Memorial Hospital Community Health Needs Assessment 2013
Memorial Hospital Community Health Needs Assessment October 2013 Table of Contents Executive Summary Page 3 Background: Hospital Profile Page 4 Community Profile Page 5 Methodology Page 5 Service Area Page 5 Data Sources Page 5 Community Needs Assessment: Demographic Factors Page 6 Social and Economic Factors Page 7 Physical Environment Page 8 Clinical Care Page 8 Health Behaviors Page 10 Health Outcomes Page 11 Comparison of to Peer Counties Page 13 2
Executive Summary: In 2013 Memorial Hospital (PMH) conducted a Community Health Needs Assessment to identify health issues and community needs impacting the health of Residents. The results of this Community Health Needs Assessment were used to inform PMH s board and leadership decision-making with regard to how the hospital can positively impact the health of residents in its service area as part of the Hospital s strategic planning process. To assist PMH with conducting the community health needs assessment, PMH contracted the Center for Rural Health Development, Inc. In conjunction with the board, leadership and staff of Memorial Hospital, the needs assessment team sought the participation of a wider circle of interested residents through the conduct of key informant interviews. This Community Health Needs Assessment used multiple data collection tools and methods, both qualitative and quantitative, to conduct an epidemiological needs assessment of the factors that impact the health of residents. Key points of this report include the influence that the s demographic, geographic, socio-economic, clinical care and physical environment have on health outcomes of the residents of. The needs assessment team ensured data collection efforts were as inclusive as possible and incorporated the perspectives of diverse members of the community in terms of age, race/ethnicity, gender, profession, and geographic location. The team worked to develop meaningful partnerships with local agencies and other key informants in an effort to identify and mobilize community assets that will be used for the strategic planning process. 3
Hospital Profile: Marlinton Hospital and Infirmary was first established by the Court in 1926. It became known as Memorial Hospital as a tribute to the men and women who served in the military from. After nearly seventy years, the hospital was moved to Buckeye in October 1995. PMH is now a 25 bed critical access hospital with a federally designated Rural Health Clinic. The mission of Memorial Hospital is to be the community s first choice for integrated health care by hardwiring excellence through continuing education, effective collaboration and by providing exceptional customer service. In pursuing its mission, Memorial Hospital strives to: Be the provider of choice for health care to our communities. Create an environment that promotes healthy living. Be a key resource to promote stability in our communities. Be a leader in patient education, prevention and outreach. Promote physical, emotional and financial well-being of our communities. The guiding principles of Memorial Hospital are those principles which form the foundation on which we perform work and conduct ourselves. Our Nine Guiding Principles are: Principle 1: Commit to Excellence. Principle 2: Use Measurement to Diagnose Problems and improve Processes. Principle 3: Build a Culture around Service Principle 4: Create and Develop Leaders Principle 5: Focus on Employee Satisfaction Principle 6: Build Individual Accountability Principle 7: Align Behaviors with Goals and Values Principle 8: Communicate at All Levels Principle 9: Recognize and Reward Success Memorial Hospital is a 25 bed Critical Access Hospital that provides a continuum of services that include: Acute care Emergency services Diabetes education Laboratory services Occupational therapy Physical therapy Physical therapy X-ray and other imaging services Respite care for care givers Respiratory therapy Community outreach services and programs Skilled rehabilitation services Outpatient services, including physical exams, chronic disease management, family practice, immunizations and women s and children s services 4
Community Profile: Memorial Hospital is located in the county seat of Marlinton, WV in. is the home to the National Radio Astronomy Observatory Green Bank Telescope and is part of the National Radio Quiet Zone. In addition, the county is known as the birthplace of rivers as it is the location of the headwaters for eight rivers: Cherry River, Cranberry River, Elk River, Gauley River, Greenbrier River, Tygart Valley River, Williams River, and Shavers Fork of the Cheat River. has the highest average elevation of any county east of the Mississippi. The county also has the largest concentration of public lands in West Virginia of which 349,000 acres is either state or federal property. More than 800 miles of hiking and biking trails are located in the county with more than 1/3 of the Monongahela National Forest located within the county. Given its natural landscape, more than one million tourists visit the county each year, although the county is one of smallest in terms of population in West Virginia. Methodology: The purpose of the community