1212 W. Hwy. 24 Phone: / Fax: Job Point 1212 Hwy. 24 West Phone: Little Dixie Regional Libraries 111 North 4th Phone: Fax: Manpower #2 Melgrove Ln., Suite 104 Hannibal, MO Phone: Merrell University 401 W. Reed Phone: Website: Missouri Career Center Workforce Development 1212 W. Hwy. 24 Phone: Fax: Moberly Area Community College 101 College Avenue Phone: Ext. 307 or 327 Toll Free: Fax: Moberly Public Schools 926 KWIX Road Phone: Website: NEMO Workforce Investment Board 111 East Monroe Paris, MO Phone: Toll Free: Fax: New Traditions Moberly Area Community College 101 College Avenue Phone: Ext. 232 or 319 Toll Free: Fax: Randolph County Family Literacy Center 1800 Dolphin Court Phone: / University of Missouri Extension 100 W. Sparks, Suite B Phone: Fax: Vocational Rehabilitation 1500 Vandiver Drive, Suite 111 Columbia, MO Phone: Fax: FARM Orscheln Farm & Home Store 314 Hwy 24 E. Phone: Website: Rolling Knolls Farm 4691 E. Hwy. 24 Phone: Twin Acres Ranch 1875 Hwy. M Phone: Sydenstricker Farm & Garden 1810 N. Missouri, P.O. Box 467 Macon, MO Website: FOOD Bratchers Market 301 S. Morley Phone:

58 Casey s 326 S. Morley Phone: Hurley Phone: Website: Cherith Brook Food Pantry Family LifeFellowship 339 N. Williams Website: Christos Center 111 North 5th Phone: Country Meat Shop 1515 W. Outer Road Phone: Huntsville Ministerial Alliance 105 E. Elm Huntsville, MO Phone: Ritters Fruit & Vegetables 1726 N. Morley Phone: Wal-Mart Supercenter 1301 Hwy. 24 E. Phone: FUNERAL HOME Cater Funeral Home, Inc E. Rollins Phone: Website: Million Taylor Funeral Homes 320 S. Williams Phone: Website: Pathway Memorial Funeral Home 411 Union Avenue Phone: Website: HOUSING Country Villa Apartments 2251 Silva Lane Phone: JAD Properties P.O. Box 101 Phone: Moberly Housing Authority P.O. Box 159 Phone: TTD: Allendale Manor / Countryview Garden 23 Kehoe Phone: Fax: Moberly Towers / L. W. Case Towers & Case Apts. 205 Farror Phone: Fax: Allendale Community Center 23 Kehoe Phone: N.E.C.A.C. North East Community Action Corporation 1210 Highway 24 West Phone: In-Home: Fax: Orscheln Properties Management, LLC P.O. Box 676 Phone:

59 INSURANCE All State 208 W. Rollins Phone: Randolph County Farm Bureau 1010 Hwy. 24 W. Phone: Website: State Farm 1315 Hwy. 24 E., Suite D Phone: Valentine Insurance 630 N. Morley St. Phone: Website: JUDICIAL SERVICES 14th Circuit CASA 210 North Williams, Suite 104 Phone: Fax: Probation and Parole 1150 S. Morley Phone: Fax: Randolph County Juvenile Court Services 210 North Williams, Suite 104 Phone: Fax: LICENSES Moberly License Office Missouri State Motor Vehicle, Marine, and Drivers Licensing Bureau 209 N. Clark Phone: MEDICAL American Cancer Society 1900 N. Providence Road, Suite 105 Columbia, MO Phone: Fax: / Toll Free: ACS-2345 Website: Angel Flight America Phone: Website: Mobile Classroom Web Site Website: Look Good Feel Better Web Site for Teens Website: American Red Cross 1805 W. Worley Street Columbia, MO Phone: Fax: Website: Website: Central Missouri Audiology & Hearing Aid Center, Inc S. Morley St. Phone: Comprehensive Care Services and Solutions 318 W. Coates S.t, Ste. 102 Phone: Homecare of Mid-Missouri Home Health, Homemaker and Hospice 102 West Reed Phone: Fax: Midwest Bone & Joint 1527 Union Ave. Moberly Regional Medical Center 1515 Union Avenue Phone: Fax: Website: 58

60 Randolph County Ambulance Service 1366 E. 24 Highway Emergency: 911/ Non-Emergency: Randolph County Ambulance District 1366 East Highway 24 Emergency: 911/ Business: Randolph County Health Department/Home Health Care P.O. Box 488, 423 East Logan Phone: Fax: MENTAL HEALTH / SUBSTANCE ABUSE E.S.C.A.P.E. Alcohol & Drug Out/Patient Counseling Center Administrative Office: 501 North Ault Phone: Fax: Website: escapealcoholdrugs.com Olive Tree Counseling 300 N. Morley St. Phone: University Behavior Health Services 421 W. Reed Phone: Fax: Crisis Hotline: NURSING HOMES (Licensed) Loma Linda Healthcare, Inc E. Rollins Phone: Moberly Nursing and Rehab 700 East Urbandale Drive Phone: Fax: North Village Park Care Center 2041 Silva Lane Phone: Fax: OPTOMETRIST Columbia EDP Center, Inc Vandiver Dr. Columbia, MO Phone: Website: Moberly Eye Center 1633 S. Morley Phone: PEST CONTROL ABAN Pest Control 2042 Silva Ln. Phone: Hayes Pest Control 509 W. Rollins St. Phone: PHARMACY Hils Pharmacy 907 N. Morley St. Phone: Website: Kribbs Family Pharmacy 319 W. Reed Phone: Sam s Health Mart Pharmacies 300 N. Morley, Suite J Phone: East 24 Highway Phone: Website: 59

61 PROVIDERS ARDHANARI, SIVAKUMAR, M.D. Cardiology Moberly Heart & Vascular 1513 Union Avenue Phone: Website: MoberlyHeartandVascular.com BOSTICK, BRIAN, M.D. Cardiology Moberly Heart & Vascular 1513 Union Avenue Phone: Website: MoberlyHeartandVascular.com CHAN, ALBERT, M.D. Cardiology Moberly Heart & Vascular 1513 Union Avenue Phone: Website: MoberlyHeartandVascular.com GESSLING, HEATHER, M.D. Family Medicine Moberly Rural Health Clinic 1501 Union Avenue, Suite A&B Phone: Website: MoberlyRuralHealthClinic.com GILBERT, DANIEL, D.O. General Surgery Moberly Surgical Associates 1517 Union Avenue, Suite D Phone: Website: MoberlySurgicalAssociates.com HOLTZ, MIKE, N.P.-C. Allied Health Professional Chariton Valley Family Medicine 413 West Second Street Salisbury, MO Phone: Website: CharitonValleyFamilyMedicine.com HOLYOAK, JOSHUA, M.D. Urology Moberly Urology 1517 Union Avenue, Suite A Phone: Website: MoberlyUrology.com KUMAR, ARUN, M.D. Cardiology Moberly Heart & Vascular 1513 Union Avenue Phone: Website: MoberlyHeartandVascular.com LEONARD-SCOTT, CASSIDY, D.O. Pediatrics Moberly Rural Health Clinic 1501 Union Avenue, Suite A&B Phone: Website: MoberlyRuralHealthClinic.com MCCOY, CRAIG, D.O. OB/GYN, URO/GYN Moberly Women's Health 1517 Union Avenue, Suite C Phone: Website: MoberlyWomensHealth.com RAMPTON, JON, D.O. Family Medicine Moberly Family Medicine 1501 Union Avenue, Suite C&D Phone: Website: MoberlyFamilyMedicine.com RAMSEY, COURTNEY, F.N.P. Allied Health Professional Moberly Rural Health Clinic 1501 Union Avenue, Suite A&B Phone: Website: MoberlyRuralHealthClinic.com RASMUSSEN, SUSAN, F.N.P. Allied Health Professional Moberly Rural Health Clinic 1501 Union Avenue, Suite A&B Phone: Website: MoberlyRuralHealthClinic.com 60

62 STITZER, PHILIP, D.O. Family Medicine Moberly Family Medicine 1501 Union Avenue, Suite C&D Phone: Website: MoberlyFamilyMedicine.com THRASHER, TERRY, D.O. Family Medicine Chariton Valley Family Medicine 413 West Second Street Salisbury, MO Phone: Website: CharitonValleyFamilyMedicine.com WILLIAMS, KATE, M.D. Family Medicine Moberly Rural Health Clinic 1501 Union Avenue, Suite A&B Phone: Website: MoberlyRuralHealthClinic.com WEMHOFF, DIANA, F.N.P. Allied Health Professional Moberly Family Medicine 1501 Union Avenue, Suite C&D Phone: RESIDENTIAL CARE FACILITIES Mark Twain Retirement Centers 104 E. Elm St. Huntsville, MO Phone: Union Ave. Phone: Meadow Ridge Estates 521 Meadow Ridge Ln. Phone: Website: Moberly Senior Housing/Lucille Manor 800 Sinnock Ave. Phone: Ravenwood Terrace Assisted Living 1830 Ravenwood Drive Phone: U-Rest Boarding Home 612 W. Coates Phone: PARENTING EDUCATION Birthright 416 E. Logan Phone: Emergency Phone: Parents as Teachers Moberly Phone: Huntsville Phone: Renick Phone: Cairo Phone: PUBLIC SAFETY Moberly Fire Department 310 N. Clark St N. Morley St Emergency: 911 Non-Emergency: Randolph County Fire Departments Southeast Randolph County Fire Department Phone: /911 Northeast R-IV Fire Department Phone: /911 Village of Cairo Fire Department Phone: /911 Western Randolph County Fire Department Phone: /911 Eastern Randolph Rural Fire Department Phone: /911 Higbee Fire District Phone: /911 Moberly Police Department Moberly Police Department 300 North Clark Street Phone: Allendale Substation Phone: Emergency Phone:

