Harris County Community Assessment

Transcription

1 Harris County Community Assessment 2004

2 Harris County Hospital District Community Assessment 2004 I. Summary 2 II. Presentation of Data 7 III. Harris County Community Health Survey 47 a. Survey 48 b. Overall Summary 52 c. Sectioned by Zipcode/Community Health Center 56 i. Acres Home Community Health Center ii. Aldine Community Health Center iii. Baytown Community Health Center iv. Casa de Amigos Community Health Center v. Gulfgate Community Health Center vi. Martin Luther King Community Health Center vii. Northwest Community Health Center viii. Peoples Community Health Center ix. Settegast Community Health Center x. E.A. Squatty Lyons Community Health Center xi. Strawberry Community Health Center IV. Statistical Review of HCHD Community Health Center Patient Population 100 a. FY2004 Top 10 Diagnostic Categories per CHC 101 b. Multiple Years Statistics Race of Patients Obtaining Services from the HCHD Community Health Program Age of Patients Obtaining Services from the HCHD Community Health Program Zipcode of Patients Obtaining Services from the HCHD Community Health Program Adult, Pediatric, and Dental Visits to Physicians/Dentists in the HCHD Community Health Program and School Based Clinics 1. FY FY FY Harris County Hospital District Page 1 of Community Assessment

3 Harris County Hospital District Community Assessment 2004 The Harris County Hospital District delivers healthcare services that are designed to improve the community s health. Evaluating our success in fulfilling this mission, the Hospital District seeks measures to reflect the impact of our services on the community s health. The annual community assessment enables the Hospital District to analyze national, state, and local data and evaluate the changes in health status over time. We partner with the community in improving the public s health by seeking Harris County leader, community member, and business owner evaluation of the health status of the community. The District s annual community assessment contains a socioeconomic and demographic description of our service area, a description of the service area s health status, an analysis of the demographics of the individuals we serve, an assessment of the service area s existing health care resources, and a survey of the community service area. This report shares highlights from the 2004 Harris County Hospital District Community Assessment. The Hospital District s community assessment consists of three major parts: o Greater Houston Community Health Needs Assessment which analyzes the available health data for Harris County, Fort Bend County, and Montgomery County against national and state data. o Harris County Community Health Survey which analyzes the survey response of Harris County leaders, community members, and business owners. o Statistical review of the demographics of the population served and the service area. County growth projections continue to predict that Harris County will reach a population of 4.5 million in The major growth is expected to be outside the inner city toward the periphery of Harris County. Trends by race/ethnicity continue to predict that in 2020 Harris County will be 48% Hispanic origin; 28% White; 16% Black; and 8% Other (e.g. Asian descent, American Indian). Unemployment has risen significantly, reaching 7.0% in Harris County. Counties within the area are experiencing unemployment at higher levels with Brazoria at 8.9%, Galveston 8.2%, and Liberty 10.4%. The household income Harris County Hospital District Page 2 of Community Assessment

4 in Harris County rose in 2003 with the number of households whose income is under $50,000 declining to 52% from 59% in Households with income less than $25,000 are predominately located in the inner city and eastern sections of the county. The number of insured individuals under 65 remains low, with Harris County reporting only 77% of its under 65 population having health insurance coverage in With the recent changes in CHIP and Medicaid, the number of insured individuals under 65 has decreased significantly since Major findings in this assessment related to health status include a general decline in the number of Tuberculosis cases to 11.9 per 100,000. The County still has work to reach the Healthy People 2010 Target of 1 case per 100,000. Houston s immunization rate lags behind the nation. Even with significant improvement, only 64% of Houston s children months were properly immunized in accordance with the 4:3:1:3 series of immunizations in New AIDS cases are phenomenally high in Harris County with 92 new cases per 100,000 as compared to the state s new AIDS cases at 9 per 100,000. This rate is significantly higher than 2002 s 58.4 new cases per 100,000 and is believed to be related to a lag in reporting. Age-adjusted mortality from heart disease remains high. The age-adjusted mortality from Diabetes continues to be lower than the Healthy People 2010 target of 45 per 100,000. The ageadjusted death rate from accidents is climbing in Harris County and Texas. The leading causes of mortality by age are attached. The absolute number of deaths in Harris County for age ranges 0-14 has been declining while the population is increasing evidence of a true decline in mortality rates. Significant declines in the number of accident-related deaths occurred in the age range of 5-14 while rising steadily in the age range of Cardiovascular disease and neoplasms remain the leading cause of death of Harris County residents as they age. Across Harris County there have been changes in zip code clusters in the rates of diseases, homicides, and other indicators of health. In general the county s health has deteriorated over the 12 focus areas with major declines related to cardiovascular disease and diabetes. The Medical Center and Memorial Park zip code clusters have health care status ratings that are well below average. Harris County Hospital District Page 3 of Community Assessment