health needs assessment was to compile current data on the key health issues faced by residents of. The community health needs assessment included both quantitative and qualitative assessments. Quantitative Assessment: Data was collected to create a profile of the following characteristics of the county: Demographic Factors Social and Economic Factors Physical Environment Clinical Care Health Behaviors Health Outcomes Qualitative Assessment: Key informant interviews were conducted with community leaders. Information from 19 key informants was collected representing a variety of sectors including local government, agriculture, education, industry and business, civic groups, public health, law enforcement, service industry, etc. Service Area: The service area is the geographic area from which a significant number of people using the hospital s services reside. As hospital utilization data provides the clearest definition of the service area, based on hospital discharge data for 2012, the bulk of patients discharged from Memorial Hospital resided in. Thus, was defined as the service area for this Community Health Needs Assessment. Data Sources: The following data sources were used in compiling the August 2013 Community Needs Assessment for, WV: Community Health Needs Assessment Data Report;, WV; May 2013. www.chna.org. Community Health Status Report;, WV; 2009; www.communityhealth.hhs.gov Key Informant Interviews; conducted June 2013. 5
Demographic Factors It is important to examine demographic factors in the service area as current population demographics and changes in demographic composition over time play a determining role in the types of health and social services needed by communities. As demonstrated in Table 1, has realized a 4.51% loss in population from 2000 to 2010. However, Table 1 Change in Total Population Total Population, 2010 Census Total Population, 2000 Census Percent Change from 2000-2010 Census, West Virginia 8,719 9,131-4.51% West Virginia 1,852,994 1,808,344 + 2.47% United States 308,745,538 281,421,906 + 9.71% hospital utilization is greatly impacted by the age groups that make up the total population. Thus, Table 2 indicates the total population by age groups in. As indicated the age group that uses the most health care services, age 65+ years, represents the greatest proportion of residents in the county. Table 2 Total Population, Percent by Age Groups Age 0-4 Age 5-17 Age 18-24 Age 25-34 Age 35-44 Age 45-54 Age 55-64 Age 65 + 4.58% 13.98% 6.57% 10.87% 12.43% 16.84% 16.02% 18.72% West Virginia 5.64% 15.52% 9.17% 11.94% 13.20% 15.15% 13.57% 15.82% United States 6.62% 17.73% 9.94% 13.22% 13.89% 14.57% 11.28% 12.75% The majority of residents are white (99.16%), with the next highest being Black (0.36%) and multiple races (0.26%). The Asian population was the only race identified as linguistically isolated. That is, 100% of the Asian population in aged 5 and older reported to speaking a language other than English at home and speaking English less than "very well." This indicator is relevant because an inability to speak English well creates barriers to healthcare access, provider communications, and health literacy/education. Key Informant interviews indicated that s aging population was a significant health determinant and as a result transportation and distance were also identified as major 6
problems in accessing health care services. In addition, a lack of availability for non-emergency medical transportation was identified as a major barrier to health care services. Social and Economic Factors Social and economic factors are examined as part of a community health assessment as economic and social insecurity often are associated with poor health. Poverty, unemployment, and lack of educational achievement affect access to care and a community s ability to engage in healthy behaviors. Without a network of support and a safe community, families cannot thrive. Ensuring access to social and economic resources provides a foundation for a healthy community. Tables 3 and 4 describe how relates to West Virginia and the nation in terms of the social and economic factors indicated. Those statistics highlighted in green indicate factors in which the population is exceeding state and/or national data; while those factors highlighted in red indicate areas in which the population is below state and/or national data. Report Area West Virginia United States HP 2020 Target %Adults Reporting Adequate Social or Emotional Support Table 3 Social and Economic Factors %Free/Reduced Price Lunch Eligible % Children in Poverty On-Time Graduation Rate %Population with Income Below 200% Poverty Level % Population with No High School Diploma 83.80% 59.93% 20.59% 82.60 43.59% 20.99% 81.00% 51.48% 23.79% 77 39.09% 18.09% 80.33% 48.34% 19.19% 75.50 31.98% 14.97% >82.4 Percent Population in Poverty Table 4 Social and Economic Factors % Population Receiving SNAP Benefits Teen Births /1,000 Births Unemployment Rate 15.27% 17.07% 42.50 0 West Virginia 17.35% 18.35% 46.20 7.30 United States 13.82% 12.60% 41.20 7.77 7