63 Randolph County Sheriff s Department 372 Hwy. JJ Huntsville, MO Phone: SENIOR SERVICES ICAN/Randolph County Developmental Disability Services 105 North Avenue Phone: Missouri Department of Health and Senior Services Division of Senior and Disability Services 1715B South Morley Phone: Hour Hotline: Fax: Senior American Center 205 Farror Phone: Fax: Services for Independent Living 1401 Hathman Place Columbia, MO Phone: TTY: Fax: Toll Free: Website: TRANSPORTATION Magic City Express Transportation Service: Oats, Inc Jims Road Macon, MO Phone: Toll Free: Fax: MISCELLANEOUS RECREATION A Stroke of Magic 215 West Reed St. Phone: Website: B & B Theatres 3000 N. Morley Street Phone: Everlast Fitness Mfg Corp Hwy. DD Phone: Website: Heritage Hills Golf Course 3534 Hwy. JJ Phone: Website: Memory Lanes 1616a North Morley Street Phone: Website: The Art Department 214 N. Fourth Phone: Trophy Country 4472 Private Road 1296 Huntsville, MO Phone: MISCELLANEOUS SOCIAL AGENCIES Big Brothers/Big Sisters of Randolph County P.O. Box 33 Phone: Website: Boy Scouts of America 1203 Fay St. Columbia, MO Phone: Caring Communities Partnership 421 E. Logan, P.O. Box 653 Phone: Fax:

64 Chamber of Commerce 211 West Reed Phone: Fax: Website: Community Enhancement Group 1115 Epperson St. Phone: Fraternal Order of Eagles 1408 N. Morley Phone: Goodwill - Missouri Goodwill Industries 1600 N. Morley Phone: Hannah s Closet 335 N. Williams Phone: Website: Health and Hope Ministries 421 E. Logan, P.O. Box 653 Phone: Ext. 2 Moberly Area Council of the Arts 101 College Ave Phone: Website: Moberly Area Economic Development Corporation 115-A North Williams, P.O. Box 549 Phone: Fax: Moberly Friends of the Park Foundation 200 N. Clark Street x 2040 Website: Moberly Optimist Club 719 Brierwood Phone: Website: Moberly Parks and Recreation 109 N. Clark Phone: Moberly Public Schools Foundation P.O. Box 104 Moberly Rotary Club P.O. Box 3 Randolph Area Pachyderm Club P.O. Box 842 Randolph County Agricultural Fair Board 423 E. Logan St. Phone: Website: Randolph County Board of Realtors P.O. Box 365 Phone: Randolph County Caring Communities 423 East Logan St. Phone: Randolph County Cattlemen s Association County Road 1015 Madison, MO Phone: Randolph County Excel, Inc County Road 2735 Phone: Moberly Kiwanis Club P.O. Box 361 Phone:

65 Randolph County Historical Society Library Archives and Museum 223 N. Clark St. Phone: Free Railroad Museum 100 Sturgeon Randolph County Republican Central Committee 2457 County Road 1330 Safe Passage Domestic Violence Shelter Crisis Intervention Services P.O. Box 456 Administrative Phone: Crisis Line: Toll Free: Fax: Thomas Hill Wildlife Area Location: Twenty-three miles northwest of Moberly Blacktop T Excello, MO Phone: / Other Recreation Areas Long Branch Lake Location: Macon County Clarence Cannon Dam Location: Monroe County The Lake of the Ozarks Location: Eighty miles south of Randolph County Salvation Army Thrift Store 104 N. Fourth Phone: Social Security Administration 803 Grey Oak Drive, Columbia, MO Phone: Toll Free: Fax: Website: United Way of Randolph County P.O. Box 576 Phone: US Postal Service Moberly Branch 121 Johnson Street Phone: OUTDOOR RECREATIONAL AREAS Rudolf Bennitt Wildlife Area Location: 7 miles west of Clark on Route B, then 1.5 miles south on a gravel road Sugar Creek Lake Location: 2 miles north of Moberly 64

66 General Online Healthcare Resources Doctors and Dentists--General AMA Physician Select: Online Doctor Finder (American Medical Association) DocFinder (Administrators in Medicine) Find a Dentist (Academy of General Dentistry) Find a Dentist: ADA Member Directory (American Dental Association) Physician Compare (Centers for Medicare & Medicaid Services) Hospitals and Clinics--General Find a Health Center (Health Resources and Services Administration) Find a Provider: TRICARE Provider Directories (TRICARE Management Activity) Hospital Quality Compare (Centers for Medicare & Medicaid Services) Doctors and Dentists--Specialists ACOG's Physician Directory (American College of Obstetricians and Gynecologists) ACR: Geographic Membership Directory (American College of Rheumatology) American College of Surgeons Membership Directory (American College of Surgeons) American Osteopathic Association D.O. Database (American Osteopathic Association) ASGE: Find a Doctor (American Society for Gastrointestinal Endoscopy) Cancer Genetics Services Directory (National Cancer Institute) Child and Adolescent Psychiatrist Finder (American Academy of Child and Adolescent Psychiatry) Dystonia: Find a Health Care Professional (Dystonia Medical Research Foundation) Expert Locator: Immunologists (Jeffrey Modell Foundation) Find a Dermatologic Surgeon (American Society for Dermatologic Surgery) Find a Dermatologist (American Academy of Dermatology) Find a Gastroenterologist (American College of Gastroenterology) Find a Gynecologic Oncologist (Society of Gynecologic Oncologists) Find a Hand Surgeon (American Society for Surgery of the Hand) Find a Hematologist (American Society of Hematology) Find a Neurologist (American Academy of Neurology) Find a Pediatric Dentist (American Academy of Pediatric Dentistry) Find a Pediatrician or Pediatric Specialist (American Academy of Pediatrics) Find a Periodontist (American Academy of Periodontology) Find a Physical Medicine & Rehabilitation Physician (American Academy of Physical Medicine and Rehabilitation) Find a Plastic Surgeon (American Society of Plastic Surgeons) Find a Podiatrist (American Podiatric Medical Association) Find a Thyroid Specialist (American Thyroid Association) Find a Urologist (American Urological Association) Find an ACFAS Physician (American College of Foot and Ankle Surgeons) Find an Allergist/Immunologist: Search (American Academy of Allergy, Asthma, and Immunology) Find an Endocrinologist (Hormone Health Network) Find an Eye M.D. (American Academy of Ophthalmology) Find an Interventional Radiologist (Society of Interventional Radiology) Find an Oncologist (American Society of Clinical Oncology) Find an Oral and Maxillofacial Surgeon (American Association of Oral and Maxillofacial Surgeons) Find an Orthopaedic Foot and Ankle MD (American Orthopaedic Foot and Ankle Society) Find an Otolaryngologist (ENT) (American Academy of Otolaryngology--Head and Neck Surgery) Finding an Eye Care Professional (National Eye Institute) GI Locator Service (American Gastroenterological Association) Other Healthcare Providers AMTA's Find a Massage Therapist (American Massage Therapy Association) Cancer Genetics Services Directory (National Cancer Institute) Find a Diabetes Educator (American Association of Diabetes Educators) Find a Genetic Counselor (National Society of Genetic Counselors) Find a Midwife (American College of Nurse-Midwives) Find a Nurse Practitioner (American Academy of Nurse Practitioners) Find a Physical Therapist (American Physical Therapy Association) Find a Professional: Online Directory of Audiology and Speech-Language Pathology Programs (American Speech-Language-Hearing Association) Find a Registered Dietitian (Academy of Nutrition and Dietetics) Find a Therapist (Anxiety Disorders Association of America) Find an Audiologist (American Academy of Audiology) Manual Lymphatic Drainage Therapists (National Lymphedema Network) National Register of Health Service Providers in Psychology (National Register of Health Service Providers in Psychology) NCCAOM: Find Nationally Certified Practitioners (National Certification Commission for Acupuncture and Oriental Medicine) Search for an Emergency Contraception Provider in the United States (Princeton University, Office of Population Research) 65