5 Residents of Harris County still exhibit behaviors that increase their risk for disease and illness. Estimates of the population s risk factors indicate that 20% of Harris County residents smoke, 36% are overweight, and 80% do not exercise. In relation to pregnant Houstonians, 48% have less than 12 years education, 16% have late or no prenatal care, and 5% smoked during pregnancy. Only 80% of pregnant women in Harris County received prenatal care in the first trimester in Infant mortality for African American children continues to increase, reaching a statewide high of 13.5 per 1,000 births. As a bellwether indicator of public health, Harris County s increase in infant mortality for the first time since 1990 send a very strong message about the state of the public s health. 1 The Harris County community of uninsured/underinsured is served by a wide variety of public, non-profit, and community based providers distributed primarily in the central section of Harris County. The Harris County Hospital District (HCHD) is the largest provider of services to the un/underinsured. The Hospital District is the fourth largest public metropolitan hospital system in the United States according to admissions, and accommodates 16% of the area s Emergency Department visits 2 and 18% of the area s outpatient visits 3. HCHD provides a wide range of services, and is predominately funded by tax revenues, patient revenue, and DSH/UPL funding. Utilization of the Hospital District s services are constrained by physical limitations, but have shown modest growth in the areas of patient admissions, births, and outpatient community health center and specialty clinic visits. The greatest utilization of outpatient services is among adults with a 29% increase in the number of CHP patients aged from FY2002 to FY2004. The increase in the year olds is 25% male and 31% female and is related in part to the reduction in prenatal services for low income women across the community. The Community Health Centers are seeing a significant increase in the Hispanic population using the services of the Health Centers with a 30% increase bringing the number of unduplicated Hispanic patients to more than 95,000. The number of physician visits continues to increase. 1 Barbara McCormick President-Houston s Children@Risk, Houston Chronicle, 10/29/ Based on the Market Share of the primary Emergency Room providers in Harris County (HCHD, Christus, Memorial Hermann, Methodist, St. Luke s Episcopal, and Texas Children s) 3 Based on the Market Share of the primary hospital outpatient providers in Harris County (HCHD, Christus, Memorial Hermann, Methodist, St. Luke s Episcopal, and Texas Children s) Harris County Hospital District Page 4 of Community Assessment

6 The greatest percentage of hospital utilization across the nation has been for individuals 65+. The utilization of healthcare services in terms of hospital admissions and patient days are projected to continue to increase, with circulatory diseases and deliveries as the top diagnosis for hospitalized patients. There is a worsening environment for healthcare with the growth in the uninsured population, economic uncertainty in relation to governmental funding, staff shortages in numerous healthcare professions, and restrictions on the hours that medical residents may deliver care. The Hospital District s current capacity has been virtually unchanged since the early 1990s. The Harris County population currently includes 830,000 uninsured individuals, and the county population is expected to grow 1.5% per year for the next 12 years. Today the Hospital District can provide healthcare services for approximately 23% of the County s uninsured. To reach 43% of the uninsured in FY2015, HCHD must serve 489,000 unique patients (insured and uninsured) and increase the number of community health center visits to 1,067,000, emergency center visits to 279,000, specialty clinic visits to 564,000, and inpatient discharges to 56,000. The total Harris County demand for health care services will require a doubling of the Hospital District s capacity. A strategic plan has been developed and is serving as a framework for responding to the community s needs. The plan recommends adding an additional 200 hospital beds, doubling the capacity of community-based primary and preventive care, and adding significant capacity in specialty clinic facilities to meet increased demand and existing congestion. Current capacity limitations have resulted in a healthcare system with gaps in services that is undersized to meet the needs of the community. There are lengthy waits for primary care appointments and specialty care services. The time from entry to the ER to discharge is approximately 6.5 hours, and the length of a primary care appointment is 2.2 hours. Access to care is limited by inefficient, overcrowded, and undersized facilities. Trauma Centers are on diversion 30% of the time, causing ambulances to be turned away as hospitals are at capacity. Between patients/1000 leave the emergency room without treatment, and 13 patients/1000 leave the emergency room against medical advice. The Harris County Community Health Survey was completed by 2,433 respondents ranging from of years. Seventy-two percent of the Harris County Hospital District Page 5 of Community Assessment

7 respondents were women, 33% used Hospital District services, 38% spoke Spanish, 44% spoke English, 13% spoke Vietnamese, and 3% spoke a language other than Spanish, English, or Vietnamese. Thirty nine percent of the respondents stated they did not have a primary care physician/primary health care provider, and 16% felt they had been denied healthcare they thought they needed. The majority of the respondents felt the community s health was OK (the 2.13 mean score is exactly the same mean score of FY2003 and an insignificant increase from FY2002 s survey s mean score of 2.03). Health issues from the community s perspective did not change significantly from the FY2003 survey. In FY2003, Health Insurance jumped to the number one issue from number six while Diabetes fell from the number one issue to number three. They remain at these rankings in FY2004. Tobacco/Drugs/Alcohol remain as issue number two while Stress/Depression and Nutrition/Exercise rose to rankings four and five. Heart Disease/Stroke dropped from the number two issue in FY2002 to number four in FY2003 and number six in FY2004. Respondents cited five primary reasons for not using Hospital District Services: Eligibility 45% (down from 49% in FY2003); Can t get Appointment 24% (16%); Services not Offered 23% (26%); Transportation 16% (17%); and Hours of Operation 10% (11%). Additional information in the community survey provides insight into the community s preferred hours and days of operation, where medical care is received when low-income patients aren t using the HCHD, and the community s suggestions for improving the community s health. Harris County Hospital District Page 6 of Community Assessment

