community health needs assessment...•comprehensive report suitable for submission to the irs that...

Community Health Needs Assessment

Five Stage Process

• Current/projected demographics

• Capacity of area physicians to help address community health issues.

STAGE 1 – MAPPING Secondary data Online survey of physicians

• Overview of the health needs of the area’s population and what resources are in place to address these needs

STAGE 2 – COMMUNITY HEALTH NEEDS/ANALYSIS Secondary Research

• Learn what residents see as the greatest unmet health needs of the area

• Understand the community’s sense of health

STAGE 3 – VALIDATE FINDINGS Primary Research: Phone + Online: 302 consumers

• Develop consensus on how we can all work together to meet the health needs of the entire community

STAGE 4 – COMMUNITY ENGAGEMENT / SUMMIT Leadership Forum with local agency and government leaders

• Comprehensive report suitable for submission to the IRS that outlines community health needs and the role of the hospital in addressing those needs

STAGE 5 – FINAL REPORT Written report/presentation by Stratasan

PATIENT ORIGIN Data Analysis

3

AUGUSTA COUNTY DEMOGRAPHICS Data Analysis

8

Demographic Dashboard

Source: Stratasan/ESRI 9

Category Augusta Co Staunton

City Waynesboro

City Augusta

Health Area Virginia USA

Population 73,606 23,968 21,068 118,642 8,064,574 311,212,863 Median Age 43.1 42.4 38.8 42.3 37.4 37.2

Median Income $51,273 $39,219 $38,765 $46,329 $58,234 $50,227

Educ ≥ % Assoc/Bach

23.5% 30.9% 26.3% 25.7% 40.3% 34.9%

Pop Growth 11-16 0.46% 0.65% 0.51% 0.51% 0.86% 0.67% Households 28,458 10,583 8,930 47,971 3,080,302 117,457,661 Businesses 2,041 1,296 1,080 4,417 289,694 11,699,792 Employees 29,567 13,674 11,918 55,159 3,725,018 127,274,941

Medical Care Index 101 85 81 94 120 100

Average Health Spend

$3,660 $3,053 $2,916 $3,386 $4,340 $3,611

Total Spent $104,165,018 $32,309,989 $26,035,456 $162,420,486 $13,369,323,978 $424,173,676,593

The geography analyzed in this report is the Augusta Health Area also known as Augusta County Inclusive Area, which is Augusta County, Staunton, and Waynesboro.

Income and Race/Ethnicity

10

The inclusive County has wide ranges of household incomes, but a very homogeneous racial and ethnic population