67 Hospitals and Clinics--Specialized Accredited Birth Centers (Commission for the Accreditation of Birth Centers) Alzheimer's Disease Research Centers (National Institute on Aging) Cystic Fibrosis Foundation: Find a Chapter (Cystic Fibrosis Foundation) Cystic Fibrosis Foundation: Find an Accredited Care Center (Cystic Fibrosis Foundation) Dialysis Facility Compare (Centers for Medicare & Medicaid Services) FDA Certified Mammography Facilities (Food and Drug Administration) Find a Free Clinic (National Association of Free Clinics) Find an Indian Health Service Facility (Indian Health Service) Find Treatment Centers (American Cancer Society) Genetics Clinic Directory Search (University of Washington) Locate a Sleep Center in the United States by Zip Code (American Academy of Sleep Medicine) MDA ALS Centers (Muscular Dystrophy Association) Mental Health Services Locator (Substance Abuse and Mental Health Services Administration) NCI Designated Cancer Centers (National Cancer Institute) Neurofibromatosis Specialists (Children's Tumor Foundation) Post-Polio Directory 2011: Post-Polio Clinics, Health Professionals, Support Groups (Post-Polio Health International including International Ventilator Users Network) Spina Bifida Clinic Directory (Spina Bifida Association of America) Substance Abuse Treatment Facility Locator (Substance Abuse and Mental Health Services Administration) Transplant Center Search Form (BMT InfoNet) U.S. NMDP Transplant Centers (National Marrow Donor Program) VA Health Care Facilities Locator & Directory (Veterans Health Administration) Where to Donate Blood (AABB) Where to Donate Cord Blood (National Marrow Donor Program) Other Healthcare Facilities and Services Alzheimer's Disease Resource Locator (Fisher Center for Alzheimer's Research Foundation) American College of Radiology Accredited Facility Search (American College of Radiology) APA District Branch / State Association Directory (American Psychiatric Association) Directory of Organizations (Deafness and Communication Disorders) (National Institute on Deafness and Other Communication Disorders) Dog Guide Schools in the United States (American Foundation for the Blind) Eldercare Locator (Dept. of Health and Human Services) Find a Hospice or Palliative Care Program (National Hospice and Palliative Care Organization) Find Services (for People with Vision Loss) (American Foundation for the Blind) Find Urgent Care Centers by State (Urgent Care Association of America) Genetic Testing Laboratory Directory (University of Washington) Home Health Compare (Centers for Medicare & Medicaid Services) Medicare: Helpful Contacts (Centers for Medicare & Medicaid Services) Muscular Dystrophy Association Clinics and Services (Muscular Dystrophy Association) National Foster Care and Adoption Directory Search (Children's Bureau) Nursing Home Compare (Centers for Medicare & Medicaid Services) Organizations That Offer Support Services (National Cancer Institute) Poison Control Centers (American Association of Poison Control Centers) Resources and Information for Parents about Braille (American Foundation for the Blind) State-Based Physical Activity Program Directory (Centers for Disease Control and Prevention) TSA Chapters in the USA (Tourette Syndrome Association) Violence against Women: Resources by State (Dept. of Health and Human Services, Office on Women's Health) Where to Find Hair Loss Accessories and Breast Cancer Products (American Cancer Society) SOURCE: MedlinePlus provides links to directories to help you find libraries, health professionals, services and facilities. National Library of Medicine (NLM) does not endorse or recommend the organizations that produce these directories, nor the individuals or organizations that are included in the directories. 66

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74 Randolph County Health Department (Primary Service Area) Community CHNA Town Hall Attendees, 10/18/2016 N=42 Category Last Name First Name Organization Address City ST Zip County Directors or staff of health and human services organizations. Calvert Holly Children's Division 1715 South Morley #B, P.O. Box 857 Moberly MO Randolph Education officials and staff - school superintendents, principals, teachers and school nurses. Berry Marcey St. Pius X School 210 S. Williams St. Moberly MO Randolph Public health officials. Billeck Chelsea Randolph County Health Department 423 E. Logan St Moberly MO Randolph Coalitions working on health or other issues. Buckman Kimberly Caring Communities 423 E. Logan Moberly MO Randolph Political, appointed and elected officials. Charrier Jim City of Moberly 204 N. Clark St. Moberly MO Randolph Mental health providers. Connoley Melissa Burrell Behavioral Health 210 N. Williams St. Moberly MO Randolph Political, appointed and elected officials. Crane Brian City of Moberly 101 W. Reed St. Moberly MO Randolph The hospital administration. Dawes John Moberly Regional Medical Center 1515 Union Avenue Moberly MO Randolph Press (Paper, TV, Radio). Duvall Connie Moberly Monitor Index 218 N. Williams Moberly MO Randolph Family Nurse Practitioner. Gibson Rebecca Randolph County Health Department 423 E. Logan Moberly MO Randolph Family Nurse Practitioner. Gipson Brooke Randolph County Health Department 423 E. Logan Moberly MO Randolph Public health officials. Greer Leona Randolph County Health Department 423 E. Logan Moberly MO Randolph Community leaders. Heath Paula A Stoke of Magic 215 W. Reed Moberly MO Randolph Welfare and social service agency staff. Hendren Patty Randolph County Caring Communities 423 E. Logan Moberly MO Randolph Representatives from businesses - owners/ceos of large businesses (local or large corporations with local branches). Jackson Rhonda Reality Check Screening, LLC 2188 Highway JJ Moberly MO Randolph Representatives from businesses - owners/ceos of large businesses (local or large corporations with local branches). Jamerson Andie Reality Check Screening, LLC 2188 Highway JJ Moberly MO Randolph Leaders in other not-for-profit health care organizations, such as hospitals, clinics, nursing homes and home-based and community-based services. Johnston Tom Moberly Regional Medical Center 1527 Union Ave. Moberly MO Randolph Community leaders. Joiner Clay Randolph County Ambulance 1366 E. 24 Hwy. Moberly MO Randolph Public health officials. Laird Debra Randolph County Health Department 423 E. Logan Moberly MO Randolph Community leaders. LaMonda Chad Mental health providers. Lester Daniel Catholic Charities of Central and Northern Missouri 3401 Berrywood Drive, Suite 204 Columbia MO Boone Community leaders. McGarvey Scott Apostolic Pentecostal Church Mile Ln. Moberly MO Randolph Press (Paper, TV, Radio). Miedler Howard KWIX/KRES/KIRK P.O. Box 619 Moberly MO Randolph Welfare and social service agency staff. Miles Lorna Randolph County Caring Communities 423 E. Logan Moberly MO Randolph The hospital administration. Morgans Jaime Moberly Regional Medical Center 1515 Union Avenue Moberly MO Randolph Mental health providers. Morgans Johnathan Olive Tree Counseling 222 N. Williams St. Moberly MO Randolph Family Nurse Practitioner. Ramsey Courtney Moberly Rural Health Clinic- MRMC 1501 Union Avenue Moberly MO Randolph Representatives from businesses - owners/ceos of large businesses (local or large corporations with local branches). Riley Barb Century 21, McKeown & Associates, Inc Silva Ln. Moberly MO Randolph Political, appointed and elected officials. Riley Bob City of Moberly 101 W. Reed Moberly MO Randolph Leaders in other not-for-profit health care organizations, such as hospitals, clinics, nursing homes and home-based and community-based services. Sutherland Stephanie Dialysis Clinic Inc Union Ave. Moberly MO Randolph Public health officials. Taylor Diana Randolph County Health Department 423 E. Logan Moberly MO Randolph Education officials and staff - school superintendents, principals, teachers and school nurses. Terrell Jerimah University of Missouri Extension P.O. Box 655 Moberly MO Randolph Political, appointed and elected officials. Truesdell John Randolph County Commissioner 101 S. Main Huntsville MO Randolph Education officials and staff - school superintendents, principals, teachers and school nurses. Vanderburg Lisa Moberly Board of Education 926 KWIX Road Moberly MO Randolph Leaders in other not-for-profit health care organizations, such as hospitals, clinics, nursing homes and home-based and community-based services. Vanduzer Penny Home Care of Mid Missouri 102 W. Reed St. Moberly MO Randolph Community leaders. VanHouten Mary Ellen Wells Fargo Vendor Financial Services 421 W. Reed St. Moberly MO Randolph Public health officials. Walker Sandy Randolph County Health Department 423 E. Logan Moberly MO Randolph Community leaders. Wandrum Nancy Presbyterian Church, USA 1430 Harvest Ln. Moberly MO Randolph Community leaders. Wandrum Wallis Presbyterian Church, USA 1430 Harvest Ln. Moberly MO Randolph Community leaders. Weidenaar Randal Notionfront Marketing 1302 County 2455 Huntsville MO Randolph Public health officials. Whisenard Sharen Randolph County Health Department 423 E. Logan Moberly MO Randolph Leaders in other not-for-profit health care organizations, such as hospitals, clinics, nursing homes and home-based and community-based services. Wilson Jackie Senior Circle 1160 Highway BB Moberly MO Randolph 73

75 Randolph County Health Department (Primary Service Area) - Community Health Needs Assessment Meeting N=42 Community Members Present Parents Those taking care of the elderly Elected officials (Mayor, County/City) Providers Schools Home Health/ Hospice TAB 1: Demographic Profile Have poverty in our county Veterans going to VA in Columbia or clinic in Kirksville for healthcare Hispanic population / Spanish language growth happening TAB 2: Economic / Business Profile Unemployment percentage differs between can t or won t get a job TAB 5: Hospitalization / Provider Profile About 1,800 people in the prison EMS says 70% MRMC ED market share is incorrect, should be much lower TAB 6: Behavioral Health Profile There is a six month waiting list to see a mental health provider, data is not right Tab 7: Risk Indicators and Factors Profile Just had a report come out their water is drinkable but did have some violations Online Feedback Survey Substance Abuse: Meth, Pharmaceuticals, Marijuana, Synthetics (K-2, Bath Salts) Wellness could be education, nutrition or access Regional sewage system in talks down 24 Highway to 63 that could improve economic development Healthy Schools Healthy Communities grant through Missouri Foundation for Health Parks and Rec sales tax up for review next year County / City classification 74