8 Community Assessment 2004 The Harris County Population 7

9 Harris County Population 5,000,000 4,541,661 4,500,000 4,000,000 3,500,000 3,400,578 3,508,888 3,674,011 3,951,682 4,240,026 3,000, Source: Texas State Data Center, December, Population Growth, %Change Montgomery County Outline Harris County Montgomery County Fort Bend County Fort Bend 31.3% to 32.0% 32.0% to 35.2% Harris County 35.2% to 43.7% 43.7% to 60.0% Harris -1.4% to 4.9% 4.9% to 8.0% 8.0% to 11.5% 11.5% to 21.7% Montgomery 16.1% to 21.2% Fort Bend County 0 Miles % to 22.2% 22.2% to 25.3% 25.3% to 47.1% Source: ERSI/CACI Demographics 16 8

10 Harris County Population Trends by Race/Ethnicity 100% 80% 60% 40% 20% 0% 4% 6% 6% 7% 8% 23% 26% 33% 19% 20% 41% 48% 19% 18% 16% 54% 50% 43% 35% 28% White Black Hispanic Origin Other (e.g. Asian, American Indian) Source: U.S. Census Bureau, Texas State Data Center. Note: based on 1990 U.S. Census; based on one-half migration scenario of TSDC Population Estimates and Projections Program. 17 Unemployment Trends Selected Counties % Unemployment 8% 7% 6% 5% 4% 3% 2% 1% 0% Harris Montgomery Fort Bend Texas Source: Texas Employment Security Commission 18 9

11 Households by Income Category, Harris County % Households 35% 30% 25% 20% 15% 10% 5% 0% 29% 28% 28% 24% 31% 32% 31% 28% 28% 30% 28% 29% 7% 8% 8% 12% 4% 4% 5% 7% <$25 $25-49 $50-99 $ $ Harris County Median HH Income 1997: $39, : $41, : $40, : $51,136 Source: ERSI/CACI Demographics Number of Households with Income <$25,000 Montgomery County Outline Harris County Montgomery County Fort Bend County Fort Bend 107 to to 1,021 Harris County 1,021 to 2,131 2,131 to 3,226 Harris 34 to 1,402 1,402 to 2,130 2,130 to 3,780 3,780 to 8,911 Montgomery 202 to 657 Fort Bend County 0 Miles to 1,053 1,053 to 1,379 1,379 to 3,362 Source: ERSI/CACI Demographics 20 10

12 Persons < 65 with Health Insurance Coverage % Insured 100% 95% 90% 85% 80% 75% 70% 65% 60% Healthy People 2010 Target U.S. Total U.S. Black U.S. Hispanic Harris County Source: Healthy People 2010; U.S. Census Population Survey Health Status 11

13 Tuberculosis Cases/100,000 Number Cases/100, Healthy People 2010 Target U.S. Total U.S. Black U.S. Hispanic Texas Total Harris Source: Health, U.S., Texas Department of Health. 4:3:1:3 Immunizations, Children Months 90% 85% Healthy People 2010 Target % Immunized 80% 75% 70% 65% 60% U.S. Texas Houston Source: CDC National Immunization Survey 24 12

14 New AIDS Cases/100,000 Number Cases/100, Healthy People 2010 Target Texas Harris US Source: Health, U.S., Texas Department of Health, CDC. Note1: A backlog in case reporting artificially inflated growth rates. Heart Disease Age-Adjusted Adjusted Heart Disease Deaths 300 Number of Deaths/100, Texas Harris County US Healthy People 2010 Target Source: Texas Department of Health; Healthy People 2000, Healthy People

15 Diabetes Age-Adjusted Adjusted Death Rate Number of Deaths/100, Texas Harris County US Healthy People 2010 Target Source: Texas Department of Health; CDC; Healthy People 2000, Healthy People Injury/Violence Prevention Age-Adjusted Adjusted Accident Death Rate Number of Deaths/100, Healthy People 2000 Target Healthy People 2010 Target Source: Texas Department of Health; Healthy People 2000, Healthy People Texas Harris County US 14

16 Mortality by Leading Cause Harris County, Age Number of Deaths Source: Texas Department of Health Perinatal Congenital Ill-Defined Mortality by Leading Cause Harris County, Age Number of Deaths Accidents Neoplasms Homicides Source: Texas Department of Health 15

17 Mortality by Leading Cause Harris County, Age Number of Deaths Homicides Accidents Suicides Source: Texas Department of Health Mortality by Leading Cause Harris County, Age Number of Deaths HIV/Other Infect Neoplasms Accidents Source: Texas Department of Health 16

18 Mortality by Leading Cause Harris County, Age Number of Deaths Source: Texas Department of Health Neoplasms Cardio- vascular Ill-Defined Mortality by Leading Cause Harris County, Age 65+ Number of Deaths Cardio- vascular Neoplasms Ill-Defined Source: Texas Department of Health 17

19 Harris County Clusters Layers Harris Zip Codes Bellaire Galleria Hwy 6 Cypress Katy Kingwood Medical Center NE Harris SE Harris Miles Memorial Park Source: ERSI/CACI Demographics Focus Area/Objective Zipcode Cluster Comparison to Harris County Average Katy Bellaire Galleria Cypress Kingwood Med Cen Mem Park NE Har SE Har Cancer Diabetes 18.9 Cirrhosis 9.2 Heart Disease Cerebrovascular 38.9 HIV 9.0 Homicide 10.1 Accident 16.0 Suicides 10.7 Prenatal Care 78.9 Low Birth Wt 7.9 Teen Preg. 0.0 Har Avg Source: Healthy People 2010; Texas Department of Health Better than Average About Average Poorer than Average Well Below Average Improving Worsening 36 18

20 Health Behaviors Risky Behavior, Harris County % 80% % of Population 70% 60% 50% 40% 30% 20% 10% 0% Smoking Overweight No Exercise Source: BRFSS, Office of Information and Analysis. 19

