Harris County Community Assessment

Harris County Community Assessment 2004

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. FY2002 103 2. FY2003 107 3. FY2004 111 Harris County Hospital District Page 1 of 115 2004 Community Assessment

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 2020. 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 115 2004 Community Assessment

in Harris County rose in 2003 with the number of households whose income is under $50,000 declining to 52% from 59% in 2001. 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 2002. With the recent changes in CHIP and Medicaid, the number of insured individuals under 65 has decreased significantly since 2002. 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 19-35 months were properly immunized in accordance with the 4:3:1:3 series of immunizations in 2002. 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 15-44. 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 115 2004 Community Assessment

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 2002. 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 18-44 with a 29% increase in the number of CHP patients aged 18-44 from FY2002 to FY2004. The increase in the 18-44 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, 10/29/2004. 2 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 115 2004 Community Assessment

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 78-109 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 18-66+ years. Seventy-two percent of the Harris County Hospital District Page 5 of 115 2004 Community Assessment

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 115 2004 Community Assessment

Community Assessment 2004 The Harris County Population 7

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 3,000,000 2000 2002 2005 2010 2015 2020 Source: Texas State Data Center, December, 2001 15 Population Growth, 2001-2006 %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 10 20 21.2% to 22.2% 22.2% to 25.3% 25.3% to 47.1% Source: ERSI/CACI Demographics 16 8

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% 1990 1996 2000 2010 2020 White Black Hispanic Origin Other (e.g. Asian, American Indian) Source: U.S. Census Bureau, Texas State Data Center. Note: 1990-1996 based on 1990 U.S. Census; 2000-2020 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% 1996 1997 1998 1999 2000 2001 2002 2003 Harris Montgomery Fort Bend Texas Source: Texas Employment Security Commission 18 9

Households by Income Category, Harris County 1997-2003 % 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 $100-149 $150 + 1997 1999 2001 2003 Harris County Median HH Income 1997: $39,622 1999: $41,912 2001: $40,766 2006: $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 357 357 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 10 20 657 to 1,053 1,053 to 1,379 1,379 to 3,362 Source: ERSI/CACI Demographics 20 10

Persons < 65 with Health Insurance Coverage % Insured 100% 95% 90% 85% 80% 75% 70% 65% 60% Healthy People 2010 Target 1996 1997 1998 1999 2000 2001 2002 2003 U.S. Total U.S. Black U.S. Hispanic Harris County Source: Healthy People 2010; U.S. Census Population Survey Health Status 11

Tuberculosis Cases/100,000 Number Cases/100,000 30 25 20 15 10 5 0 Healthy People 2010 Target 1995 1996 1997 1998 1999 2000 2001 2002 2003 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 19-35 Months 90% 85% Healthy People 2010 Target % Immunized 80% 75% 70% 65% 60% 1995 1996 1997 1999 2000 2001 2002 U.S. Texas Houston Source: CDC National Immunization Survey 24 12

New AIDS Cases/100,000 Number Cases/100,000 100 90 80 70 60 50 40 30 20 10 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 1 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/100,000 250 200 150 100 50 0 1999 2000 2001 2002 Texas Harris County US Healthy People 2010 Target Source: Texas Department of Health; Healthy People 2000, Healthy People 2010. 13

Diabetes Age-Adjusted Adjusted Death Rate Number of Deaths/100,000 90 80 70 60 50 40 30 20 10 0 1999 2000 2001 2002 Texas Harris County US Healthy People 2010 Target Source: Texas Department of Health; CDC; Healthy People 2000, Healthy People 2010. Injury/Violence Prevention Age-Adjusted Adjusted Accident Death Rate Number of Deaths/100,000 40 35 30 25 20 15 10 5 0 Healthy People 2000 Target 1995 1996 1997 1998 1999 2000 2001 2002 Healthy People 2010 Target Source: Texas Department of Health; Healthy People 2000, Healthy People 2010. Texas Harris County US 14

Mortality by Leading Cause Harris County, Age 0-40 250 Number of Deaths 200 150 100 50 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 Source: Texas Department of Health Perinatal Congenital Ill-Defined Mortality by Leading Cause Harris County, Age 5-145 Number of Deaths 50 45 40 35 30 25 20 15 10 5 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 Accidents Neoplasms Homicides Source: Texas Department of Health 15

