COMMUNITY HEALTH NEEDS ASSESSMENT HINDS, RANKIN, MADISON COUNTIES STATE OF MISSISSIPPI Sample CHNA. This document is intended to be used as a reference only. Some information and data has been altered to fit the needs of this sample document. Contents Executive Summary... 2 Health Status... 2 Health Status Gap Analysis... 2 Goals for Your Hospital to Facilitate Health Status Improvement... 3 Quantitative Assessment Key Health Indicators... 4 A. Methodology... 4 Objectives... 4 Oversight... 4 Study Steps... 5 COMMUNITY HEALTH NEEDS ASSESSMENT METHODOLOGY FLOW... 6 B. Demographic Analysis... 7 C. Health status... 8 D. Health Disparities... 11 E. Health Care Providers... 12 F. Primary Data Gathering... 12 Priority Health Service Issues/ Gaps... 15 Qualitative Analysis of Services and Delivery System Needs... 16 Service Delivery Issues and Options... 17 Conclusion... 17 Action Plan Template... 18 1
Executive Summary Health Status Hinds, Rankin, and Madison Counties show a health status pattern that is similar to the overall State of Mississippi health status. Key disease issues for the overall populations of both Mississippi and the three counties are: 1. Deaths from heart disease 2. Deaths from cancer 3. Deaths from diabetes There are clear health disparities in the three counties between Whites and Non Whites in that mortality rates for the diseases of our focus is significantly higher in Non Whites than in Whites. The only exception to this pattern is that the cancer mortality rate in Rankin County is higher in Whites than in Non Whites. Evidence exists that the health status of Mississippi and the three counties reviewed is largely due to poor diet, tobacco use, and sedentary lifestyle. Health Status Gap Analysis The health status gap is defined as the gap in the key population health metrics between each county s population health status and: Mississippi s health status U.S. health status 2
The mortality rates vary as follows: Table 1 Mortality Rates Age Adjusted Causes of Death (Rate per 100,000) Indicator Hinds Rankin Madison Mississippi U.S. Heart disease Overall 251.3 238.9 267.5 274.8 190.9 Heart disease White 203.2 230.8 248.1 303.7 187.6 Heart disease Non White 294.6 277.8 305.3 230.3 247.1 Cancer Overall 157.4 131.1 454.8 203.2 183.8 Cancer White 130.4 131.6 412.6 226.1 182.4 Cancer Non White 193.7 127.3 542.9 167.7 224.2 Diabetes Overall 13.7 13.6 14.2 21.9 22.5 Diabetes White 4.8 10.4 8.6 18.4 20.5 Diabetes Non White 23.4 34.0 26.9 27.3 42.8 Source: Office of Vital Records, Mississippi State Department of Health, 2007 The mortality rates reflect racial disparities that are also generally present in the other health status indicators, which are detailed in the body of the Assessment Report. Why does this gap exist and why do variances exist? There are several major reasons, including: 1. Demographics of the counties, which vary primarily by race, but also slightly by gender and age category. 2. Number of health care providers, which vary by county, but are largely considered one geographic health market. 3. Access to health care, expressed in the rate of uninsured (or as a factor of living below poverty income levels). Goals for Your Hospital to Facilitate Health Status Improvement The Hospital has established, and operated for many years, clinical service lines that address the needs of the population in these areas of mortality and morbidity through preventive, diagnostic, and therapeutic inpatient and outpatient services. The hospital makes a significant investment and provides significant uncompensated care through execution of its mission in these clinical areas and therefore is meeting the community s needs through normal execution of the mission. The Hospital does intend to improve its outreach in the areas of education and prevention as described below. 3
Your Hospital intends to take the following actions to: (1) improve the overall health status of the three counties and (2) facilitate overall improvement by focusing on narrowing the health disparities present in the three counties within the Hospital s statements of Mission, Vision and Values. 1. Develop and offer hospital based educational programs that address disease prevention and treatment 2. Offer free diagnostic screening examinations at intervals throughout the year 3. Make free educational material available to the public The Hospital, through its Board of Trustees, management and medical staff, will establish more detailed action plans to accomplish these goals. Action plans will be specific, measurable, action oriented, realistic and time bound. The preliminary Action Plan is located at the end of the document. Quantitative Assessment Key Health Indicators A. Methodology Objectives The following are the objectives for the Community Health Needs Assessment: Describe the health of populations residing in the primary and secondary service areas. Identify priority health service issues in those populations. Identify how priority health needs differ among subgroups of the population. Assess trends in the health status and health behaviors of residents, if possible. Identify opportunities to improve the health status of these populations. Develop opportunities for health status improvement that are within the scope of the hospital s mission. Oversight The ultimate oversight of the Assessment is provided by the hospital s Board of Trustees, with senior management acting on the Board s behalf. The Hospital s project champion will be Name of Champion. The Hospital will appoint an Assessment Team comprised of hospital subject matter experts to serve as the project team. 4