21 Pregnancy Risk Factors % of Pregnant Women 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Teens Less Than 12 Years Education Late/No Prenatal Care Smoked During Pregnancy Source: Kids Count 2002 Houston Austin Dallas Ft. Worth El Paso San Antonio Prenatal Care in the First Trimester % of Pregnant Women 100% 95% 90% 85% 80% 75% 70% 65% 60% Healthy People 2010 Target U.S. Total U.S. Black U.S. Hispanic Texas Harris County Source: Healthy People 2010; U.S. Census Population Survey 20

22 Infant Mortality Infant Deaths/1000 Live Births Healthy People 2010 Target U.S. Total Texas Black Texas Harris County Infant Mortality: Ratio of Infant Deaths under 1 yr/1000 Live Births Source: Healthy People 2010; Health, U.S.; Texas Dept of Health Healthcare Delivery Throughout Harris County 21

23 Un/Underinsured HealthCare Services Harris County Hospital District Health Centers HCHD or District Harris County Public Health & Environmental Services Health Centers County City of Houston Department of Health & Human Services Health Centers City Independent Non-Profit Clinics Community School-Based Clinics Teen Clinics Mental Health & Mental Retardation Authority Clinics MHMRA 44 22

24 Annual Visits in Thousands ,626 HCHD 191,517 City Patient Visits 150, ,252 County Community 50,000 School-Based 16,614 Teen NOTE: Most clinics count visits, not unique patients Source: Gateway to Care; Phone Surveys to individual clinics Harris County Hospital District The fourth largest public metropolitan hospital system in the U.S., with More than 50,000 annual admissions More than 750,000 annual outpatient visits About 11,000 births a year More than 168,000 annual ER visits 46 23

25 Market Share of Selected Harris County Hospitals Total ED Visits, 1991, 1996, % 20.0% 10.0% 0.0% 12.3% 20.1% 16.0% BTGH & LBJ % 4.1% 3.0% Christus - St. Joe's 21.2% 18.5% 17.4% 5.9% 6.4% 2.9% 2.4% 2.4% 4.3% 2.1% 2.3% 2.2% Mem'l Hermann Methodist St. Luke's Texas Children's ED visits to Harris County 1991 hospitals, overall, 1996 increased % from 853,968 in 1991 to 1,172,622 in The hospitals in the graph represent 45% of total in 1991 and 51% of the total in Selected hospitals in Harris County presented in graph based on overall volume, location, and trend over the period. 2 Combined in the source data. Source Data Obtained From: Texas Department of health, Market Share of Selected Harris County Hospitals Outpatient Visits, 1991, 1996, % 20.0% 10.0% 0.0% 18.9% 18.0% 14.9% 9.9% 9.1% 7.1% 7.9% 8.2% 8.4% 6.2% 7.3% 4.9% 4.2% 4.9% 1.3% 2.4% 4.1% 2.5% BTGH & LBJ (2) Christus - St. Joe's Mem'l Hermann Methodist St. Luke's Texas Children's OP visits to Harris County hospitals, overall, increased 122.8% from 1.7 million in 1991 to 3.9 million in The hospitals in the graph represent 36% of total in 1991 and 50% of the total in (1) Selected hospitals in Harris County presented in graph based on overall volume, location, and trend over the period. (2) Combined in the source data. Source Data Obtained From: Texas Department of health,

26 Range of Services The Harris County Hospital District offers specialized health care services ranging from infant and childhood immunizations, through maternity and adult care, to rehabilitation and geriatric services. The Hospital District does not offer organ transplant services or a full range of dialysis, and has limitations on selected medical specialties. 49 HCHD Sources of Revenues, FY2005 DSH/UPL 15% Tobacco Rev 1% Other/ Interest 2% $753.6 million Patient Rev 34% Tax Rev 48% Patient Rev Tax Rev Tobacco Rev DSH/UPL Other/Interest 50 25

27 Utilization of District Services 51 HCHD Hospital Admissions ,014 52,921 49,233 49,543 43,588 41,384 39,087 31,746 34, FY76 FY80 FY85 FY90 FY95 FY00 FY02 FY03 FY 04 FY2004 unaudited Admissions (excluding newborns) 26

28 HCHD Emergency Room Visits 200, , , , , ,000 80,000 60,000 40,000 20, ,986 90,194 90,689 81, , , , , ,249 FY76 FY80 FY85 FY90 FY95 FY00 FY02 FY03 FY04 Emergency Room Visits Newborns 20,000 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2, ,976 15,444 13,390 11,280 9,752 10,097 10,849 10,494 10,776 FY76 FY80 FY85 FY90 FY95 FY00 FY02 FY 03 FY 04 Newborns 27

29 HCHD Outpatient Specialty Clinic Visits , , , ,703 FY76 FY80 FY85 FY90 FY95 FY00 FY02 FY03 HCHD Specialty Clinic Visits HCHD Community Health Program (CHP) Outpatient Clinic Visits 600, , , , , , , , , , , , , ,000 0 FY76 FY80 FY85 FY90 FY95 FY00 FY02 FY03 HCHD CHP Visits 28

30 70,000 Unduplicated Patients by Age 60,000 50,000 40,000 30,000 20,000 FY02 FY03 FY04 10, % Change Unduplicated CHP Patients by Age FY 02 to FY04 35% 30% 29% 25% 20% 15% 17% 21% 19% 19% % Change FY02-FY04 10% 5% 0%