Mortality by Leading Cause Harris County, Age 15-24 250 Number of Deaths 200 150 100 50 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 Homicides Accidents Suicides Source: Texas Department of Health Mortality by Leading Cause Harris County, Age 25-44 Number of Deaths 800 700 600 500 400 300 200 100 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 HIV/Other Infect Neoplasms Accidents Source: Texas Department of Health 16

Mortality by Leading Cause Harris County, Age 45-64 Number of Deaths 1800 1600 1400 1200 1000 800 600 400 200 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 Source: Texas Department of Health Neoplasms Cardio- vascular Ill-Defined Mortality by Leading Cause Harris County, Age 65+ Number of Deaths 4500 4000 3500 3000 2500 2000 1500 1000 500 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 Cardio- vascular Neoplasms Ill-Defined Source: Texas Department of Health 17

Harris County Clusters Layers Harris Zip Codes 1960-290 Bellaire Galleria Hwy 6 Cypress Katy Kingwood Medical Center NE Harris SE Harris Miles Memorial Park 0 10 20 Source: ERSI/CACI Demographics Focus Area/Objective Zipcode Cluster Comparison to Harris County Average 1960-290 Katy Bellaire Galleria Cypress Kingwood Med Cen Mem Park NE Har SE Har Cancer 130.9 Diabetes 18.9 Cirrhosis 9.2 Heart Disease 157.1 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

Health Behaviors Risky Behavior, Harris County 2002 90% 80% % of Population 70% 60% 50% 40% 30% 20% 10% 0% Smoking Overweight No Exercise Source: BRFSS, Office of Information and Analysis. 19

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 1994 1995 1996 1997 1998 1999 2000 2001 2002 U.S. Total U.S. Black U.S. Hispanic Texas Harris County Source: Healthy People 2010; U.S. Census Population Survey 20

Infant Mortality Infant Deaths/1000 Live Births 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 Healthy People 2010 Target 1994 1995 1996 1997 1998 1999 2000 2001 2002 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

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

Annual Visits in Thousands 500 450 400 350 300 250 200 150 100 50 0 490,626 HCHD 191,517 City Patient Visits 150,000 113,252 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

Market Share of Selected Harris County Hospitals Total ED Visits, 1991, 1996, 2001 1 30.0% 20.0% 10.0% 0.0% 12.3% 20.1% 16.0% BTGH & LBJ - 2 6.3% 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 2001 37.3% from 853,968 in 1991 to 1,172,622 in 2001. The hospitals in the graph represent 45% of total in 1991 and 51% of the total in 2001. 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, 2003. 47 Market Share of Selected Harris County Hospitals Outpatient Visits, 1991, 1996, 2001 30.0% 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 1991 1996 2001 OP visits to Harris County hospitals, overall, increased 122.8% from 1.7 million in 1991 to 3.9 million in 2001. The hospitals in the graph represent 36% of total in 1991 and 50% of the total in 2001. (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, 2003. 48 24

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

Utilization of District Services 51 HCHD Hospital Admissions 60000 50000 40000 30000 60,014 52,921 49,233 49,543 43,588 41,384 39,087 31,746 34,726 20000 10000 0 FY76 FY80 FY85 FY90 FY95 FY00 FY02 FY03 FY 04 FY2004 unaudited Admissions (excluding newborns) 26

HCHD Emergency Room Visits 200,000 180,000 160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0 103,986 90,194 90,689 81,303 186,859 176,241 168,031 166,545 155,249 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 2,000 0 16,976 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

HCHD Outpatient Specialty Clinic Visits 500000 450000 400000 350000 300000 250000 200000 150000 100000 50000 0 332186 209662 216380 217451 195,931 225,693 231,870 262,703 FY76 FY80 FY85 FY90 FY95 FY00 FY02 FY03 HCHD Specialty Clinic Visits HCHD Community Health Program (CHP) Outpatient Clinic Visits 600,000 559,909 490,626 500,000 445,535 400,000 346,655 300,000 200,000 138,774 141,774 267,488 212,294 100,000 0 FY76 FY80 FY85 FY90 FY95 FY00 FY02 FY03 HCHD CHP Visits 28

70,000 Unduplicated Patients by Age 60,000 50,000 40,000 30,000 20,000 FY02 FY03 FY04 10,000 0 0-5 6-17 18-44 45-64 65+ 57 % 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% 0-5 6-17 18-44 45-64 65+ 58 29