76 STRENGTHS: Good park system Health stakeholder collaboration Good community partnerships (i.e. Summer Food for Kids) School health Vaccination program at the Health Department Availability at rural health clinics Ambulance service Multiple funding sources (United Way, grants through Health Department) Churches WEAKNESSES: Working outside the community (long commute) Mental Health especially for children (access, diagnosis, placement) Dental / Vision services for Medicaid No local Cancer treatment Self-accountability for health practices Healthcare transportation Health education at middle / high schools Drug abuse (Meth, Prescription, Marijuana, Synthetics) School lunches Smoking Affordable, quality housing New health department building under construction Home Health Nursing program at MACC Hospice Access to healthcare Proximity to Columbia for additional services Primary Care Hospital YMCA Parents as Teachers Additional providers (OB, Ortho, Peds, Psych, Pulm, Sexual Assault Examiners) Economic development Teen pregnancy Uninsured (losing 2 out of 3 local health plans) Quality Nursing Homes Nutrition Breastfeeding Expand affordable outdoor recreation Education on available healthcare resources Daycare Local providers working together Physician retention 75

77 # Today: What are the strengths of our community that contribute to health? 1 Good school system 80 Environment 2 Faith-based community 81 Park 3 Rural Health Clinic - sliding scale available 82 Summer Meal # Today: What are the strengths of our community that contribute to health? 4 Primary Care access - new RCAD 83 Having health literacy for consumers 5 Growing number of specialists available at MRMC 84 Wellness education for youth 6 Community Health Needs Assessment Randolph County Health Department PSA - Strengths (Color Cards) N=42 Excellent ER engagement in improving health and wellness 85 Largest city park 7 Community leaders and school 86 Indoor fitness facilities 8 Sewer project to attract businesses 87 Walking trails 9 Home Health 88 Parents as Teachers 10 Hospice 89 Summer Food Program 11 Park systems 90 Churches - faith-based 12 Ambulance - Life Flight Services 91 Nursing program 13 Stakeholders collaboration 92 Parks and Recreation 14 School health initiatives 93 Sales tax renewal 15 Summer Meal 94 School recreation 16 Rural Clinics 95 Trail system - walkability 17 Environment 96 Parks - especially Rothwell 18 RCCC 97 Farmer's Market 19 Funding sources 98 Active coalitions of agency providers 20 Access to healthcare 99 Use NP's 21 School health - educating 100 Community partnerships - i.e. Healthy Families 22 Students - wellness 101 Nurse Practitioners 23 Nutrition 102 Parks 24 Exercise 103 Farmer's Market 25 Work together 104 YMCA 26 Park system 105 Youth activities / sports 27 Rural Health 106 ER times are low 28 Home healthcare 107 Physician ratio - doctor to patient 29 School health 108 Community investment in health 30 YMCA 109 Ambulance 31 Nursing program at MACC 110 Pharmacy 32 Trail - Rothwell Park 111 Relationship among healthcare agencies 33 Pharmacies United Way funds to RCHD for uninsured folks 112 (1,690 uninsured) 34 Ambulance 113 WIC program educates mothers / families 35 School nurses 114 Involvement of stakeholders 36 ER is statistically delivering 115 Funding sources / resources 37 Primary Care 116 Collaboration 38 Parents as Teachers 117 Rural Health / hospital 76

78 # Today: What are the strengths of our community that contribute to health? Community Health Needs Assessment Randolph County Health Department PSA - Strengths (Color Cards) N=42 # Today: What are the strengths of our community that contribute to health? 39 Park system 118 Having the conversation 40 Stakeholders 119 Walking / riding paths 41 Schools 120 Home care 42 Nursing 121 WIC 43 Environment 122 Parks 44 Summer Meal 123 Meal programs 45 Access to good food 124 Dog park 46 Access to hospitals / providers 125 People - caring community partners / churches 47 Churches 126 Wellness in schools 48 Size of community 127 Education - college 49 School nurses 128 YMCA 50 WIC program 129 Walking and riding paths 51 Nursing 130 Health Department 52 Clean environment 131 Hospital 53 Number of doctors 132 Conversation with community 54 Parks Department 133 Home care 55 Hospital / doctors 134 WIC 56 Health care choices 135 Parents as Teachers 57 Environment 136 People / groups who care enough to give help 58 Great hospital Support groups like Church community, United 137 Way, etc. 59 Great schools / education 138 Hospital / Health Department 60 Community / businesses 139 MACC hotline 61 MACC 140 Home Health 62 Hospital - involvement in community 141 Primary Care 63 Caring community 142 Wellness / education in schools 64 Good school system 143 Summer Food Program for kids 65 Vaccination / prophylaxis process 144 Wellness in schools 66 Prenatal care availability 145 Access to parks / recreation 67 Healthy Schools, Healthy Communities 146 Full-time consistent NP 68 Home Health 147 Community programs addressing obesity 69 Good opportunities for wellness 148 Parks and Recreation facilities / walking trails 70 Community working better together 149 Proximity to Columbia 71 Community truly cares 150 Good health care facilities 72 Vaccination program 151 Many restaurants have some smoke free 73 Healthy schools 152 New HD building - better service 74 Home Health 153 Schools being involved getting kids moving 75 Activity in our schools among students 154 Areas in town to exercise / park system 76 Learning to eat healthier / try new foods 155 Schools helping w/ feeding children at lower levels Close proximity to other services not available in 77 Walking / exercising / "moving" throughout the day 156 Randolph 78 Backpack program, summer feeding program 157 Smoke-free establishments 79 Work together 77

79 # Today: What are the weaknesses of our community that contribute to health? 1 Obesity 108 # Today: What are the weaknesses of our community that contribute to health? Costs of care at MRMC vs care in Columbia - availability of specialists 2 Mental Health 109 Teen births - education 3 Insurance Marketplace Fatherhood / motherhood Need more Mental Health providers 112 Obesity 6 Need more specialists in Pulmonary Apathy in their healthcare decisions - obesity 114 Smoking average 8 Drug use in schools 115 Drug use School activity slows in middle schools, essentially stops in high school Honest education about STI's, sex education, drug use No health teachers at MMS or MHS - Coaches, teachers, nurses, admin have to fill the void or bring in speakers who may or may not be adequately trained or educated, or may be afraid to speak truth because it's unpopular 9 Nursing Home care is deplorable 116 Single-parent households / poverty 10 Rural Health Clinic only Monday through Friday 117 Diabetes 11 Urgent Care doesn't follow up for complete care 118 STI's 12 Mental Health 119 Local doctors won't go to our hospital 13 Wellness education 120 No local Cancer treatment 14 Chronic disease management 121 More counselors for children 15 Child care 122 MRMC ER reputation 16 Substance abuse Housing 124 Housing - affordable 18 Number of Internists 125 Wellness - obesity, healthy eating, teen pregnancy, STI's Behavioral Health - drugs, smoking, OB care, obesity 19 Number of specialists 126 Insurance - too high cost 20 Number of Mental Health providers 127 Prevention initiatives 21 Dentists accepting Medicaid 128 Poverty 22 Improvement of water 129 Pediatrics 23 Required education for parents that have proven not to be addressing their children's needs - physical and mental Community Health Needs Assessment Randolph County Health Department PSA - Weakness (Color Cards) N= OB 24 Sidewalk on Kwix Rd 131 Children's Mental Health 25 Employment 132 MRMC reputation 26 Drug use 133 Smoke-free businesses 27 Smoking 134 Foreign language - grade school 28 Mental Health available / accessible resources 135 Education on diet - adults 29 Mental Health stigma 136 Exercise 30 Public transportation 137 Suicide - Behavioral Health 31 Smoking 138 Mental Health access 32 Drug 139 Dental access - poverty 78

80 # Community Health Needs Assessment Randolph County Health Department PSA - Weakness (Color Cards) N=42 Today: What are the weaknesses of our community that contribute to health? 33 Hypertension 140 Suicide 34 Mental Health providers 141 Suicide 35 Dentists accepting Medicaid 142 Mental Health 36 Wellness education 143 Chronic disease 37 Number of Internists 144 Poverty # Today: What are the weaknesses of our community that contribute to health? 38 Dentists accepting Medicaid 145 Smoking - more proactive against 39 Behavioral Health Suicide rate - Mental Health is offshoot 147 Peds 41 Bike / walk path 148 Psych 42 Wellness education 149 OB/GYN Community effort to promote smoking cessation - all areas 43 Public transportation 150 Drug issues, especially high school 44 Working outside county 151 Nursing Home care 45 Eye / dentists - no Medicaid 152 Mental Health care 46 Poor lifestyle choices 153 Healthy choices of food at schools without throwing away 47 Healthcare available / accessible / not a long wait 154 Access to PCP - sliding scale, low income For the poor to know about how to access healthcare Better access to Dental for uninsured and Medicaid patients 155 Diabetic screenings 156 Collaboration of healthcare / education 50 Better Mental Health services - less stigma 157 More patients to MRMC Local OB / delivery services - many can't get to Columbia City Council be supportive of smoke-free businesses 158 Self accountability to healthcare services 159 MRMC ER reputation 53 Smoking cessation 160 Access to Mental Health care 54 Improvement in Dental services available for Medicaid recipients 161 Doctors and hospital cooperation 55 Mental Health services 162 Engaged citizens - too much apathy 56 No OB services available 163 People leaving community for services 57 Smoking cessation 164 After-hours healthcare 58 Dental Information flow on insurance / Medicare / 165 Medicaid 59 Family support for single moms 166 Financial aid for access to facilities 60 Breastfeeding friendly businesses 167 Doctors who will stay long-term 61 Obesity 168 Better nursing facilities 62 Mental Health 169 No smoking community Need more collaborating physicians for incoming Mental Health provider lacking - missing certain NP's populations / after-house / weekends 64 Mental Health services for uninsured 171 Transportation 65 Dental services for uninsured 172 Dental providers 66 Prescription assistance for uninsured 173 Leaving county for work, healthcare cost in Moberly compared to Columbia 79