Physical Environment A community s health also is affected by the physical environment. A safe, clean environment that provides access to healthy food and recreational opportunities is important to maintaining and improving community health. Table 5 describes how relates to West Virginia and the nation in terms of the availability of healthy foods. Grocery stores are defined as supermarkets and smaller grocery stores primarily engaged in retailing a general line of food, such as canned and frozen foods; fresh fruits and vegetables; and fresh and prepared meats, fish, and poultry. Included are delicatessen-type establishments. Although data indicated that did not have problem with access to fresh fruits and vegetables, the key informant interviews indicated that the population, especially children, used gas stations to purchase meals and that many did not understand healthy eating concepts and thus were making very unhealthy food choices. Clinical Care # Fast Food Restaurants / 100,000 Pop Table 5 Physical Environment # Beer, Wine or Liquor Stores / 100,000 Pop # Grocery Stores / 100,000 Pop %Living in Food Deserts WIC- Authorized Food Store/ 100,000 Pop. Recreational Facilities / 100,000 Pop. 22.94 57.35 0 0% 56.91 no data WV 68.27 20.67 2.54 8.82% 18.80 7.45 US 69.14 21.81 10.20 9.10% 15.60 9.68 A lack of access to care presents barriers to good health. The supply and accessibility of facilities and physicians, the rate of un-insurance, financial hardship, transportation barriers, cultural competency, and coverage limitations affect access. Rates of morbidity, mortality, and emergency hospitalizations can be reduced if community residents access services such as health screenings, routine tests, and vaccinations. Prevention indicators can call attention to a lack of access or knowledge regarding one or more health issues and can inform program interventions. Table 6 describes how relates to West Virginia and the nation in terms of the factors impacted by access to clinical care services. Unfortunately, residents of indicate that the population is below state and/or national data with regard to clinical care indicators. Ambulatory Care Sensitive Conditions reports the discharge rate (per 8
1,000 Medicare enrollees) for conditions that are ambulatory care sensitive (ACS). ACS conditions include pneumonia, dehydration, asthma, diabetes, and other conditions which could have been prevented if adequate primary care resources were available and accessed by those patients. This indicator is relevant because analysis of ACS discharges allows demonstrating a possible return on investment from interventions that reduce admissions (for example, for uninsured or Medicaid patients) through better access to primary care resources. West Virginia United States Primary Care Providers / 100,000 Pop. % Females ages 67 69 Mammogram in Past 2 Years Table 6 Clinical Care %Medicare Enrollees with Diabetes receiving annual Hb A1c test % Adults w/o Pneumonia Vaccine Preventable Hospitalizations (ACS discharge rate) 68.81 57.83% 81.53% no data 106.82 87.80 60.74% 82.86% 53.57% 99.07 84.70 65.37% 83.81% 55.68% 66.54 Current Health Care Providers Memorial Hospital s Rural Health Clinic is designated as being located in a Health Professions Shortage Area (HPSA). In addition, the northern and southern regions of are designated as a Medically Underserved Areas (MUA). Table 7 lists the providers located in in October 2013. Key Informants indicated that the availability of local health care services was a concern. Although many indicated that they were satisfied with their primary care providers, they were concerned about what would happen if they left as many felt there were very few alternatives. Several key informants indicated that lack of specialists was a concern and many indicated that this is why they seek care out of the county. Although key informants indicated that PMH has made major improvements over the past few years, several indicated that there was a lingering community perception that the hospital was there to stabilize patients prior to transfer. Many of the key informants indicated a desire for the following services to be available in : OB/GYN, mammography, PAP tests MRI Non-emergency transportation Dialysis Pediatrics Expanded dental care, i.e. crowns and extractions Colonoscopy Orthopedics; need to be able to set bones Ophthalmology 9
Finally, key informants were pleased with the availability of after-hour and weekend care at the rural health clinic, but indicated that many in the community were unaware that these services were available. Several key informants indicated that they were well pleased with the school-based health centers. Table 7 Providers Located in October 2013 Provider Location Services Frankie Puckett, M.D. General Surgery Stephen Otto, M.D. PMH Emergency Medicine Mark Spitzer, M.D. PMH Emergency Medicine Luke McElwain, PMH Emergency Medicine Jeffrey Davis, M.D. PMH Emergency Medicine William Browning, JR, D.O. Northern Greenbrier Health Family Practice Clinic Neal Rehberg, D.O. PMH Family Practice Patricia Browning, D.O. Northern Greenbrier Health Family Practice Clinic Sarita Bennett, D.O. Marlinton Family Practice Terry Thomas, D.O. PMH Family Practice Dr. Debra Auble, MD Community Care Family Practice Donna Lidel Burley, NP PMH Nurse Practitioner; Family Practice Rachel Taylor, PA-C Community Care Physician Assistant; Family Practice Valarie