% 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% 0-5 6-17 18-44 45-64 65+ 59 120,000 100,000 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

% 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 160000 140000 120000 100000 80000 60000 40000 20000 0 Acres Aldine Baytown Casa MLK NW People Gulfgate Settegast Squatty Strawberry 3/01-2/02 3/02-2/03 3/03-2/04 62 31

% 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

Health Care Utilization by Patient Age U.S. 2000 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 65+ 45-64 15-44 0-14 Source: National Center for Health Statistics, National Hospital Discharge Survey and National Ambulatory Medical Care Survey, 2002. U.S. Utilization Trends Discharges in Millions 45 43 41 39 37 35 33 31 29 27 25 High Forecast Low Forecast 1997 1998 1999 2000 2006 Proj 220 210 200 190 180 170 160 150 Patient Days in Millions Admissions Source: NCHS, National Hospital Discharge Survey, 2002; The Advisory Board Patient Days 33

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

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 1,000 500 0 1960 1970 1980 1990 2000 2002 2010 5000 4500 4000 3500 3000 2500 2000 1500 1000 500 0 HCHD Total Square Feet in Thousands Source: HCHD Corporate Communications, Planning; U.S. Census Bureau, Texas State Data Center 35

2003 Harris County Population Uninsured Medicaid Medicare Private (1) Total # 830,000 256,000 260,000 2.3 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 3,121 343 331 120 1,561 446 662 60 Use rates by category and by payor (Medicaid, Medicare, Private, Uninsured) are applied to population to determine total Harris County demand 72 36

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 423,000 183,000 299,000 36,000 1,067,000 279,000 564,000 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%. 74 37

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

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

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

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. 81 170 160 150 140 130 120 110 100 90 80 70 60 50 40 30 20 10 0 BTGH Emergency Center Patients Leaving Before Concluding Treatment 131.6 115.4 115.9 104.8 109.8 16.9 18.8 14.4 13.1 13.3 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

LBJGH Emergency Center Patients Leaving Before Concluding Treatment 150 140 130 120 110 100 90 80 70 60 50 40 30 20 10 0 112.6 115.3 117.8 96.4 10.4 10.9 12.3 13.9 77.5 12.9 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

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: 767 34-49: 764 50-65: 616 66+: 261 Language: English 1,068 Spanish 916 Vietnamese 326 Other 75 HCHD Services - No Response 125 Age - No Response 25 Language - No Response 48 86 43

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 - 679 Primary Care Provider - No Response 81 Denied HealthCare - No Response 64 87 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 139 575 1139 434 62 % 6 25 49 19 3 Mean 2.13 Most Respondents rate the Overall Health of the Community as OK Overall Health - No Response 84 88 44

Issues in the Community Responses Frequency % Health Insurance 1140 51% Tobacco/Drugs/Alcohol 1068 48% Diabetes 964 43% Stress/Depression 850 38% Nutrition/Exercise 738 33% Heart Disease/Stroke 729 33% Teen Pregnancy 646 29% Support Services for Elderly 611 27% Cancer 571 25% Domestic Violence/Crime 539 24% 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 488 260 246 169 103 % 45% 24% 23% 16% 10% Don t Use HCHD services? 1473 Why Don t Use HCHD services? No Response 392 90 45

For questions, please contact: Jean Dols, PhD, Associate Administrator Harris County Hospital District 713-566-6424 jean_dols@hchd.tmc.edu 46

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 115 2004 Community Assessment

Harris County Hospital District Overall Summary What is your sex? (n = 2433) Male 688 28.3 Female 1745 71.7 How old are you? (n = 2408) 18-33 767 31.9 34-49 764 31.7 50-65 616 25.6 66 and older 261 10.8 What language do you speak? (n = 2385) English Only 1068 44.8 Spanish Only 351 14.7 Vietnamese Only 186 7.8 English/Spanish 565 23.7 English/Vietnamese 140 5.9 Other 75 3.1 Do you and/or your children have health insurance? (n = 1754) Private - You 752 42.9 Medicaid - Your Children 447 25.5 Medicare - You 352 20.1 Medicaid - You 317 18.1 Private - Your Children 297 16.9 CHIP - Your Children 210 12.0 Medicare - Your Children 58 3.3 CHIP - You 46 2.6 2004 Community Health Opinion Survey Page 52