81 # Community Health Needs Assessment Randolph County Health Department PSA - Weakness (Color Cards) N=42 Today: What are the weaknesses of our community that contribute to health? 67 School-based health 174 1,690 uninsured # Today: What are the weaknesses of our community that contribute to health? 68 Improve access to care 175 Elderly Medicare / Medicaid knowledge / access 69 Better retention of physicians in community 176 Nursing Homes - quality No physicians at Primary Care level for consistency 70 in care 177 Smoking rates More access to fitness centers to get information 71 from consumers 178 More indoor facilities 72 Downtown 179 Teen pregnancy 73 Farmer's Market 180 Proactive about health / wellness 74 Storm water improvements 181 Resource education 75 Housing 182 Universal breakfast 76 Indoor fitness during winter 183 Expand Summer Food / after school program 77 More psychiatrists locally 184 Tobacco use - still in restaurants 78 Improve image of hospital 185 Pregnant, with kids 79 Improve services for seniors in home 186 Downtown 80 Wellness education of resources 187 Livable streets 81 Tobacco use Transportation and accessibility - expand magic city 188 route 82 SAFE / SANE providers 189 Specialists 83 AOA compliance throughout county 190 Tobacco use 84 Transportation 191 Mental Health 85 More psychiatrists 192 Diabetes 86 Education / health wellness 193 Dental 87 Medicaid / Dental services 194 Chronic health issues - Heart / CA 88 16% uninsured 195 Suicide 89 Dentists who don't take Medicaid 196 Insurance coverage 90 Keeping people local for their care 197 Cost of exercise facilities 91 Improved access to Mental Health care 198 Dental services for uninsured 92 Awareness about SAD diet 199 Adults and Medicaid 93 Training 200 OB services 94 Daycare - 41% single moms 201 Mental Health services for low income / uninsured / under-insured 95 Employment 202 Need county smoking ordinance 96 Obesity / wellness 203 Obesity 97 Mental Health / suicide 204 Employment 98 Tobacco 205 Mental Health - attitude 99 Teen pregnancy 206 Housing 100 Drugs 207 Declining population 101 Housing 208 Unemployment 102 Health - smoking 209 Attitude toward community 103 Economics 210 Housing 104 Drugs 211 Employment 80

82 # Community Health Needs Assessment Randolph County Health Department PSA - Weakness (Color Cards) N=42 Today: What are the weaknesses of our community that contribute to health? # Today: What are the weaknesses of our community that contribute to health? 105 Psychiatry 212 More counselors for children 106 Suicide prevention 213 Randolph County through ACA will be losing 2 of their providers and will be limited to 1 provider 107 Affordability of Mental Health counselors 214 Transportation - public / free 81

83 Public Notice and Invitation [VVV Consultants LLC] 82

84 MRMC, health department working to identify community health priorities Posted Aug 29, 2016 at 4:00 PM Updated Aug 29, 2016 at 4:41 PM By MI Staff Local health agencies have set out on a three-month endeavor to update the 2013 Randolph County Community Health Needs Assessment, according to a press release from a Moberly Regional Medical Center spokesperson. The Randolph County Health Department will be working with MRMC and other community health providers to update the CHNA, which identifies health-related strengths and weaknesses in communities. For Missouri Health Departments that are preparing to apply for accreditation, the Public Health Accreditation Board recommends working diligently with other providers on a Community Health Assessment and Community Health Improvement Plan, according to the news release. Area health agencies have created an online survey (found athttps:// they are encouraging all community residents to complete by Oct. 10. This work is key to determine health direction for our county, said Debra Laird, Randolph County Health Department administrator, in the press release. The local health agencies involved in this effort have retained Vince Vandehaar, M.B.A., of VVV Consultants, an independent research firm based in Olathe, Kansas, to conduct this research across Randolph County. A town hall meeting will be held on Tuesday, Oct. 18, from 11:30 a.m. to 1 p.m. at the Randolph Area YMCA. We hope that all community stakeholders will take advantage of this opportunity to provide input into the future of healthcare delivery in our community, said MRMC CEO John Dawes in the news release. The 2013 CHNA identified maternal and child health, chronic disease and access to mental health care, among others, as health priorities for Randolph County, according to the 2016 survey. 83

85 From: Debra Laird, RCHD Administrator and John Dawes, MRMC CEO Date: August 29, 2016 To: Community Leaders, Providers and Hospital Board and Staff Subject: CHNA Online Survey 2016 Randolph County Health Department is partnering with Moberly Regional Medical Center and other community health providers to update the 2013 Community Health Needs Assessment (CHNA). For Missouri Health Departments that are preparing to apply for accreditation, the Public Health Accreditation Board (PHAB) recommends working diligently with other providers on a Community Health Assessment and Community Health Improvement Plan. Your feedback and suggestions regarding community health delivery are very important to collect in order to complete the 2016 Community Health Needs Assessment and implementation plan updates. To accomplish this work, a short online survey has been developed: Please complete the survey by Monday, October 10 th, All responses are confidential. Thank you in advance for your time and support in participating with this important request. Also, please hold October 18 from 11:30-1p.m. in order to attend our CHNA Town Hall at the Randolph area YMCA. A light lunch will be provided. Sincerely, Debra Laird RCHD Administrator John Dawes MRMC CEO 84

86 PRESS RELEASE 9/21/16 For immediate release Contact: Debra Laird, Administrator, Randolph County Health Department Randolph County Health Department and Moberly Regional Medical Center to Host Community Health Needs Assessment Town Hall on Tuesday, October 18 In order to gauge the overall health needs of Randolph County, Missouri residents, Randolph County Health Department, in conjunction with the Moberly Regional Medical Center, invites the public to participate in a Community Health Needs Assessment Town Hall roundtable on Tuesday, October 18 from 11:30 to 1:00 p.m. at the Randolph area YMCA. This event is being held to identify and prioritize the health needs of Randolph County, Missouri residents. Feedback from the event will also serve to fulfill the Public Health Accreditation Board s (PHAB) Missouri Health Department accreditation application process. This Town Hall meeting will be an opportunity to review our previous CHNA, share your experiences and make suggestions to improve health care delivery within our county, said Debra Laird, Administrator, Randolph County Health Department. We encourage your attendance, as your input is very valuable to build a healthy community, added John Dawes, CEO, Moberly Regional Medical Center. A light lunch will be served. Vince Vandehaar, Principal Consultant, VVV Consultants LLC from Olathe, Kansas will facilitate this meeting. To RSVP to the Town Hall, please call (660) , Extension 3053 or use the following link: ## 85

87 From: Debra Laird, RCHD Administrator and John Dawes, MRMC CEO Date: September 26, 2016 To: Community Leaders, Providers and Hospital Board and Staff Subject: Hold the Date - Community Health Needs Assessment Town Hall, Tuesday, October 18 at 11:30 a.m. Randolph County Health Department is partnering with Moberly Regional Medical Center and other community health providers to update the 2013 Community Health Needs Assessment (CHNA). For Missouri Health Departments that are preparing to apply for accreditation, the Public Health Accreditation Board (PHAB) recommends working diligently with other providers on a Community Health Assessment and Community Health Improvement Plan. To continue this work, Randolph County Health Department and Moberly Regional Medical Center will host a Town Hall meeting on Tuesday, October 18 from 11:30-1 p.m. at the Randolph area YMCA. Please plan to attend. A light lunch will be provided starting at 11 a.m. To RSVP to the Town Hall, please call (660) , Extension 3053 or use the following link: Thank you for your consideration. 86