Study Steps The primary steps of the study will be to: Define study regions. Profile the demographic composition of service areas. Identify peer group communities. Develop and conduct community health status, utilization and preference survey. Develop health status indicator profile and identify priority health issues. Assess current services for priority health issues. Develop health services planning document. Present findings to the Steering Committee, Board of Trustees and local stakeholders. Produce and disseminate final planning report. The methodology is outlined in the flow diagram on the next page. 5
COMMUNITY HEALTH NEEDS ASSESSMENT METHODOLOGY FLOW Primary Data and Community Input Assessment Secondary and Comparative Data Community Household Survey Health Status Risk Factors Disease Prevalence Utilization Services Preference Quantitative Assessment Key Health Indicators Access and Quality Indicators Prevalence of Mental Health/Substance Abuse Conditions Inpatient/ER/Outpatient Use Indicators Related Chronic Conditions Mortality Indicators Risk Factors for Mental Health/ Substance Abuse. Region Level Data Hospital Utilization Data Mortality Data ER/Outpatient data Program Specific Data Discussions with Key Stakeholders Key Community Members Clinical Providers Other Service Providers Identify Priority Health Service Issues/Gaps Qualitative Analysis of Services and Delivery System Needs Benchmarking National Benchmarks Clinical Standards Best Practice Guidelines Model Community Programs and Delivery System Options Service Needs: Prevention Detection Treatment Sub acute Summary Planning Report Major Findings Service Delivery Issues/Options Transformation Barriers and Opportunities 6
B. Demographic Analysis The study team gathered secondary data already published on various web sites to analyze the demographics of the three counties as compared to Mississippi and the United States. The following is a high level summary of the demographic data: Table 1 Demographic Indicators Indicator Hinds Rankin Madison Mississippi U.S. Gender distribution Male 47% 49% 48% 48% 49% Female 53% 51% 52% 52% 51% Racial distribution White 29% 78% 60% 61% 65% Non white 71% 22% 40% 39% 35% Age distribution Age 0 14 23% 22% 24% 23% 22% Age 15 24 16% 13% 14% 16% 14% Age 25 44 25% 29% 28% 28% 30% Age 45 64 25% 25% 24% 21% 22% Age 65+ 11% 11% 10% 12% 12% Poverty Percent in poverty, 2009 all ages 23.3% 11.2% 12.7% 21.8% 14.3% Percent in poverty, 2009 under 18 32.9% 15.8% 17.1% 30.7% 20.0% Workforce Unemployment rate, May 2011 8.8% 6.1% 6.9% 10.0% 9.2% Poverty Levels: http://www.census.gov/did/www/saipe/county.html Gender, Racial, and Age Distribution: http://www.msdh.state.ms.us/msdhsite/_static/31,0,299,463.html Unemployment Levels: http://www.policymap.com/landingpages/unemployment.html?gclid=ck7bgqlepqocfygw2godcxc7wg Conclusions Demographics: Each of the three counties in this study is proportionately distributed for gender in relation to Mississippi and the United states. Hinds County is predominantly Non White, which differs from the other two counties, the state of Mississippi, and the United States where White is the predominate race. Age distributions within the counties are distributed in the same proportion, as are age distributions in Mississippi and the United States. Poverty rates in Rankin and Madison Counties are lower than the overall poverty rates in Mississippi and the United States. The poverty rate of Hinds County is significantly higher than the poverty rates in the compared counties and the United States. The unemployment rates of all three counties are lower than the rates of Mississippi and the United States. Hinds County has the highest poverty rate of the counties studied. 7
C. Health status The study team gathered secondary data already gathered on various web sites to analyze the health status of the three chosen counties as compared to Mississippi and the United States. The following is a summary of the health status data: Table 1 Mortality Rates Age Adjusted Causes of Death (Rate per 100,000) Indicator Hinds Rankin Madison Mississippi U.S. Heart disease Overall 251.3 238.9 267.5 274.8 190.9 Heart disease White 203.2 230.8 248.1 303.7 187.6 Heart disease Non White 294.6 277.8 305.3 230.3 247.1 Cancer Overall 157.4 131.1 454.8 203.2 183.8 Cancer White 130.4 131.6 412.6 226.1 182.4 Cancer Non White 193.7 127.3 542.9 167.7 224.2 Diabetes Overall 13.7 13.6 14.2 21.9 22.5 Diabetes White 4.8 10.4 8.6 18.4 20.5 Diabetes Non White 23.4 34.0 26.9 27.3 42.8 Source: Office of Vital Records, Mississippi State Department of Health, 2007 8
350.0 300.0 Heart Disease Incident Rate 2007 Heart disease Overall Heart disease White Heart disease Non White 250.0 200.0 150.0 100.0 50.0 0.0 600.0 Hinds Rankin Madison Mississippi U.S. Cancer Incident Rate 2007 500.0 400.0 300.0 Cancer Overall Cancer White Cancer Non White 200.0 100.0 0.0 Hinds Rankin Madison Mississippi U.S. 9