Harris County Hospital District Overall Summary Do you have a primary care physician or health care provider? (n = 2388) Yes 1462 61.2 No 926 38.8 Have you been denied healthcare you thought you needed? (n = 2369) Yes 380 16.0 No 1989 84.0 Do you or your children use HCHD services? (n = 2324) No 1473 63.4 Yes 851 36.6 If you do not use HCHD services, why not? (n = 1081) Problem with eligibility 488 45.1 Can't get an appointment 260 24.1 Services not offered 246 22.8 Problem with transportation 169 15.6 Hours of operation 103 9.5 What clinic hours are best for you (Days)? (n = 2230) Monday - Friday 744 33.4 Monday - Saturday 1000 44.8 Monday - Sunday 486 21.8 2004 Community Health Opinion Survey Page 53

Harris County Hospital District Overall Summary What clinic hours are best for you (Hours)? (n = 2247) 7:00 AM - 5:00 PM 416 18.5 7:00 AM - 7:00 PM 612 27.2 8:00 AM - 5:00 PM 519 23.1 8:00 AM - 8:00 PM 700 31.2 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 256 101 37 394 hours are best 11.8 4.6 1.7 18.1 for you (Hours) 7:00 AM - 7:00 PM? 89 407 97 593 4.1 18.7 4.5 27.2 8:00 AM - 5:00 PM 233 217 54 504 10.7 10.0 2.5 23.1 8:00 AM - 8:00 PM 143 252 292 687 6.6 11.6 13.4 31.5 Frequency 721 977 480 2178 Percent 33.1 44.9 22.0 100.0 2004 Community Health Opinion Survey Page 54

Harris County Hospital District Overall Summary Which of the issues below are a problem in your community? (n = 2244) Health Insurance 1140 50.8 Tobacco / Drugs / Alcohol 1068 47.6 Diabetes 964 43.0 Stress / Depression 850 37.9 Nutrition / Exercise 738 32.9 Heart Disease / Stroke 729 32.5 Teen Pregnancy 646 28.8 Support Services for the Elderly 611 27.2 Cancer 571 25.4 Domestic Violence / Crime & Violence 539 24.0 STD / AIDS / HIV 471 21.0 Immunizations 351 15.6 Sexual Assault / Rape 339 15.1 Injuries from Household Accidents 246 11.0 Other 174 7.8 How would you rate the overall health of your community? (n = 2349) 1 - Very Bad 62 2.6 2 - Bad 434 18.5 3 - OK 1139 48.5 4 - Good 575 24.5 5 - Very Good 139 5.9 2004 Community Health Opinion Survey Page 55

Harris County Hospital District Acres Home Health Center What is your sex? (n = 204) Male 64 31.4 Female 140 68.6 How old are you? (n = 203) 18-33 76 37.4 34-49 70 34.5 50-65 45 22.2 66 and older 12 5.9 What language do you speak? (n = 199) English Only 117 58.8 Spanish Only 9 4.5 Vietnamese Only 14 7.0 English/Spanish 37 18.6 English/Vietnamese 19 9.5 Other 3 1.5 Do you and/or your children have health insurance? (n = 140) Private - You 60 42.9 Private - Your Children 37 26.4 Medicaid - Your Children 37 26.4 Medicaid - You 25 17.9 Medicare - You 21 15.0 CHIP - Your Children 11 7.9 Medicare - Your Children 8 5.7 CHIP - You 4 2.9 2004 Community Health Opinion Survey Page 56