88 Town hall illuminates Randolph County health priorities Thursday Posted Oct 20, 2016 at 2:00 PM Updated Oct 20, 2016 at 2:39 PM By Connie Duvall, MI News Reporter A Community Health Needs Assessment town hall meeting Tuesday at the Randolph Area YMCA provided health care officials the opportunity to gather input from the public, those within various health care fields, community leadership groups, and others in an effort to understand Randolph County's health care strengths and weaknesses. Three years ago, the Community Needs Assessment identified maternal and child health, chronic disease and access to mental health care, among other issues, as health areas of focus for Randolph County. During Tuesday's town hall, areas discussed to improve or change in no particular order were local providers working together; working outside the community; affordable quality housing; mental health care (access, diagnosis and placement), especially for children; dental and vision services for Medicaid; more local cancer treatment; health education in middle and high school; physician retention; smoking, nutrition and breastfeeding; expanding affordable indoor recreation; drug use; education on available health care resources; self-accountability for health practices; economic development; teen pregnancy; the uninsured; quality nursing homes; and health care transportation. All attendees were given four dots to place beside the categories they felt need most improvement. MRMC Director of Professional Outreach Jaime Morgans said Wednesday afternoon that, once the results of the survey and town hall are known, officials will announce an action planning meeting. Tactics will be discussed on how to improve or solve those top areas of need, she said. The town hall event was sponsored by the Randolph County Health Department and MRMC. Randolph County Health Department Administrator Debra Laird said the town hall points out where health care providers need to focus their attention. Laird said she was very pleased with the town hall event. It showed that many are invested in the community, she said. The room at the YMCA filled quickly with interested parties ready to give their input. Moberly Regional Medical Center CEO John Dawes welcomed everyone and turned the floor over to Vince Vandehaar, principal consultant and owner of VVV Consultants. A PowerPoint presentation about county health rankings compiled by the Robert Wood Johnson Foundation and the University of Wisconsin Health Institute was shown. It ranked the health services of Randolph County with similar-size communities. Per capita income showed Randolph County down at $18,263 compared to the rural norm of 26 counties at $21,699. For health care, that's not good, Vandehaar pointed out. You have to have money to pay for health care, he said. 87

89 Live births in the county were also down. In 2010, there were 323. In 2014, there were 270. On the positive side, drug overdoses were down compared to other counties. The year studied showed 13 in Randolph versus the average of 16 in 17 similar counties. The same was true for alcohol-related deaths: Randolph County had 13, and similar-size counties had 34 on average. Obesity in Randolph County was up at 33 percent compared to the state average of 31 percent. The rural norm was 32.8 percent, according to the presentation. MRMC's emergency room wait time was recorded at nine minutes last week, Dawes pointed out. He said the rural norm is over 16 minutes. Each table at the town hall had a spokesperson. The tables discussed health issues, and the spokesperson offered areas of focus. Discussion began at each table and ended with a spokesperson offering areas of focus. 88

90 Randolph County health officials to develop health needs plan Friday Posted Nov 18, 2016 at 1:15 PM Updated Nov 18, 2016 at 1:15 PM By Alex Lindley, MI Managing Editor MOBERLY, Mo. After holding a town hall meeting in October to assess the health needs of Randolph County, local health officials are beginning to formulate a plan to address the needs they identified. Moberly Regional Medical Center CEO John Dawes announced Thursday in an ed communication to a list of community health partners that the Randolph County Health Department will on Dec. 1 hold a working lunch meeting to brainstorm health improvement ideas and tactics. Those efforts will focus on how to address the categories the health department and MRMC identified through the recent health needs town hall meeting and an online survey. Those categories include providers, wellness, behavioral health, smoking and dental/vision, according to Dawes. During this meeting, we will review the needs in detail, assign leads and then brainstorm on how we will address each issue, Dawes wrote. Attendees of the October health needs town hall meeting were given dots to place beside health categories that they felt needed the most improvement in Randolph County. Categories discussed during that meeting included local providers working together; working outside the community; affordable quality housing; mental health care (access, diagnosis and placement), especially for children; dental and vision services for Medicaid; more local cancer treatment; health education in middle and high school; physician retention; smoking, nutrition and breastfeeding; expanding affordable indoor recreation; drug use; education on available health care resources; self-accountability for health practices; economic development; teen pregnancy; the uninsured; quality nursing homes; and health care transportation. All of these efforts are part of the Community Health Needs Assessment. Three years ago, the previous Community Health Needs Assessment found that chronic disease, access to mental health care, and maternal and child health, among other areas, were the most in need of attention in Randolph County. Among the items noted at the most recent health needs town hall was a statistic about Randolph County's obesity rate. Vince Vandehaar, of VVV Consultants, noted in a presentation that the obesity rate in Randolph County was 33 percent, compared to the state average of 31 percent. Drug overdoses in Randolph County were down on average when compared to other counties. Compared to similar counties, which noted 16 drug overdoses on average in a single year, Randolph County recorded 13. The lunch meeting is to be held Dec. 1 from 11:30 a.m. to 1 p.m. at the Randolph County Health Department. 89

91 Detail Primary Research Primary Service Area [VVV Consultants LLC] 90

92 Methodology Community Health Needs Assessment Round #2 Community Feedback A community feedback survey was created on behalf of the CHNA client to gather primary service area stakeholder feedback on health perceptions and progress in addressing previous CHNA community needs. All community residents were encouraged to take the survey online by entering the following address into their personal browser: In addition, an invite letter was sent to all primary service area stakeholders (i.e. Schools, County, City, Clergy, Public Health Leaders). Below is a summary of public response: Randolph County Health Department (PSA) - Moberly, MO N= For reporting purposes, are you involved in or are you a...? Option C Stakeholders Round #2 Bottom 2 Boxes Randolph County N=162 Other Health Professional 7.1% 9.5% Consumers of Health Care 8.4% 8.4% Mental Health 2.9% 8.1% Civic Club / Chamber 5.0% 7.2% Education Official / Teacher 4.6% 6.7% Business / Merchant 5.9% 6.4% Hospital 11.5% 6.1% College / University 2.4% 5.8% Board Member 4.2% 5.0% Nursing 7.9% 3.9% Health Department 1.7% 3.3% Charitable Foundation 2.5% 2.8% Other (please specify) 3.6% 2.8% Farmer / Rancher 3.8% 2.5% Social Worker 1.1% 2.5% Economic Development 1.4% 2.2% Elected Official (City / County) 1.5% 2.2% Consumer Advocate 1.2% 1.9% Veteran 1.8% 1.7% Welfare / Social Service 0.8% 1.7% Case Manager / Discharge 0.7% 1.1% Clergy / Congregational Leader 1.4% 1.1% Low Income / Free Clinics 0.8% 1.1% Physician Clinic 1.3% 1.1% Dentist 0.3% 0.8% Housing / Builder 0.4% 0.8% Media (Paper, TV, Radio) 0.5% 0.8% Senior Care / Nursing Home 1.4% 0.8% Insurance 1.1% 0.6% Law Enforcement 0.6% 0.3% Pharmacy 0.4% 0.3% Physician (MD / DO) 0.9% 0.3% EMS / Emergency 1.3% 0.0% Labor 1.1% 0.0% Parent / Caregiver 8.7% 0.0% TOTAL 100.0% 100.0% 91

93 KEY - CHNA Open End Comments CODE Physician Specialty CODE Physician Specialty ALLER Allergy/Immunology ONC Oncology/Radiation Oncology AES Anesthesia/Pain OPTH Ophthalmology CARD Cardiology ORTH Orthopedics DERM Dermatology ENT Otolaryngology (ENT) EMER Emergency PATA Pathology ENDO Endocrinology PEDS Pediatrics FP Family Practice (General) PHY Physical Medicine/Rehabilitation GAS Gastroenterology PLAS Plastic/Reconstructive SUR General Surgery PSY Psychiatry GER Gerontology PUL Pulmonary HEM Hematology RAD Radiology IFD Infectious Diseases RHE Rheumatology IM Internal Medicine VAST Thoracic/Cardiovascular/Vascular NEO Neonatal/Perinatal URL Urology NEP Nephrology MDLV Mid-Level NEU Neurology SURG Surgery NEUS Neurosurgery TEL Telemedicine OBG Obstetrics/Gynecology (Delivery) KEY - CHNA Open End Comments Code Healthcare Themes Code Healthcare Themes VIO Abuse/Violence NURSE More Nurse Availability ACC Access to Care NEG Neglect AGE Aging (Senior Care/Assistance) NH Nursing Home AIR Air Quality NUTR Nutrition ALC Alcohol OBES Obesity ALT Alternative Medicine ORAL Oral Surgery ALZ Alzheimer s ORTHD Orthodontist AMB Ambulance Service OTHR Other ASLV Assisted Living OP Outpatient Services/Surgeries AUD Auditory OZON Ozone BACK Back/Spine PAIN Pain Management BD Blood Drive PARK Parking BRST Breastfeeding PHAR Pharmacy CANC Cancer DOCS Physicians CHEM Chemotherapy FLU Pneumonia / Flu KID Child Care FOOT Podiatrist CHIR Chiropractor POD Podiatrist CHRON Chronic Diseases POV Poverty CLIN Clinics (Walk-In, etc.) PNEO Prenatal 92