Monico, PA-C PMH Physician Assistant; Family Practice Dr. Jennifer Beverage, D.O. Community Care Osteopathic Manipulative Medicine Dr. John Eilers, D.O. Big Springs Clinic Osteopathic Manipulative Medicine Health Behaviors Health behaviors such as poor diet, a lack of exercise, and substance abuse contribute to poor health status and thus are important to understand in planning for future health services in the service area. Table 8 describes how relates to West Virginia and the nation in terms of selected health behaviors. Those statistics highlighted in green indicate factors in which the population is exceeding state and/or national data; while those factors highlighted in red indicate areas in which the population is below state and/or national data. Information from the key informant interviews validated that obesity, as well as lack of physical activity and poor eating habits were concerns. The key informants were especially concerned about these issues in children. In addition, substance abuse was also identified as a concern by several key informants. 10
Table 8 Health Behaviors % Adults % Adult % Adult % Adult Heavy Consuming Few Physically Cigarette Drinkers Fruits or Inactive Smokers Vegetables 17.40% 75.20% 18.70% 32.21% West Virginia 11% 81.30% 28.30% 26.40% United States 16.61% 75.92% 24.66% 19.27% Health Outcomes Measuring morbidity and mortality rates allows assessing linkages between social determinants of health and outcomes. By comparing, for example, the prevalence of certain chronic diseases to indicators in other categories (e.g., poor diet and exercise) with outcomes (e.g., high rates of obesity and diabetes), various causal relationship may emerge, allowing a better understanding of how certain community health needs may be addressed. Tables 9, 10, 11 and 12 describe how relates to West Virginia and the nation in terms of health outcomes. Unfortunately, residents of indicate that the population is below state and/or national data with regard to health outcomes for several of the health outcome indicators reported. It is important to note that 41.53% of the suicide deaths are in males in. Breast Cancer Incidence/ 100,000 Pop Table 9 Health Outcomes Cancer Mortality / 100,000 Pop. Cervical Cancer Incidence / 100,000 Pop. Colon/rectal Cancer incidence/ 100,000 Pop. 110.40 184.29 no data 39.90 West Virginia 112.20 201.68 9.80 52.60 United States 122 176.66 8 40.20 HP 2020 Target: < 160.6 < 7.1 < 38.6 11
Table 10 Health Outcomes Heart Disease Percent Adults Infant Mortality / % Low Birth Deaths / 100,000 with Diabetes 1,000 Births Weight Pop. 10.80% 140.28 17.19 9.32% West Virginia 11.39% 154.65 7.60 9.31% United States 8.77% 134.65 6.71 8.10% HP 2020 Target: < 100.8 < 6.0 Table 11 Health Outcomes Lung Cancer Incidence/ 100,000 Pop Motor Vehicle Deaths/ 100,000 Pop % Adult Obesity % Adults Reporting Poor General Health 84.90 42.05 30.90% 22% West Virginia 90.40 18.60 32.92% 21.60% United States 67.20 11.13 27.35% 16.27% HP 2020 Target: < 12.4 Prostate Cancer Incidence / 100,000 Pop Table 12 Health Outcomes Stroke Deaths / 100,000 Pop Suicide Deaths / 100,000 Pop Prostate Cancer Incidence /100,000 Pop 91.80 60.37 20.54 91.80 West Virginia 138.40 48.19 14.14 138.40 United States 151.40 41.78 11.57 151.40 HP 2020 Target: < 33.8 < 10.2 12
Peer Counties The Community Health Needs Assessment also identified counties and county-like geographic areas were identified as peer counties to. Peer counties were stratified on the basis of the following factors: frontier status, population size, poverty, age, population density. Below are peer county ranges representing the 10 th and 90 th percentile of values: Population size: 4,798 13,625 Population density (people/sq mile): 8 19 Individuals living below poverty level: 16.8 25.4% Age Distribution: Under age 19: 20.4-25.4% Age 19-64: 55.1-62.0% Age 65 84: 12.8-19.7% Age 85+: 2.3-4.3% Race/Ethnicity: White: 71.2-98.0% Black: 0.2-26.1% American Indian: 0.2-16.4% Asian/Pacific Islander: 0.1-0.8% Hispanic origin: 0.9-23.6% Those counties identified a Peer Counties to included: Arkansas: Bradley Fulton Montgomery Scott Searcy Stone Georgia: Quitman Iowa: Decatur Michigan: Lake Missouri: Oregon Ozark Putnam Scotland St. Clair Wayne Worth Montana: Deer Lodge Oklahoma: Atoka Cotton Greer Hughes Jefferson Nowata Okfuskee Pushmataha Texas: Childress Coleman Comanche Delta Hardeman Haskell Houston Mitchell Red River San Augustine Trinity 13
Compared to US Rates FAVORABLE UNFAVORABLE Table 13 indicates how compared to its Peer Counties in terms of health indicators. Table 13 s Health Indicators Compared to Peer Counties Compared to Peer Counties UNFAVORABLE FAVORABLE Low Birth Weight (<2500 g) Infant Mortality White non-hispanic Infant Mortality Neonatal Infant Mortality Post-neonatal Infant Mortality Breast Cancer (female) Suicide Unintentional Injury Births to Women under 18 Colon Cancer Coronary Heart Disease Lung Cancer Motor Vehicle Injuries Stroke Very Low Birth Weight (<1500 g) Premature Births (< 37 weeks) Births to Women age 40-54 Births to Unmarried Women No Care in First Trimester Indicates a status favorable to peer county median value Indicates that a closer look and perhaps redicution to the percent or rate may be needed 14