Harris County Hospital District Acres Home Health Center Do you have a primary care physician or health care provider? (n = 204) Yes 115 56.4 No 89 43.6 Have you been denied healthcare you thought you needed? (n = 202) Yes 54 26.7 No 148 73.3 Do you or your children use HCHD services? (n = 201) No 135 67.2 Yes 66 32.8 If you do not use HCHD services, why not? (n = 127) Problem with eligibility 55 43.3 Can't get an appointment 37 29.1 Services not offered 24 18.9 Problem with transportation 24 18.9 Hours of operation 5 3.9 What clinic hours are best for you (Days)? (n = 191) Monday - Friday 55 28.8 Monday - Saturday 80 41.9 Monday - Sunday 56 29.3 2004 Community Health Opinion Survey Page 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 18 9.6 7:00 AM - 7:00 PM 49 26.1 8:00 AM - 5:00 PM 39 20.7 8:00 AM - 8:00 PM 82 43.6 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 8 8 2 18 hours are best 4.3 4.3 1.1 9.6 for you (Hours) 7:00 AM - 7:00 PM? 5 29 15 49 2.7 15.4 8.0 26.1 8:00 AM - 5:00 PM 20 15 4 39 10.6 8.0 2.1 20.7 8:00 AM - 8:00 PM 22 26 34 82 11.7 13.8 18.1 43.6 Frequency 55 78 55 188 Percent 29.3 41.5 29.3 100.0 2004 Community Health Opinion Survey Page 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 108 54.3 Health Insurance 94 47.2 Nutrition / Exercise 79 39.7 Diabetes 78 39.2 Stress / Depression 75 37.7 Teen Pregnancy 71 35.7 STD / AIDS / HIV 71 35.7 Domestic Violence / Crime & Violence 66 33.2 Support Services for the Elderly 64 32.2 Heart Disease / Stroke 60 30.2 Immunizations 46 23.1 Cancer 41 20.6 Sexual Assault / Rape 41 20.6 Injuries from Household Accidents 24 12.1 Other 18 9.0 How would you rate the overall health of your community? (n = 202) 1 - Very Bad 4 2.0 2 - Bad 61 30.2 3 - OK 81 40.1 4 - Good 48 23.8 5 - Very Good 8 4.0 2004 Community Health Opinion Survey Page 59

Harris County Hospital District Aldine Health Center What is your sex? (n = 219) Male 51 23.3 Female 168 76.7 How old are you? (n = 226) 18-33 101 44.7 34-49 85 37.6 50-65 31 13.7 66 and older 9 4.0 What language do you speak? (n = 219) English Only 66 30.1 Spanish Only 61 27.9 Vietnamese Only 4 1.8 English/Spanish 84 38.4 English/Vietnamese 4 1.8 Other 0 0.0 Do you and/or your children have health insurance? (n = 182) Medicaid - Your Children 105 57.7 Medicare - You 36 19.8 Private - You 36 19.8 Medicaid - You 31 17.0 CHIP - Your Children 30 16.5 Private - Your Children 8 4.4 Medicare - Your Children 6 3.3 CHIP - You 4 2.2 2004 Community Health Opinion Survey Page 60

Harris County Hospital District Aldine Health Center Do you have a primary care physician or health care provider? (n = 220) Yes 99 45.0 No 121 55.0 Have you been denied healthcare you thought you needed? (n = 219) Yes 39 17.8 No 180 82.2 Do you or your children use HCHD services? (n = 220) Yes 113 51.4 No 107 48.6 If you do not use HCHD services, why not? (n = 109) Problem with eligibility 69 63.3 Services not offered 20 18.3 Can't get an appointment 19 17.4 Problem with transportation 9 8.3 Hours of operation 5 4.6 What clinic hours are best for you (Days)? (n = 220) Monday - Friday 61 27.7 Monday - Saturday 114 51.8 Monday - Sunday 45 20.5 2004 Community Health Opinion Survey Page 61

Harris County Hospital District Aldine Health Center What clinic hours are best for you (Hours)? (n = 225) 7:00 AM - 5:00 PM 30 13.3 7:00 AM - 7:00 PM 84 37.3 8:00 AM - 5:00 PM 42 18.7 8:00 AM - 8:00 PM 69 30.7 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 15 10 5 30 hours are best 6.8 4.6 2.3 13.7 for you (Hours) 7:00 AM - 7:00 PM? 7 64 12 83 3.2 29.2 5.5 37.9 8:00 AM - 5:00 PM 20 13 6 39 9.1 5.9 2.7 17.8 8:00 AM - 8:00 PM 18 27 22 67 8.2 12.3 10.0 30.6 Frequency 60 114 45 219 Percent 27.4 52.1 20.5 100.0 2004 Community Health Opinion Survey Page 62

Harris County Hospital District Aldine Health Center Which of the issues below are a problem in your community? (n = 194) Health Insurance 94 48.5 Tobacco / Drugs / Alcohol 89 45.9 Diabetes 71 36.6 Stress / Depression 62 32.0 Teen Pregnancy 60 30.9 Domestic Violence / Crime & Violence 53 27.3 Nutrition / Exercise 49 25.3 Support Services for the Elderly 45 23.2 Cancer 43 22.2 Heart Disease / Stroke 42 21.6 STD / AIDS / HIV 34 17.5 Injuries from Household Accidents 33 17.0 Sexual Assault / Rape 32 16.5 Immunizations 32 16.5 Other 15 7.7 How would you rate the overall health of your community? (n = 217) 1 - Very Bad 4 1.8 2 - Bad 27 12.4 3 - OK 114 52.5 4 - Good 68 31.3 5 - Very Good 4 1.8 2004 Community Health Opinion Survey Page 63