94 KEY - CHNA Open End Comments Code Healthcare Themes Code Healthcare Themes COMM Communication PREV Preventative Healthcare CORP Community Lead Healthcare PRIM Primary Care: CONF Confidentiality PROS Prostate DENT Dentists DOH Public Health Department DIAB Diabetes QUAL Quality of care DIAL Dialysis REC Recreation DUP Duplication of Services RESP Respiratory Disease ECON Economic Development NO Response "No Changes," etc. EMER Emergency Room SANI Sanitary Facilities EMS EMS SNUR School Nurse EYE Eye Doctor/Optometrist STD Sexually Transmitted Diseases FAC Facility SMOK Smoking FAM Family Planning Services SS Social Services FEM Female (OBG) SPEC Specialist Physician care FINA Financial Aid SPEE Speech Therapy FIT Fitness/Exercise STRK Stroke ALL General Healthcare Improvement DRUG Substance Abuse (Drugs/Rx) GEN General Practice SUIC Suicide GOV Government TPRG Teen Pregnancy HRT Heart Care THY Thyroid HIV HIV/AIDS TOB Tobacco Use HH Home Health TRAN Transportation HSP Hospice TRAU Trauma HOSP Hospital TRAV Travel MAN Hospital Management ALCU Underage Drinking INFD Infidelity INSU Uninsured/Underinsured IP Inpatient Services URG Urgent Care/After Hours Clinic LEAD Lead Exposure VACC Vaccinations BIRT Low Birth Weight VETS Veteran Care LOY Loyalty WAG Wages MAMO Mammogram WAIT Wait Times MRKT Marketing H2O Water Quality STFF Medical Staff WELL Wellness Education/Health Fair BH Mental Health Services WIC WIC Program 93

95 ID Zip Overall HC Rating c1 c2 c Good ACC BH DENT Fair ACC BH NUTR Fair ACC BH Fair ACC COLUM Are there healthcare services in Randolph County, MO that you feel need to be improved and/or changed? Access to mental health care with counseling services. Dentist that would accept Medicaid. More access to mental health services; easier access to healthy foods (as in fruits and vegetables); more collaboration between providers in the community; easier/cheaper access to fitness activities (more sidewalks, bike paths, walking trails, gym access, etc. ) More understandable/accessible services for adults with higher functioning autism such as mental health support like psychologist/psychiatrist. I really don't know. We access healthcare services in Boone County ACC DENT INSUR access to dental treatment for Medicaid Fair ACC DENT BH Ability to access dental and psychiatric for Medicaid clients Good ACC WAIT Better accessibility and less wait time Good ACC WAIT Broader range of services maintained in the home environment for more hours of the day Fair ALL Yes. Everything needs to change Fair AMB PRIM Ambulance service could be improved overall. Number of primary care physicians could be increased, since very few we have at the moment are accepting new patients Fair APPT STAFF appointments met sooner, better bed side manner Good BH ACC CARD Very Good BH COST DENT Good BH DAYCR INSUR Increased mental health access options; increased coverage of Cardiovascular services; a healthcare stakeholder focus on coordinated access, delivery, and collaboration to assure population health management in this region. Would like to see more Mental Health Professionals available. The need for reasonably priced dental care also exists. I would love to see more support for dementia patients and caregivers. Perhaps affordable daycare, non Medicaid options for respite care or assisted living maybe. Definitely more education to the community when friends/family don't realize how much work caregiving is and also that they are not "just forgetful" like all seniors. There is much more to it Good BH DOCS We could use more mental health physicians Fair BH ELDER DAYC nursing homes, elderly day care options Very Good BH OP DERM Good BH THER INSUR Good BH Fair BH Mental health Good BH psychiatric services Good CARD BH SURG CHNA Community Feedback 2016 Randolph County Health Department (Primary Service Area) N= Good CARD PEDS Cardiology, pediatrics Psychiatrist available for OP care Dermatology available Daily walk in clinic for emergent counseling needs Counseling and Mental Health, Therapy...not all of the counselors/psychologists in town take my insurance or it is not covered under insurance. As in most communities, mental health service providers needs to be expanded and/or improved. Continued focus on Cardio vascular, mental health, chronic disease, and recruitment of surgical and medical specialties Very Good CARD PULM OBG Cardiopulmonary, Gynecology Fair CARD More cardiologist in Moberly. 94

96 CHNA Community Feedback 2016 Randolph County Health Department (Primary Service Area) N=238 ID Zip Overall HC Rating c1 c2 c3 Are there healthcare services in Randolph County, MO that you feel need to be improved and/or changed? Good CLIN STAFF The clinic at the RCHD is often short staffed, which I personally feel has resulted in sub part medical care as a patient Very Good COMM More collaboration. It seems like this concept is improving but patients benefit from a healthcare system that works together. The community also benefits by keeping the dollars in the community Good COST BH affordable mental health services and counseling Poor COST CLIN RX more free clinic for BS follow-up, medication compliance Good COST COLUM Rates for services at MRMC are much higher than those in the more competitive market in Columbia, in some cases as much as triple the cost. I understand paying a little more to be treated in a rural hospital, but feeling like you're being gouged makes a person reconsider where they wish to be treated Good COST DENT OBG affordable dental care pre-natal care and delivery in Randolph County Poor COST DENT OBG More help for the low income families, dental help for the adults, more information and programs for first time mothers Fair COST DENT VIS Needs to be more low income Healthcare like dentist and vision Poor COST INSUR Poor and uninsured need health care Fair COST OBG PEDS too costly---not enough for maternity and children Fair COST Cost per visit should be lowered for people to afford to go Poor COST Free health care Fair COST Good DENT COST BH Services for the poor is still limited when you fall into a certain income range. Adult dental, medications at a low cost for those having physiological issues Good DENT COST BH Affordable Dental care. Mental health services Fair DENT DOCS INSUR Good DENT INSUR BH Fair DENT INSUR BH Good DENT INSUR IMMUN Good DENT INSUR OBG The health care in Randolph could be improved with more dentist and doctors willing to take kids that are insured by Medicaid. There is a lack of dental services for adults without dental insurance. We need dental providers that will work with low income individuals that cannot afford the full price of care. There is also a lack of mental health providers that are affordable and not faith based. We need dentists that accept Medicaid, counselors that specialize in LGBT issues, counselors who can treat people who have developmental disabilities, and expanded ER capabilities. Our hospital sends everyone on to Columbia. They do not even have basic poison control treatments available. Also, medical practitioners of all categories need to improve their comfort level in working with people who have disabilities. As a school nurse, I think the need of more dentist that will accept kids that are insured with Medicaid. Immunizations are also an area that is difficult for older students in middle school and high school to get updated and to be in compliance with the state law. The health department could help with this if an "Immunization Clinic" could be held in the area schools. Dental Services for low income, uninsured, underinsured. O.B. Services - Hospital no longer has labor & Delivery. Affordable Mental Health Services. 95

97 CHNA Community Feedback 2016 Randolph County Health Department (Primary Service Area) N=238 ID Zip Overall HC Rating c1 c2 c Fair DENT INSUR OBG Fair DENT NUTR ED Good DENT Fair DOCS COLUM EMER Fair DOCS COST BH Good DOCS WAIT Are there healthcare services in Randolph County, MO that you feel need to be improved and/or changed? there are no dental services in Moberly that accept Medicaid. There's barely any OBGYN's and not a wide variety of insurances taken. Dental, Nutrition Education, Preventative Screenings, Mental Health/Behavioral Interventions - Overall, improvement is needed in access and comprehensive and collaborative care. Dental services for those on Medicaid and without dental insurance or low income is a great need. The quantity of "quality" permanent doctors in the area is low. It appears that most individuals prefer to drive to Columbia or go to one of the Columbia clinics here. The "quality" doctors are too booked and won't take new patients. I've known people that have went to the ER for a broken bone or bad sprain and they have even been referred to a Columbia hospital because no one could treat them. local doctors need to support MRMC and visa versa low income or no income mental health help more active and stronger social services for elderly We need a better group of Family Practitioners to choose from. Our current Doctors are full or are not in the office at convenient times. 96

98 CHNA Community Feedback 2016 Randolph County Health Department (Primary Service Area) N=238 ID Zip Overall HC Rating c1 c2 c3 Throughout the past two years, did you or someone you know receive healthcare services outside of Randolph County, MO? Good ALLER ALERGY DR Good ALLER ALERGY DR Fair AMB EMER Ambulance, Emergency Room Fair AMB Ambulance services Good AUD ENT BH Audiology, ENT, Autism, Plastic Surgery, Neurology Good BH OBG mental health, maternity Very Good BH ORTHO ONC Mental Health, Orthopedics, and Oncology Fair BH ORTHO autism testing and monitoring as well as orthopedic services Fair BOONE BJC STL Boone Hospital and doctors/ BJC hospital in St Louis Fair BOONE BJC STL Boone Hospital and doctors/ BJC hospital in St Louis Fair BOONE BJC STL Boone Hospital and doctors/ BJC hospital in St Louis Good BOONE COLUM Boone hospital. Columbia special Doctor Poor BOONE Boone Co Good BOONE Boone Hospital Good CANC ORTHO cancer treatment, knee replacement Fair CANC SPEC Cancer Treatment and other specialty care Fair CANC SURG MAMM cancer treatment, surgery, 3d mammography Fair CANC SURG NEUR cancer treatment - surgeries - blackout / seizures Good CARD OBG Open heart surgery, and high risk pregnancy Fair CARD ORTHO ENDO too numerous to list all. heart, back, endo Very Good CARD SURG heart surgery Good CARD Cardiologist Fair CARD heart and vascular services Good CARD pacemaker/defibrillator implanted Fair CARD Referral to doctor to have a pacemaker put in Very Good CARD Serious heart issues Fair CHEMO COLUM Chemo therapy in Columbia Fair CLIN FP LAB physician clinic visit with all specialties and family practice, lab, hospital services both in-pt and out-pt, radiology, wound healing, psychiatric services Good COLON ORTHO SPEC Colonoscopy, and orthopedic specialist 97