31 % Change Unduplicated CHP Patients by Age/Sex FY02 to FY04 35% 30% 25% 20% 15% 17% 17% 20% 21% 25% 31% 24% 16% 21% 18% Male Female 10% 5% 0% , ,000 Unduplicated CHP Patients by Race 80,000 60,000 40,000 FY02 FY03 FY04 20,000 0 Hispanic White Black Asian Descent Other 60 30

32 % Change Unduplicated CHP Patients by Race FY 02 to FY 04 40% 35% 30% 25% 20% 15% 10% 5% 0% 30% 12% 13% 24% 34% 18% % Change FY02 - FY04 Hispanic White Black Asian Descent Indian Other 61 CHP Outpatient Visits Acres Aldine Baytown Casa MLK NW People Gulfgate Settegast Squatty Strawberry 3/01-2/02 3/02-2/03 3/03-2/

33 % Change Outpatient CHP Visits FY 02 FY 04 40% 35% 30% 25% 20% 15% 10% 5% 0% Acres Aldine Baytown Casa MLK NW People Gulfgate Settegast Squatty Strawberry 63 Health Care Utilization 32

34 Health Care Utilization by Patient Age U.S Percent of Total 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 24% 47% 39% 26% 22% 22% 32% 24% 31% 7% 17% 8% Days Office Visits Discharges Source: National Center for Health Statistics, National Hospital Discharge Survey and National Ambulatory Medical Care Survey, U.S. Utilization Trends Discharges in Millions High Forecast Low Forecast Proj Patient Days in Millions Admissions Source: NCHS, National Hospital Discharge Survey, 2002; The Advisory Board Patient Days 33

35 Projected Harris County Discharges by Clinical Service Line 2008 Clinical Service Line 586,000 discharges anticipated Total Circulatory System Diseases 17.0% Deliveries 15.6% Respiratory 10.1% Digestive 9.8% Injuries and Poisonings 8.0% Mental Health 8.0% Genitourinary 5.3% Neoplasm 4.9% Orthopedic 5.0% Endocrine 4.7% Source: Greater Houston 2004 Community Health Needs Assessment Worsening Environment for Healthcare Significant growth in uninsured population will increase demand for services and further strain limited resources Economic uncertainty and state/federal costcutting measures will lead to reductions in public health, Medicaid, and disproportionate share funding Staff shortages will increase competition for qualified professional staff Restrictions on medical residents will limit the number of hours they can deliver care 68 34

36 Capacity Requirements Population Growth & Healthcare Capacity Harris County Population in Thousands 5,000 4,500 4,000 3,500 3,000 2,500 2,000 1,500 1, HCHD Total Square Feet in Thousands Source: HCHD Corporate Communications, Planning; U.S. Census Bureau, Texas State Data Center 35

37 2003 Harris County Population Uninsured Medicaid Medicare Private (1) Total # 830, , , M 3.6 M % 23% 7% 7% 63% Harris County population is projected to grow at about 1.5% per year, to 4.3 million in 2015 (1) Private is all other insured (e.g., commercial, managed care, worker s comp, etc.) 71 Estimated Population-Based Use Rates Harris County 2003 Category Use Rates Per 1,000 Population Overall Uninsured Physician Office Visits ED Visits Hospital Clinic Visits Inpatient Discharges 3, , Use rates by category and by payor (Medicaid, Medicare, Private, Uninsured) are applied to population to determine total Harris County demand 72 36

38 Estimated 2003 HCHD Market Share within Harris County * Category Overall Market Share Uninsured Physician Office Visits ED Visits Hospital Clinic Visits Inpatient Discharges 3.6% 14.0% 23.8% 8.4% 23.1% 35.0% 36.7% 35.7% * Based on HCHD FY2003 volumes. 73 Demand in the Year 2015 Service Total Volume FY03 FY15 Community Health Center Visits Emergency Center Visits Specialty Clinic Visits Inpatient Discharges 423, , ,000 36,000 1,067, , ,000 56,000 Total Volume 941,000 1,966,000 HCHD will be able to serve 494,000 patients in the year 2015, up 92% from 2003 if HCHD 2015 is implemented. Uninsured served will from 23% to 43%

39 New and Expanded Facilities are Required HCHD should build a new 200-bed hospital outside the Texas Medical Center, to increase visibility and accessibility of inpatient services, and to alleviate congestion on TMC campus HCHD should double its capacity to deliver communitybased primary and preventive care by 2015 HCHD should add as many as 9 new CHPs, welldistributed, to serve underserved areas with high population growth HCHD should open 3 new outpatient specialty clinic facilities to meet significant increase in demand and relieve existing congestion at BTGH/LBJ 75 Impact of Capacity Limitations 38

40 Current Services Public System Unable to Meet Demand Currently Serve Only 38% of Medically Indigent (HCHD serves 23%) ~830,000 Uninsured Harris County Residents EC Used for Primary Care Trauma Centers on Diversion 30% of Time The Current System Isn t t Working There are gaps in needed services because of capacity constraints, staff shortages, and lack of funding Ad-hoc allocation of available resources leads to arbitrary rationing of services 78 39

41 Limitations on Access Next appointment: for an adult at Acres Home Health Center 45 days for eye exam at Baytown Health Center 85 days Average length of stay for: primary care appointment 2.2 hours ER visit 6.5 hours Number of patients leaving ER without being seen 109/1000 patients 79 The Current System Isn t t Working Access to care is limited by inefficient, overcrowded, poorly configured and undersized facilities Staffing shortages, long wait times, and poor customer service lead to patient dissatisfaction 80 40