Harris County Hospital District Baytown Health Center What is your sex? (n = 116) Male 30 25.9 Female 86 74.1 How old are you? (n = 116) 18-33 24 20.7 34-49 29 25.0 50-65 50 43.1 66 and older 13 11.2 What language do you speak? (n = 115) English Only 86 74.8 Spanish Only 10 8.7 Vietnamese Only 0 0.0 English/Spanish 17 14.8 English/Vietnamese 2 1.7 Other 0 0.0 Do you and/or your children have health insurance? (n = 63) Medicare - You 25 39.7 Medicaid - You 25 39.7 Medicaid - Your Children 17 27.0 Private - You 10 15.9 Private - Your Children 5 7.9 CHIP - Your Children 4 6.3 Medicare - Your Children 3 4.8 CHIP - You 1 1.6 2004 Community Health Opinion Survey Page 64

Harris County Hospital District Baytown Health Center Do you have a primary care physician or health care provider? (n = 107) Yes 57 53.3 No 50 46.7 Have you been denied healthcare you thought you needed? (n = 104) Yes 20 19.2 No 84 80.8 Do you or your children use HCHD services? (n = 103) Yes 64 62.1 No 39 37.9 If you do not use HCHD services, why not? (n = 33) Problem with transportation 14 42.4 Can't get an appointment 10 30.3 Problem with eligibility 9 27.3 Services not offered 8 24.2 Hours of operation 4 12.1 What clinic hours are best for you (Days)? (n = 106) Monday - Friday 53 50.0 Monday - Saturday 35 33.0 Monday - Sunday 18 17.0 2004 Community Health Opinion Survey Page 65

Harris County Hospital District Baytown Health Center What clinic hours are best for you (Hours)? (n = 107) 7:00 AM - 5:00 PM 44 41.1 7:00 AM - 7:00 PM 29 27.1 8:00 AM - 5:00 PM 16 15.0 8:00 AM - 8:00 PM 18 16.8 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 30 6 2 38 hours are best 30.0 6.0 2.0 38.0 for you (Hours) 7:00 AM - 7:00 PM? 9 14 5 28 9.0 14.0 5.0 28.0 8:00 AM - 5:00 PM 7 7 2 16 7.0 7.0 2.0 16.0 8:00 AM - 8:00 PM 3 6 9 18 3.0 6.0 9.0 18.0 Frequency 49 33 18 100 Percent 49.0 33.0 18.0 100.0 2004 Community Health Opinion Survey Page 66

Harris County Hospital District Baytown Health Center Which of the issues below are a problem in your community? (n = 109) Health Insurance 80 73.4 Tobacco / Drugs / Alcohol 63 57.8 Diabetes 59 54.1 Stress / Depression 54 49.5 Heart Disease / Stroke 38 34.9 Support Services for the Elderly 38 34.9 Nutrition / Exercise 38 34.9 Teen Pregnancy 30 27.5 Domestic Violence / Crime & Violence 27 24.8 Cancer 26 23.9 STD / AIDS / HIV 18 16.5 Sexual Assault / Rape 15 13.8 Immunizations 9 8.3 Injuries from Household Accidents 8 7.3 Other 6 5.5 How would you rate the overall health of your community? (n = 115) 1 - Very Bad 7 6.1 2 - Bad 9 7.8 3 - OK 67 58.3 4 - Good 22 19.1 5 - Very Good 10 8.7 2004 Community Health Opinion Survey Page 67

Harris County Hospital District Casa de Amigos Health Center What is your sex? (n = 98) Male 29 29.6 Female 69 70.4 How old are you? (n = 97) 18-33 33 34.0 34-49 21 21.6 50-65 22 22.7 66 and older 21 21.6 What language do you speak? (n = 92) English Only 22 23.9 Spanish Only 34 37.0 Vietnamese Only 3 3.3 English/Spanish 30 32.6 English/Vietnamese 3 3.3 Other 0 0.0 Do you and/or your children have health insurance? (n = 84) Medicaid - Your Children 33 39.3 Medicare - You 31 36.9 Private - You 26 31.0 Medicaid - You 18 21.4 CHIP - Your Children 10 11.9 CHIP - You 6 7.1 Private - Your Children 5 6.0 Medicare - Your Children 3 3.6 2004 Community Health Opinion Survey Page 68