99 CHNA Community Feedback 2016 Randolph County Health Department (Primary Service Area) N=238 ID Zip Overall HC Rating c1 c2 c3 Throughout the past two years, did you or someone you know receive healthcare services outside of Randolph County, MO? Good ALLER ALERGY DR Fair COLUM MAC Columbia, Macon Good COLUM MU Columbia-University Hospital Fair COLUM All realms of service completed in Columbia Poor DENT OBG BH dental, ob-gyn, mental health Good DENT OBG Dentistry, well-women visits Good DEWNT DERM ORTHO dentist -derm- ortho Fair DOCS EMER Dr's appointments, some emergency issues Good DOCS LAB TEST doctors, labs, hospital tests Fair EMER CANC SURG Emergency services, multiple cancer surgeries, radiation and chemical therapy, cardiac care Fair EMER CARD PULM ER, cardiology,pulmonologist Good EMER COLON PRIM emergency room, colonoscopy, annual check up Good EMER IP ER, AND HOSP Good EMER Emergency Room Fair EMER ER Very Good EMER ER Good ENDO COLUM I, personally, see an endocrinologist in the Columbia area because the specialty is not offered in Randolph County Good ENDO SPEC ORTHO Endocrinology Specialists, Orthopedic Specialists Good ENT URG DENT ENT, Urgent Care, Dental Fair GAS FP OBG Gastroenterology, General Practice, Well Woman Exam, Cataract Surgery, Vascular Surgery, Cardiology, Pediatric care and more Fair GI ORTHO GI, Ortho Good IMMUN Shots Fair IP ORTH COLON Repeated hospitalizations related to a chronic illness, orthodontic care, colonoscopy, allergy testing Good IP PULM inpatient hospitalization/ pulmonary services Fair IP SPEC PEDS Hospitalization, specialty care, pediatric services, surgery Good IP SURG DENT hospitalization, surgery, dental, vision Good IP Hospital stay Fair IP Hospitalization Good IP Impatient Services 98

100 CHNA Community Feedback 2016 Randolph County Health Department (Primary Service Area) N=238 ID Zip Overall HC Rating c1 c2 c3 Throughout the past two years, did you or someone you know receive healthcare services outside of Randolph County, MO? Good ALLER ALERGY DR Good MAMM DENT OBG Mammogram, dental surgery, women's health, neurosurgery Fair MCA Missouri Cancer Associates Good MU CARD NEUR University of Missouri Hospital--cardiology, neurology, respiratory Good NEP nephrology Good NEUR PAIN BH Neurology, Pain Management, Mental Health, Orthopedic/Back Fair NEUR SURG CARD Neurosurgeon, Neurologist, Cardiologist Fair OBG BH EMER Good OBG BH FP pre/post-natal care, mental/behavioral services, emergency services, surgery - heart/orthopedic, primary services, dental services, oncology Women's services, mental health, general practitioner, dentist, orthopedic, Fair OBG BOONE I had my baby at Boone Hospital Good OBG BOONE Ob/Gym-delivery of a baby to Boone County Poor OBG CHIRO PEDS Ob/gyn, chiropractic, pediatric wellness, pediatric acute care, ENT, cardiac Good OBG COLUM my nephew was born in Columbia Good OBG COLUM OB resources in Columbia Poor OBG COLUM Prenatal care and deliveries of newborns in Columbia, mo Good OBG EMER OB/ GYN; E.R Good OBG EMER Wife and it was an OBGYN emergency issue Good OBG OB services Fair OBG Various services including OBGYN Good OBG Women's health Good OBG Women's health Fair OBG Women's Health Good OP ORTHO outpatient discectomy Fair OPT FP CANC Eye doctor, general health and cancer Good OPT OBG Outpatient services and child birth Good OPT OPH PEDS Eye specialist for macular degeneration. Pediatric services Very Good OPT eye care Fair ORTHO OBG MAMM Orthopedic, Women Checks, Mammograms, Medical, Surgery, etc Fair ORTHO OBG POD Orthopedic, gynecology, podiatry, dermatology. 99

101 CHNA Community Feedback 2016 Randolph County Health Department (Primary Service Area) N=238 ID Zip Overall HC Rating c1 c2 c3 Throughout the past two years, did you or someone you know receive healthcare services outside of Randolph County, MO? Good ALLER ALERGY DR Fair ORTHO SURG CARD ortho surgery, cardiac services Good ORTHO SURG CARD Shoulder surgery. Cardiac care. Gym services Very Good ORTHO SURG back surgery Good ORTHO SURG orthopedic surgery Good ORTHO VIS DENT orthopedic, vision, dental 100

102 Community Health Needs Assessment Randolph County (MO) Health Department Let Your Voice Be Heard! Randolph County Health Department, in collaboration with Moberly Regional Medical Center, is updating its 2013 Community Health Needs Assessment (CHNA). Your feedback from this survey will help us identify the current health issues in our community and while your participation is voluntary, we would greatly appreciate your input. All answers will be kept confidential. All 2016 Community Health Needs Assessment feedback is due by Monday, October 10, Thank you for your participation. Community Health Needs Assessment Randolph County (MO) Health Department Part I: Introduction 1. Three years ago, Randolph County Health Department completed a Community Health Needs Assessment (CHNA). This assessment identified a number of health needs for our community. Today, we are updating this assessment and would like to know how you rate the "Overall Quality" of healthcare delivery in our community? Very Good Good Fair Poor Very Poor Health Rating: Community Health Needs Assessment Randolph County (MO) Health Department 2. Are there healthcare services in Randolph County, MO that you feel need to be improved and/or changed? (Please be specific.) Community Health Needs Assessment Randolph County (MO) Health Department 101

103 3. From our last CHNA (2013), a number of health needs were identified as priorities. Are any of these 2013 CHNA needs still an Ongoing Problem" in Randolph County, MO? Not a Problem Anymore Somewhat of a Problem Major Problem Chronic Disease Maternal / Child Health Mental Health Access Community Health Needs Assessment Randolph County (MO) Health Department 4. How would you rate each of the following services offered in Randolph County, MO? (Please select one box per row.) Ambulance Services Child Care Chiropractors Dentists Emergency Room Eye Doctor / Optometrist Family Planning Services Home Health Hospice Very Good Good Fair Poor Very Poor N/A Community Health Needs Assessment Randolph County (MO) Health Department 102

104 5. How would you rate each of the following services offered in Randolph County, MO? (Please select one per row.) Inpatient Services Mental Health Services Nursing Home Outpatient Services Pharmacy Primary Care Public Health Department School Nurse Specialists Very Good Good Fair Poor Very Poor N/A Community Health Needs Assessment Randolph County (MO) Health Department 6. In your own words, what is the general community perception of healthcare providers (i.e. Health Department, Hospital, Doctors, etc.) serving Randolph County, MO residents? Community Health Needs Assessment Randolph County (MO) Health Department 7. Throughout the past two years, did you or someone you know receive healthcare services outside of Randolph County, MO? Yes Don't Know No If yes, please specify the healthcare services received. 103

105 Community Health Needs Assessment Randolph County (MO) Health Department 8. Are there any other health needs from the list below that need to be discussed at our upcoming CHNA Town Hall meeting? (Please select top three that need to be on our agenda.) Abuse / Violence Alcohol Cancer Diabetes Drugs / Substance Abuse Family Planning Heart Disease Lead Exposure Mental Illness Nutrition Obesity Ozone (Air) Physical Exercise Poverty Respiratory Disease Sexually Transmitted Diseases Suicide Teen Pregnancy Tobacco Use Vaccinations Water Quality Wellness Education Other (please specify) Community Health Needs Assessment Randolph County (MO) Health Department * 9. What is your home zip code? Community Health Needs Assessment Randolph County (MO) Health Department Demographics 104

106 10. For reporting purposes, are you involved in or are you a...? (Please select all that apply.) Board Member Business / Merchant Case Manager / Discharge Planner Civic Club / Chamber Charitable Foundation Clergy / Congregational Leader College / University Consumer Advocate Consumers of Healthcare Dentist Economic Development Education Official / Teacher Elected Official - City / County EMS / Emergency Farmer / Rancher Health Department Hospital Housing / Builder Insurance Labor Law Enforcement Low Income / Free Clinics Mental Health Nursing Other Health Professional Parent / Caregiver Pharmacy Physician (MD / DO) Physician Clinic Media (Paper, TV, Radio) Senior Care / Nursing Home Social Worker Veteran Welfare / Social Service Other (please specify) Community Health Needs Assessment Randolph County (MO) Health Department You have just completed the Community Health Needs Assessment Survey. Thank you for your participation. By selecting "Done," you are submitting your responses and giving others an opportunity to complete the same survey. Again, thank you for your participation. 105

107 CHNA Report Contact : Vince Vandehaar, MBA VVV Consultants LLC Adjunct Professor / Professional Healthcare Marketing and Strategic Planning Consulting Services 601 N Mahaffie, Olathe, KS (913) (C) VVV@VandehaarMarketing.com LinkedIn: vandehaar Website: VandehaarMarketing.com 106