42 A Growing ER Crisis Diversion: When a hospital has no capacity to take new ER patients, ambulances with patients needing emergency care are turned away. Trauma Centers are on diversion 30% of the time BTGH Emergency Center Patients Leaving Before Concluding Treatment FY 2000 FY 2001 FY 2002 FY 2003 FY 2004 Annual Monthly DNA Annual Monthly AMA 25th Percentile Number of Patients per 1000 Who Leave the Emergency Center Against Medical Advice (AMA) and Do Not Answer (DNA) Before and After Triage 82 41

43 LBJGH Emergency Center Patients Leaving Before Concluding Treatment Annual Monthly DNA Annual Monthly AMA 25th Percentile FY 2000 FY 2001 FY 2002 FY 2003 FY 2004 Number of Patients per 1000 Who Leave the Emergency Center Against Medical Advice (AMA) and Do Not Answer (DNA) Before and After Triage 83 Harris County Community Health Survey 42

44 Survey of the Harris County Community Conducted annually by HCHD Health Education/Outreach Population surveyed in FY2004: 2,433 Harris County leaders, community members, business owners 85 Survey Respondents (2,433) Sex: Males 688 Females 1,745 HCHD Services: No 1,505 Yes 803 Age: 18-33: : : : 261 Language: English 1,068 Spanish 916 Vietnamese 326 Other 75 HCHD Services - No Response 125 Age - No Response 25 Language - No Response

45 Survey Respondents (2,360) Do you have a primary care physician/health care provider? Yes 1,426 No 926 Have you ever been denied healthcare you thought you needed? Yes 380 No 1,989 Insured No Response Primary Care Provider - No Response 81 Denied HealthCare - No Response Overall Health of the Community Very Good (Ranking Score 4) Good (Ranking Score 3) OK (Ranking Score 2) Bad (Ranking Score 1) Very Bad (Ranking Score 0) Frequency % Mean 2.13 Most Respondents rate the Overall Health of the Community as OK Overall Health - No Response

46 Issues in the Community Responses Frequency % Health Insurance % Tobacco/Drugs/Alcohol % Diabetes % Stress/Depression % Nutrition/Exercise % Heart Disease/Stroke % Teen Pregnancy % Support Services for Elderly % Cancer % Domestic Violence/Crime % Community Health Problems - No Response 189 If You Don t t Use HCHD Services, Why Not? Eligibility Problem Can t get Appointment Services not Offered Transportation Problem Hours of Operation Frequency % 45% 24% 23% 16% 10% Don t Use HCHD services? 1473 Why Don t Use HCHD services? No Response

47 For questions, please contact: Jean Dols, PhD, Associate Administrator Harris County Hospital District

48 2004 Harris County Community Health Survey A Community Health Survey is distributed by the Harris County Hospital District Health Educators and Outreach Educators to representative members of the Harris County community. The individuals completing these surveys include patients, Community Health Center Council Members, leaders in the community (church, school, etc.), and individuals who live or work in the respective community. Efforts are made to assure that the sample of respondents is representative of all ages (18 and older), languages, and a crosssection of the community. As in the previous 8 surveys conducted, women are over-represented in the sample population. In order to assure that the entirety of Harris County is included in the sampling, the County is divided into sections containing the zipcodes traditionally assigned to specific Community Health Centers. The Educators focus on obtaining a representative sample from each zipcode area. The survey is comprised of four (4) major sections. In section one, the respondent is asked to provide demographic information about themselves. In section two, the respondent is asked to provide information about their family s health insurance status, primary care physician/provider, and use of healthcare services including the use of Hospital District services, preferred hours/days, and barriers to/denial of healthcare services. In section three, the respondent is asked to indicate the overall health and health problems of the community. Section four provides the respondent with an opportunity to elaborate on strategies to improve the health of the community, needed programs/services, and sources of medical care for low-income community members. The first survey report provided is an overall summary of the responses for Harris County. Following this report are individual survey reports of the responses from each zipcode section of the community divided by the traditional zipcodes of the Community Health Centers. Thomas Street and Casa are aggregated into one report. Results from the three open-ended questions are available upon request. Harris County Hospital District Page 47 of Community Assessment

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51 Harris County Hospital District Overall Summary What is your sex? (n = 2433) Male Female How old are you? (n = 2408) and older What language do you speak? (n = 2385) English Only Spanish Only Vietnamese Only English/Spanish English/Vietnamese Other Do you and/or your children have health insurance? (n = 1754) Private - You Medicaid - Your Children Medicare - You Medicaid - You Private - Your Children CHIP - Your Children Medicare - Your Children CHIP - You Community Health Opinion Survey Page 52

52 Harris County Hospital District Overall Summary Do you have a primary care physician or health care provider? (n = 2388) Yes No Have you been denied healthcare you thought you needed? (n = 2369) Yes No Do you or your children use HCHD services? (n = 2324) No Yes If you do not use HCHD services, why not? (n = 1081) Problem with eligibility Can't get an appointment Services not offered Problem with transportation Hours of operation What clinic hours are best for you (Days)? (n = 2230) Monday - Friday Monday - Saturday Monday - Sunday Community Health Opinion Survey Page 53