45.0 Diabetes Incident Rate 2007 40.0 35.0 30.0 25.0 20.0 Diabetes Overall Diabetes White Diabetes Non White 15.0 10.0 5.0 0.0 Hinds Rankin Madison Mississippi U.S. Conclusions Health Status Mortality rates of the major health issues of the counties reviewed reflect racial disparities between the counties, the state of Mississippi and the United States. Non Whites have an overall higher mortality rate from heart disease in the three counties and the United States. The state of Mississippi as a whole, however, has a higher mortality rate from heart disease in Whites. Mortality rates for cancer in Hinds County, Madison County, and the United States are higher in Non Whites. Research shows that, in Rankin County and the state of Mississippi, Whites have a higher mortality rate from cancer. Hinds, Rankin, and Madison Counties show a higher mortality rate from diabetes in Non Whites, which is mirrored in the state of Mississippi and the United States. 10
D. Health Disparities The major health disparities in the studied counties are: Hinds County o Heart Disease Higher mortality rate in Non Whites o Cancer Higher mortality rate in Non Whites o Diabetes Higher mortality rate in Non Whites Rankin County o Heart Disease Higher mortality rate in Non Whites o Cancer Higher mortality rate in Whites o Diabetes Higher mortality rate in Non Whites Madison County o Heart Disease Higher mortality rate in Non Whites o Cancer Higher mortality rate in Non Whites o Diabetes Higher mortality rate in Non Whites Strategies to help narrow the disparities might include: Strategy TEMPLATE ENTER YOUR STRATEGIES HERE Currently in Place? (Y/N) Plan to Do (Y/N) Will Consider (Y/N) Not in Organizational Scope The strategies are described in more detail below: DISCUSS STRATEGIES TO BE IMPLEMENTED HERE 11
E. Health Care Providers According to the Mississippi Center for Health Workforce, in 2008, almost one third of Mississippians resided in a Primary Care Health Professional Shortage Area. This means that residents of those areas have a more difficult time finding primary health care. The patient load of Primary Care Physicians in Hinds County tends to stay within the recommended levels. Primary Care Physicians in Rankin and Madison Counties have a patient load that is up to double the recommended level. These differences in physician availability may contribute to the health disparities within the counties in Mississippi. Source: Mississippi State University, Mississippi Center for Health Workforce, 2008 TEMPLATE AFTER RESEARCH, DISCUSS WORKFORCE ISSUES IN MORE DETAIL HERE. F. Primary Data Gathering The Center for Disease Control (CDC) has developed a series of tools for communities to identify potential root causes for variation in health status from U.S. norms. At a high level, these factors are: Physical activity. Nutrition. Tobacco use. School sector. Work sector. 12
The team used these tools (See Appendices) to assess root causes, with the following results: NOTE: THESE ARE TEMPLATE RESULTS. THE TEAM SHOULD USE THE TOOLS AND SUPPLY THEIR OWN SCORES. Hinds County Module Score Summaries Policy Environment Module 72.86% 67.74% Physical Activity 63.64% 63.64% Nutrition 58.18% 72.73% Tobacco Use 73.33% 65.00% Chronic Disease Management 56.36% 72.73% Leadership Rankin County Module Score Summaries Policy Environment Module 64.52% 67.69% Physical Activity 73.44% 68.25% Nutrition 58.18% 47.27% Tobacco Use 57.78% 75.56% Chronic Disease Management 72.73% 63.64% Leadership Madison County Module Score Summaries Policy Environment Module 61.90% 62.50% Physical Activity 43.94% 59.70% Nutrition 49.09% 40.00% Tobacco Use 44.44% 51.11% Chronic Disease Management 56.36% 80.00% Leadership 13
Policy and Environmental Discussion: The answer to each area is broken down into two major divisions, policy and environment. Policy division is designed to determine if a policy need has been identified or not. Health policy identifies a particular health care goal within a community and identifies whether or not there is a plan in place to achieve that goal. The categories are listed below: 1 Not identified as problem 2 Problem identification/gaining agenda status 3 Policy formulation and adoption 4 Policy implementation 5 Policy evaluation and enforcement 99 Not applicable Response 1, Not identified as a problem, means that the problem has yet to be discovered. It doesn t mean that the policy is Not applicable such as 99. The categories of 2 through 5 bring the policy to fruition so that it is in place. Policies help to bring about change once the need is identified for correction. Environment implies that the particular element is not in place or that all the elements are in place. This provides a measurement on a scale from 1 to 5 that evaluates how the environment of the community is serving. Just like police 99 is used when the element does not apply to the community. The scale below demonstrates the levels of each measurement. Response # Environment 1 Elements not in place 2 Few elements in place 3 Some elements are in place 4 Most elements are in place 5 All elements in place 99 Not applicable 14