Source: Stratasan/ESRI

Age Distribution – Augusta County Inclusive

0%

5%

10%

15%

20%

0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

2011 Augusta Area VA US

0%

5%

10%

15%

20%

0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

2016 Augusta Area VA US

11 The population is older than Virginia or the US Source: Stratasan/ESRI

2011 Population by ZIP Code

12

2011-2016 Population Growth Per Year

13

HH Income < $15,000 by census tracts

14

BUSINESS ENVIRONMENT Data Analysis

15

Retail, 729

Other Services, 657

Construction, 385

Healthcare, 349

Accommodation & Food, 297

Professional, Scientific & Tech

Services, 269

Finance & Insurance, 240

Real Estate,

Rental, & Leasing,

229

Finance, 189

Administrative & Support & Waste Management &

Remediation Services, 183

Manufacturing, 183

Wholesale, 173

Transportation & Warehousing, 115 Education, 101

Ag/Forestry/Fishing & Hunting, 81

Arts, Entertainment & Recreation, 76

Information, 76

Unclassified, 45

Utilities, 7

Mining, 5 Management, 2

The Business Community - # of Businesses

16 Augusta Area; North America Industry Classification (NAICS)

Healthcare, 8,504

Retail, 7,399

Manufacturing, 6,778

Wholesale Trade, 4,904

Accommodation & Food, 4,364

Education, 4,149

Public Admin., 3,884

Construction, 2,778

Finance, 189

Professional, Scientific & Tech Services, 2,527

Transportation & Warehousing, 1,837

Finance & Insurance, 1,300

Real Estate, Rental, & Leasing, 1,055

Information, 919

Administrative & Support & Waste Mgt & Remediation Svcs,

886

Arts, Entertainment & Rec, 598

Ag/Forestry/Fishing & Hunting, 424

Unclassified, 144

Management, 51

Utilities, 46 Mining, 40

The Business Community - # of Employees

17 Augusta Area; North America Industry Classification (NAICS)

Largest Employers

18


Unemployment May 2012

19 Source: Bureau of Labor Statistics

Unemployment Augusta County

20 Source: VA Economic Development Partnership; Bureau of Labor Statistics

May 2011 May 2012 Change

Augusta County 5.7% 5.2% -0.5

Waynesboro City 7.9% 6.5% -1.4

Staunton City 6.5% 6.0% -0.5

Commuter In-migration

21


Commuter Out-migration

22


Leakage/Surplus Factor by Industry Subsector

23

People are going without or leaving the area for furniture & home furnishing stores, electronics & appliance stores, clothing & clothing accessories stores, sporting goods, hobby, book & music stores.

23Source: Stratasan/ESRI; Augusta County Inclusive

Psychographics

24

Who Report

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Augusta PatientsResidents

The graph of your community’s psychographic profile

#17 – Green Acres 40.7 yrs, $64,480, DIY, fishing, camping, satellite TV, have a garden, own multiple vehicles

#33 – Midlife Junction 41.5 yrs, $49,139, married couples, preparing to retire, fishing, reading

#14 – Prosperous Empty Nesters 48.6 yrs, $69,227, professionals, civic clubs, travel, golf & baseball

#25 – Salt of the Earth 41.5 yrs, $51,080, married couples, professionals, gardening, CMT, NASCAR

#29 – Rustbelt Retirees 45.6 yrs, $52,728, married no kids & singles, professionals, bingo, news TV, belong to community groups