53 Harris County Hospital District Overall Summary What clinic hours are best for you (Hours)? (n = 2247) 7:00 AM - 5:00 PM :00 AM - 7:00 PM :00 AM - 5:00 PM :00 AM - 8:00 PM Frequency What clinic hours are best for you (Days)? Total Percent Monday - Monday - Monday - Comb. Friday Saturday Sunday What clinic 7:00 AM - 5:00 PM hours are best for you (Hours) 7:00 AM - 7:00 PM? :00 AM - 5:00 PM :00 AM - 8:00 PM Frequency Percent Community Health Opinion Survey Page 54

54 Harris County Hospital District Overall Summary Which of the issues below are a problem in your community? (n = 2244) Health Insurance Tobacco / Drugs / Alcohol Diabetes Stress / Depression Nutrition / Exercise Heart Disease / Stroke Teen Pregnancy Support Services for the Elderly Cancer Domestic Violence / Crime & Violence STD / AIDS / HIV Immunizations Sexual Assault / Rape Injuries from Household Accidents Other How would you rate the overall health of your community? (n = 2349) 1 - Very Bad Bad OK Good Very Good Community Health Opinion Survey Page 55

55 Harris County Hospital District Acres Home Health Center What is your sex? (n = 204) Male Female How old are you? (n = 203) and older What language do you speak? (n = 199) English Only Spanish Only Vietnamese Only English/Spanish English/Vietnamese Other Do you and/or your children have health insurance? (n = 140) Private - You Private - Your Children Medicaid - Your Children Medicaid - You Medicare - You CHIP - Your Children Medicare - Your Children CHIP - You Community Health Opinion Survey Page 56

56 Harris County Hospital District Acres Home Health Center Do you have a primary care physician or health care provider? (n = 204) Yes No Have you been denied healthcare you thought you needed? (n = 202) Yes No Do you or your children use HCHD services? (n = 201) No Yes If you do not use HCHD services, why not? (n = 127) Problem with eligibility Can't get an appointment Services not offered Problem with transportation Hours of operation What clinic hours are best for you (Days)? (n = 191) Monday - Friday Monday - Saturday Monday - Sunday Community Health Opinion Survey Page 57

57 Harris County Hospital District Acres Home Health Center What clinic hours are best for you (Hours)? (n = 188) 7:00 AM - 5:00 PM :00 AM - 7:00 PM :00 AM - 5:00 PM :00 AM - 8:00 PM Frequency What clinic hours are best for you (Days)? Total Percent Monday - Monday - Monday - Comb. Friday Saturday Sunday What clinic 7:00 AM - 5:00 PM hours are best for you (Hours) 7:00 AM - 7:00 PM? :00 AM - 5:00 PM :00 AM - 8:00 PM Frequency Percent Community Health Opinion Survey Page 58

58 Harris County Hospital District Acres Home Health Center Which of the issues below are a problem in your community? (n = 199) Tobacco / Drugs / Alcohol Health Insurance Nutrition / Exercise Diabetes Stress / Depression Teen Pregnancy STD / AIDS / HIV Domestic Violence / Crime & Violence Support Services for the Elderly Heart Disease / Stroke Immunizations Cancer Sexual Assault / Rape Injuries from Household Accidents Other How would you rate the overall health of your community? (n = 202) 1 - Very Bad Bad OK Good Very Good Community Health Opinion Survey Page 59

59 Harris County Hospital District Aldine Health Center What is your sex? (n = 219) Male Female How old are you? (n = 226) and older What language do you speak? (n = 219) English Only Spanish Only Vietnamese Only English/Spanish English/Vietnamese Other Do you and/or your children have health insurance? (n = 182) Medicaid - Your Children Medicare - You Private - You Medicaid - You CHIP - Your Children Private - Your Children Medicare - Your Children CHIP - You Community Health Opinion Survey Page 60

60 Harris County Hospital District Aldine Health Center Do you have a primary care physician or health care provider? (n = 220) Yes No Have you been denied healthcare you thought you needed? (n = 219) Yes No Do you or your children use HCHD services? (n = 220) Yes No If you do not use HCHD services, why not? (n = 109) Problem with eligibility Services not offered Can't get an appointment Problem with transportation Hours of operation What clinic hours are best for you (Days)? (n = 220) Monday - Friday Monday - Saturday Monday - Sunday Community Health Opinion Survey Page 61

61 Harris County Hospital District Aldine Health Center What clinic hours are best for you (Hours)? (n = 225) 7:00 AM - 5:00 PM :00 AM - 7:00 PM :00 AM - 5:00 PM :00 AM - 8:00 PM Frequency What clinic hours are best for you (Days)? Total Percent Monday - Monday - Monday - Comb. Friday Saturday Sunday What clinic 7:00 AM - 5:00 PM hours are best for you (Hours) 7:00 AM - 7:00 PM? :00 AM - 5:00 PM :00 AM - 8:00 PM Frequency Percent Community Health Opinion Survey Page 62

62 Harris County Hospital District Aldine Health Center Which of the issues below are a problem in your community? (n = 194) Health Insurance Tobacco / Drugs / Alcohol Diabetes Stress / Depression Teen Pregnancy Domestic Violence / Crime & Violence Nutrition / Exercise Support Services for the Elderly Cancer Heart Disease / Stroke STD / AIDS / HIV Injuries from Household Accidents Sexual Assault / Rape Immunizations Other How would you rate the overall health of your community? (n = 217) 1 - Very Bad Bad OK Good Very Good Community Health Opinion Survey Page 63