Comparing the three counties for root causes: Hinds County o Ranks equal to Rankin County by mean percentage for Policy and planning with highest marks for physical activity and chronic disease management; lowest marks are in goals for decreasing tobacco use o Ranks highest by mean percentage for Environment with highest marks related addressing tobacco use and visibility of leadership; lowest marks are seen with addressing nutritional issues Rankin County o Ranks equal to Hinds county by mean percentage for Policy with high marks in policy and planning for nutrition and visibility of leadership; lowest marks are in goals to address chronic disease management o Ranks between Hinds and Madison County for Environment with highest marks in addressing chronic disease management; lowest marks are seen with addressing tobacco use Madison County o Ranks last among the counties surveyed in Policy with the highest percentage for planning focused on encouraging increased physical activity; lowest marks are seen in addressing the nutritional needs of the community o Ranks last among the counties surveyed in Environment with highest marks noted in visibility of leadership; lowest marks are seen with addressing tobacco use Priority Health Service Issues/ Gaps Why do these gaps and variances exist? There are several major reasons, including: Demographics of the counties, which vary primarily by race, but also slightly by gender and age categories Number of health care providers, which vary by county, but are largely considered one geographic health market Access to health care, expressed in the rate of uninsured (or as a factor of living below poverty income levels) TEMPLATE DISCUSS THESE ISSUES IN MORE DETAIL AFTER RESEARCH 15
Qualitative Analysis of Services and Delivery System Needs Upon review of the findings of the CHNA, the following areas have been identified to address the gap between community needs and resources based on the target diseases. Heart Disease is the leading cause of death in Mississippi with 274.8 deaths per 100,000 as compared to 190.9 per 100,000 in the U.S., followed by cancer and diabetes. Disparities among these disease processes are found to be high in Hinds, Rankin and Madison counties. For the counties of Hinds, Rankin and Madison, health care facilities and resources are more readily available in the metropolitan areas. Attention should focus on remote areas where disparities are more common, with the following potential strategies to address Heart Disease and Diabetes: Improve cardiac health through outreach and education. Develop educational programs in nutrition, exercise and lifestyle with emphasis on reducing heart disease among diabetics. Collaborate with Schools of Nursing to check and track blood pressure and blood sugars at Senior Citizen Centers. Offer public education classes for weight management: healthy cooking, fitness courses, and stress management. Collaborate with elementary schools for introduction of healthy life styles and nutrition in early education. Cancer is the second leading cause of death in Mississippi with 203.2 deaths per 100,000 as compared to 183.8 per 100,000 nationally. Disparities exist by race in all three counties though cancer deaths are, conversely, higher among whites in Rankin County. The following recommendations are made for the counties of Hinds, Rankin, and Madison: Sponsor Smoking Cessation classes and support groups. Sponsor media coverage promoting screening for breast, colon, and prostate cancer. Offer free mammograms, pap tests, and prostate exams during specific cancer awareness months. Offer public education classes for preventative measures including dietary and weight management. Collaborate with community churches to promote awareness and prevention. Rural areas are more likely to be underserved and outreach for these areas include the following recommendations: Satellite primary health clinic(s). Mobile Health Unit for preventative care, assessment and education. 16
Prioritizing these initiatives should include the following: Degree of impact Feasibility Sustainability Service Delivery Issues and Options After collection and analyzing data from the community, Your Hospital has identified three major health issues within the community. Your Hospital has also identified several possible interventions the facility has agreed to develop and implement. Heart Disease o Sponsor community education programs with varying topics o Offer free blood pressure and cholesterol checks to the community every 6 months o Offer free EKG testing once a year Cancer o Offer free prostate screening exams annually o Offer free mammography screening annually Diabetes o Sponsor community education programs with varying topics o Offer free podiatric exams every 6 months o Offer nutritional seminars given by a Registered Dietitian Conclusion In keeping with our goals, Your Hospital intends to, within our statements of Mission, Vision and Values, narrow the health disparities present in Hinds, Rankin, and Madison Counties. We will explore options and implement interventions in an effort to facilitate improvement in the health of individuals by focusing on narrowing health disparities and thereby improving the overall health status of the three counties. The team has designed the following Action Plan to help ensure proper and timely implementation of the strategies to improve Community Health Status. 17
Action Plan Template ACTION PLAN Task No. Task Assigned To Start Date Finish Date Strategy #1 DESCRIBE STRATEGY HERE 1 2 3 4 5 Strategy #2 DESCRIBE STRATEGY HERE 1 2 3 4 18