Top Tapestry Groups

Things Your Patients Do More-Likely

Used prescription drug for arthritis/rheumatism 63%

Wear bi-focals 62%

Own treadmill 54%

Diet control for salt restriction 53%

Have life insurance w/total value: <$20000 51%

Have life insurance w/total value: $20000-49999 50%

Used prescription drug for high blood pressure 47%

Used prescr drug for diabetes (non-insulin) 46%

Used prescription drug for high cholesterol 46%

Used prescription drug for heartburn/acid reflux 43%

Visited doctor in last 12 mo: chiropractor 40%

Obtained medical insurance: Medicare 37%

Have life insurance: separate whole life policy 36%

Used prescription drug for depression 36%

Own stationary bicycle 35%

Diet control for blood sugar level 34%

Bought prescription eyewear: from eye doctor 33%

Have prescription medicine insurance 32%


Used prescription drug for anxiety/panic 28%

Used doctor`s care/diet for diet method 28%

Have accidental death and dismemberment insurance 26%

Obtained medical insurance: Medicaid 26%

Have life insurance: comb. term/whole life policy 24%

Diet control for cholesterol level 24%

Things Your Patients Don’t Do Less-Likely

Have medical insurance: Kaiser Permanente 78%

Vitamin/dietary suppl used/6 mo: echinacea 38%

Vitamin/dietary suppl used/6 mo: B complex+C 38%

Have life insurance w/total value: $500000+ 37%

Used last 6 mo: lactose intolerance product 32%

Vitamin/dietary suppl/6 mo: Centrum 32%

Exercise at club 2+ times per week 30%

Used nutrition/energy bar in last 6 months 28%

Vitamin/dietary suppl used/6 mo: A 27%

Used egg alternatives in last 6 months 24%

Visited doctor in last 12 mo: dermatologist 23%

Used butter alternatives in last 6 months 23%


Visited doctor in last 12 mo: allergist 22%

Have medical insurance: Cigna 22%

Vitamin/dietary suppl used/6 mo: antioxidant 20%

Used prescription drug for eczema/skin itch/rash 20%

Drank sports drink/thirst quencher in last 6 mo 18%

Have medical insurance - belong to HMO 18%

Used last 6 mo: children`s cough syrup 16%

Buy foods specifically labeled as natural/organic 16%

Drank meal/dietary supplement in last 6 months 15%

Visited doctor in last 12 mo: ear/nose/throat 15%

Used last 6 mo: children`s cold tablets/liquids 13%

Spent on contact lenses in last 12 mo: $100-199 13%

What Health Report: Health Habits The Healthy Habits of Your Patients

Things Your Patients Do More-Likely

HH owns riding lawn mower 222%

HH owns kerosene heater 196%

Shopped at grocery store/6 mo: IGA 179%

HH owns garden tiller 171%

Participated in hunting with shotgun 170%

HH owns welder 150%

Fam rest/steak hse last 6 mo: Bob Evans Farm 147%

Participated in hunting with rifle 144%

HH owns chain saw (gas) 139%

Shopped at grocery store/6 mo: Shop`N Save 136%

Participated in archery 135%

Have special Seniors Club account 127%

Shopped at grocery store/6 mo: Aldi 126%

HH owns stationary radial arm saw 126%

HH owns ATV/UTV 121%

Purchased vegetable seeds in last 12 months 120%

Did birdwatching in last 12 months 114%

HH owns stationary drill press 114%

Shopped at grocery store/6 mo: Fred Meyer 112%

HH owns dehumidifier 110%

Appl/hardware/electr store/12 mo: True Value 110%

Fam rest/steak hse last 6 mo: Perkins 107%

HH has satellite dish: Dish Network 107%

HH owns stationary table saw 105%

Purchased vegetable plants in last 12 months 104%

Things Your Patients Don’t Do Less-Likely

Radio format listen to: Hispanic 84%

Have medical insurance: Kaiser Permanente 78%

Visited Disneyland (CA) in last 12 months 75%

Dept/clothing/variety store/3 mo: Nordstrom 70%

Shopped at grocery store/6 mo: Vons 69%

Radio format listen to: all news 68%

Fast food/drive-in last 6 mo: Del Taco 68%

Drug store shopped at last 6 mo: Longs Drug Store 67%

Dept/clothing/variety store/3 mo: Crate & Barrel 65%

Shopped at grocery store/6 mo: Pathmark 65%

Fam rest/steak hse last 6 mo: Cheesecake Factory 63%

Drank cognac in last 6 months 62%

Used nectars in last 6 months 62%

Shopped at grocery store/6 mo: Whole Foods Market 62%

Airline used for domestic trip/12 mo: Continental 61%

HH made phone call to foreign country last 30 days 60%

Radio format listen to: jazz 59%

Spent $100+ at laundries/laundromats in last 6 mo 59%

Dept/clothing/variety store/3 mo: Banana Republic 59%

Fast food/drive-in last 6 mo: Carl`s Jr. 57%

Airline used for domestic trip/12 mo: American 56%

Shopped at AM/PM in last 6 months 55%

Shopped at grocery store/6 mo: A & P 54%

Fast food/drive-in last 6 mo: Popeyes 54%

Fast food/drive-in last 6 mo: Chipotle Mex. Grill 54%

What Summary Report: Behavior Habits The Behavior Habits of Your Patients

Health Service Demand

Stratasan Health Service Projections

29

Health Service Demand Overview

The ( _ ) = the rate of occurrence in your combined service area Rate = # Patients / Total Population 30

0.0

0.1

0.2

0.3

0.4

0.5

0.6

Inpatient Outpatient Emergency

Augusta County Staunton City Waynesboro City

Augusta Health Area Virginia USA

Source: Stratasan



0.0

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1.0

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2.0

2.5

3.0

3.5

4.0

4.5

5.0

Physician Office Visits

Augusta County Staunton City Waynesboro City


Source: Stratasan



Augusta County

Staunton City

Waynesboro City


Inpatient 9,618 3,610 3,177 16,405 1,019,756 40,692,505

(0.134) (0.151) (0.147) (0.140) (0.128) (0.131)

Outpatient 18,453 6,898 5,868 31,219 2,287,388 96,404,868

(0.256) (0.289) (0.272) (0.266) (0.287) (0.310)

Emergency 31,997 11,624 10,160 53,781 3,710,519 136,176,760

(0.444) (0.487) (0.472) (0.458) (0.466) (0.438)

Physician 296,440 100,674 89,076 486,190 28,875,808 1,045,262,266

Office Visits (4.116) (4.220) (4.134) (4.151) (3.625) (3.359)

Source: Stratasan

ENVIRONMENT & HEALTH DATA Data Analysis

33

Crime per 100,000 Population

34 34

Source: County Sheriff’s Offices and City Police Departments Town Police and VA State Police not included