63 Harris County Hospital District Baytown Health Center What is your sex? (n = 116) Male Female How old are you? (n = 116) and older What language do you speak? (n = 115) English Only Spanish Only Vietnamese Only English/Spanish English/Vietnamese Other Do you and/or your children have health insurance? (n = 63) Medicare - You Medicaid - You Medicaid - Your Children Private - You Private - Your Children CHIP - Your Children Medicare - Your Children CHIP - You Community Health Opinion Survey Page 64

64 Harris County Hospital District Baytown Health Center Do you have a primary care physician or health care provider? (n = 107) Yes No Have you been denied healthcare you thought you needed? (n = 104) Yes No Do you or your children use HCHD services? (n = 103) Yes No If you do not use HCHD services, why not? (n = 33) Problem with transportation Can't get an appointment Problem with eligibility Services not offered Hours of operation What clinic hours are best for you (Days)? (n = 106) Monday - Friday Monday - Saturday Monday - Sunday Community Health Opinion Survey Page 65

65 Harris County Hospital District Baytown Health Center What clinic hours are best for you (Hours)? (n = 107) 7:00 AM - 5:00 PM :00 AM - 7:00 PM :00 AM - 5:00 PM :00 AM - 8:00 PM Frequency What clinic hours are best for you (Days)? Total Percent Monday - Monday - Monday - Comb. Friday Saturday Sunday What clinic 7:00 AM - 5:00 PM hours are best for you (Hours) 7:00 AM - 7:00 PM? :00 AM - 5:00 PM :00 AM - 8:00 PM Frequency Percent Community Health Opinion Survey Page 66

66 Harris County Hospital District Baytown Health Center Which of the issues below are a problem in your community? (n = 109) Health Insurance Tobacco / Drugs / Alcohol Diabetes Stress / Depression Heart Disease / Stroke Support Services for the Elderly Nutrition / Exercise Teen Pregnancy Domestic Violence / Crime & Violence Cancer STD / AIDS / HIV Sexual Assault / Rape Immunizations Injuries from Household Accidents Other How would you rate the overall health of your community? (n = 115) 1 - Very Bad Bad OK Good Very Good Community Health Opinion Survey Page 67

67 Harris County Hospital District Casa de Amigos Health Center What is your sex? (n = 98) Male Female How old are you? (n = 97) and older What language do you speak? (n = 92) English Only Spanish Only Vietnamese Only English/Spanish English/Vietnamese Other Do you and/or your children have health insurance? (n = 84) Medicaid - Your Children Medicare - You Private - You Medicaid - You CHIP - Your Children CHIP - You Private - Your Children Medicare - Your Children Community Health Opinion Survey Page 68

68 Harris County Hospital District Casa de Amigos Health Center Do you have a primary care physician or health care provider? (n = 94) Yes No Have you been denied healthcare you thought you needed? (n = 92) Yes No Do you or your children use HCHD services? (n = 87) No Yes If you do not use HCHD services, why not? (n = 36) Problem with eligibility Services not offered Hours of operation Problem with transportation Can't get an appointment What clinic hours are best for you (Days)? (n = 91) Monday - Friday Monday - Saturday Monday - Sunday Community Health Opinion Survey Page 69

69 Harris County Hospital District Casa de Amigos Health Center What clinic hours are best for you (Hours)? (n = 97) 7:00 AM - 5:00 PM :00 AM - 7:00 PM :00 AM - 5:00 PM :00 AM - 8:00 PM Frequency What clinic hours are best for you (Days)? Total Percent Monday - Monday - Monday - Comb. Friday Saturday Sunday What clinic 7:00 AM - 5:00 PM hours are best for you (Hours) 7:00 AM - 7:00 PM? :00 AM - 5:00 PM :00 AM - 8:00 PM Frequency Percent Community Health Opinion Survey Page 70

70 Harris County Hospital District Casa de Amigos Health Center Which of the issues below are a problem in your community? (n = 97) Tobacco / Drugs / Alcohol Support Services for the Elderly Health Insurance Domestic Violence / Crime & Violence Diabetes Heart Disease / Stroke Teen Pregnancy Stress / Depression Nutrition / Exercise Cancer Sexual Assault / Rape Injuries from Household Accidents STD / AIDS / HIV Immunizations Other How would you rate the overall health of your community? (n = 95) 1 - Very Bad Bad OK Good Very Good Community Health Opinion Survey Page 71

71 Harris County Hospital District Gulfgate Health Center What is your sex? (n = 341) Male Female How old are you? (n = 338) and older What language do you speak? (n = 335) English Only Spanish Only Vietnamese Only English/Spanish English/Vietnamese Other Do you and/or your children have health insurance? (n = 198) Private - You Medicaid - Your Children Medicare - You Medicaid - You CHIP - Your Children Private - Your Children Medicare - Your Children CHIP - You Community Health Opinion Survey Page 72

72 Harris County Hospital District Gulfgate Health Center Do you have a primary care physician or health care provider? (n = 340) Yes No Have you been denied healthcare you thought you needed? (n = 336) Yes No Do you or your children use HCHD services? (n = 338) No Yes If you do not use HCHD services, why not? (n = 154) Problem with eligibility Services not offered Can't get an appointment Problem with transportation Hours of operation What clinic hours are best for you (Days)? (n = 330) Monday - Friday Monday - Saturday Monday - Sunday Community Health Opinion Survey Page 73