Harris County Hospital District Casa de Amigos Health Center Do you have a primary care physician or health care provider? (n = 94) Yes 57 60.6 No 37 39.4 Have you been denied healthcare you thought you needed? (n = 92) Yes 23 25.0 No 69 75.0 Do you or your children use HCHD services? (n = 87) No 57 65.5 Yes 30 34.5 If you do not use HCHD services, why not? (n = 36) Problem with eligibility 19 52.8 Services not offered 11 30.6 Hours of operation 6 16.7 Problem with transportation 3 8.3 Can't get an appointment 3 8.3 What clinic hours are best for you (Days)? (n = 91) Monday - Friday 25 27.5 Monday - Saturday 42 46.2 Monday - Sunday 24 26.4 2004 Community Health Opinion Survey Page 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 22 22.7 7:00 AM - 7:00 PM 22 22.7 8:00 AM - 5:00 PM 18 18.6 8:00 AM - 8:00 PM 35 36.1 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 13 3 5 21 hours are best 14.4 3.3 5.6 23.3 for you (Hours) 7:00 AM - 7:00 PM? 15 4 19 16.7 4.4 21.1 8:00 AM - 5:00 PM 2 11 3 16 2.2 12.2 3.3 17.8 8:00 AM - 8:00 PM 10 13 11 34 11.1 14.4 12.2 37.8 Frequency 25 42 23 90 Percent 27.8 46.7 25.6 100.0 2004 Community Health Opinion Survey Page 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 63 64.9 Support Services for the Elderly 42 43.3 Health Insurance 38 39.2 Domestic Violence / Crime & Violence 37 38.1 Diabetes 35 36.1 Heart Disease / Stroke 35 36.1 Teen Pregnancy 31 32.0 Stress / Depression 28 28.9 Nutrition / Exercise 24 24.7 Cancer 21 21.6 Sexual Assault / Rape 19 19.6 Injuries from Household Accidents 17 17.5 STD / AIDS / HIV 14 14.4 Immunizations 12 12.4 Other 4 4.1 How would you rate the overall health of your community? (n = 95) 1 - Very Bad 0 0.0 2 - Bad 20 21.1 3 - OK 49 51.6 4 - Good 22 23.2 5 - Very Good 4 4.2 2004 Community Health Opinion Survey Page 71

Harris County Hospital District Gulfgate Health Center What is your sex? (n = 341) Male 107 31.4 Female 234 68.6 How old are you? (n = 338) 18-33 89 26.3 34-49 111 32.8 50-65 92 27.2 66 and older 46 13.6 What language do you speak? (n = 335) English Only 54 16.1 Spanish Only 88 26.3 Vietnamese Only 66 19.7 English/Spanish 97 29.0 English/Vietnamese 26 7.8 Other 4 1.2 Do you and/or your children have health insurance? (n = 198) Private - You 78 39.4 Medicaid - Your Children 48 24.2 Medicare - You 39 19.7 Medicaid - You 35 17.7 CHIP - Your Children 33 16.7 Private - Your Children 26 13.1 Medicare - Your Children 13 6.6 CHIP - You 3 1.5 2004 Community Health Opinion Survey Page 72

Harris County Hospital District Gulfgate Health Center Do you have a primary care physician or health care provider? (n = 340) Yes 202 59.4 No 138 40.6 Have you been denied healthcare you thought you needed? (n = 336) Yes 61 18.2 No 275 81.8 Do you or your children use HCHD services? (n = 338) No 207 61.2 Yes 131 38.8 If you do not use HCHD services, why not? (n = 154) Problem with eligibility 64 41.6 Services not offered 47 30.5 Can't get an appointment 39 25.3 Problem with transportation 21 13.6 Hours of operation 18 11.7 What clinic hours are best for you (Days)? (n = 330) Monday - Friday 111 33.6 Monday - Saturday 135 40.9 Monday - Sunday 84 25.5 2004 Community Health Opinion Survey Page 73