0

2,000

4,000

6,000

8,000

10,000

12,000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Augusta Co

Staunton

Waynesboro

35 Source: Stratasan; ESRI

Chemical Spills and Releases

36

Releases: Manganese Compounds Hydrochloric Acid Lead Trichloroethylene (2) Copper Zinc Lead

Current Health Breakouts

37

38 Source: Virginia Department of Health (VDH), Center for Health Statistics

Smoked 9+ Packs of Cigarettes per Week

39

Used Prescription Drug for Asthma

40

98

Used Prescription Drug for High Blood Pressure

41

Used Prescription Drug for Diabetes

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Used Prescription Drug for Depression

43

Doctor’s Care for Diet

44

MARKET RESEARCH

45

Research Methodology

CHR worked closed with the AH team to design a 35-question survey

to validate the findings in Stages 1-2 while capturing community

attitudes and awareness.

Once the questionnaire design was approved, CHR handled all

aspects of the surveying process – programming the survey, hosting,

call center management, data collection, tabulation and analysis.

General population data was purchased and screened in order to

reach a random sample of the population that was representative of

the demographics of AH’s primary and secondary service areas.

CHR administered this survey through its signature M3 (MultiMode

Methodology) approach, combining landline and cell phone

interviews. A total of 302 responses were completed during the

period of July 14 – 26, 2012.

46

Community residents have a much rosier view of their health

status than do the physicians.

47

26%

50%

7%

12%

4% 0%

2%

7%

56%

21%

12%

0%

Excellent Very Good Just Okay Fair Poor Don't know

Community Physician

Base: 321

Community Q. Generally, how would you describe your health? Would you say it is…?

Physician Q. How would you describe the overall health status of the citizens of Augusta County and the surrounding counties?

Respondents represented a mixture of activity

levels – from 30% who exercise most every day,

to 11% who do not exercise at all.

Base: 302

Q26. During the past month, other than on your regular job, about how often did you participate in any physical activities or exercise such as walking,

running, weight-lifting, team sports, etc.? 48

Other mentions include:

• “Expensive”

• “I am on oxygen.”

• “I am tired after working.”

• “I don't like it. I am getting old and tired.”

• “I get enough physical activity out of my work.”

• “I work third shift and I'm tired.”

• “It is too hot.”

• “My job engages me to do exercise.”

• “On disability”

• “I am limited to what I can do.”

About two-thirds of these respondents turn to

their primary care doctor (68%) and another 22%

turn to the hospital for basic healthcare needs. turn to the hospital for basic healthcare needs.

Base: 302

Q23. If you have one person or group you turn to for basic healthcare needs, where do you go most often? 49

Other Mentions:

• “DaVita”

• “My gynecologist”

• “Nurse practitioner”

• “My wife (she’s a nurse)”

Physician access and financial issues sometimes

prevent people from seeing a doctor.

Base: 302

Q24. Was there a time in the past 12 months when you needed to see a doctor but could not?

Q25. What are some of the reasons why you could not see a doctor? (base = 47) 50

Other Mentions:

• “I don't know. They just had me waiting

in waiting in the emergency room.”

• “Miscommunication”

About one-third of respondents (35%)

indicated that they currently have some type

of chronic disease or condition.

Base: 302

Q33. Have you ever been told by a doctor you have a chronic disease, condition or challenge? 51

Other Mentions:

• Allergies

• Anemia

• Aneurism

• Carcinoma

• Degenerative knee

• Disabled related to an

accident

• Diverticulitis

• Gastrointestinal

• Graves disease

• Liver transplant

• Low thyroid

• Lupus

• PAD

• Sarcoidosis

• Vascular issues

Personal accountability, affordable health insurance, and

substance abuse are seen as the most impactful health issues here.

Base: 302

Q30. What are the top 2 or 3 issues in your community that impact people’s health? 52

Other Mentions (1% or fewer each):

• More specialists

• Safe neighborhoods

• Aging

• Education

• Information about how to cook healthy foods

• Information about managing chronic health

conditions

• Dental health services

• Mental health & behavioral health services

• More urgent care clinics

• Abuse and violence

• Affordable housing

• Safe/affordable places to relax

Six out of ten respondents agree that prescription drug

abuse is a major problem in the community (60%).

Base: 302

Q31. To what extent do you agree or disagree with the following statement?: “Prescription drug abuse is a major problem in the community.” 53

Respondents feel that people in the community may benefit from

health programs and information as well as cost-efficient care.

Base: 141 (those who answered)

Q35. What healthcare, health education or public health services or programs would you like to see offered in your community? 55

Diet and exercise top the list of concerns for children’s health in

the community.

Base: 302

Q36. In your opinion, which of these are the top 3 health concerns for children in your community? 56

Physician Survey Results

61 Respondents

57 57

What do you think the people in this region need in order to manage their health more effectively? (Select all that apply)

58 58

32.8%

1.6%

4.9%

13.1%

27.9%

39.3%

44.3%

45.9%

47.5%

47.5%

50.8%

0% 20% 40% 60%

Other (please specify)

Nothing else is needed at this time

More specialists

Health information exchange between providers…

Transportation to doctor, clinic, health center, etc.

Easier access to health and wellness services

A more integrated approach among providers to…

Insurance that's more affordable for more people

Financial assistance-for doctor visits, medical…

Compliance to drug therapies/prescriptions

More information/education about their…

In your opinion, what are the top three (3) health and community issues that need to be addressed in Augusta County and the surrounding area?

(Please select up to three responses)

59

0% 20% 40% 60%

Access: Vision health services

Community Issue: Affordable Housing

Lifestyle: Affordable, fresh foods

Lifestyle: More sidewalks

Access: Health care services for seniors

Access: More specialists

LIfestyle: Safe and affordable places to exercise

Community Issue: Transportation

Community Issue: Poverty

Access: Substance abuse services

Lifestyle: Information on nutrition and healthy cooking

Lifestyle: Waling or bike paths or trails

Community Issue: Education

Lifestyle: Affordable healhy lifestyle of fitness programs

Access: Dental health services

Lifestyle: Information on managing chronic health conditions

Access: Affordable services and programs

Community Issue: Jobs/Employment

Access: Mental health and behavioral health services

Access: Affordable health insurance

Access: More primary care professionals

Lifestyle: People taking more responability for their own health…

Community Focus Group Summary

On June 29, 20 community members participated in a focus group for input into community health needs Two other people were interviewed via telephone

22 Total Input

60 60

Most Important Health Issues • Mental/behavioral health; lack of psychiatrists

• Substance abuse: Salts, prescription drugs, methamphetamine

• Economic issues: jobs and employment, public housing, culture

• Diet and nutrition – fast food diet, affordable fresh, natural foods

• Lifestyle

• Access to services based on knowledge services exist

• Lack of access to dental services

• Abuse and violence, particularly elder abuse-self neglect, financial exploitation

• Chronic Diseases – Diabetes

– Heart Disease

– High Blood Pressure

• Smoking

• Obesity

• Teen pregnancy

61 61

How to Collaborate

• Targeted outreach – smaller is better

• Communication

• Nurturing Neighboring Networks

• Grassroots

• Community Health Forum in existence

62 62

Barriers/Political Issues

63

• There are pockets and subcultures in the County

• Need for more relationships across groups and geographies

• Some elderly and poor people do not have access to computers

• There is no transportation, cell phones or financial resources in part of the County, therefore difficulty communicating

• Lack of internal willingness to change

• Agencies stepping over each other for funding

• Communication – always too many people not knowing what is going on

63

The Health Status of the Community

64 64

Virginia State Health Rankings - 20

65

• In the past year, the % of children in poverty decreased from 15% to 12% • In the past year, binge drinking increased from 14 to 15% of adults • In the past 5 yrs, diabetes increased from 7% to 9%. 535,000 VA adults have diabetes • In the past 10 yrs, obesity increased from 18% to 26% of adults. 1.6 M Virginians are obese • While smoking decreased from 21% to 19% of adults in last 10 yrs, this is a much smaller

reduction than other states. More than 1.1 M adults still smoke in VA. America’s Health Rankings

Virginia

Source: http://www.americashealthrankings.org/VA/

Virginia

Source: CDC BRFSS

DIABETES

Virginia

Source: http://www.americashealthrankings.org/VA

How do we rank for health?

69 Source: County Health Rankings

County Health Rankings

County Health Rankings 2012

Category Augusta Staunton Waynesboro Albemarle Bath Nelson Rockbridge Rockingham

Overall Rank (1 to 134) #31 #53 #64 #4 #51 #23 #57 #20

Health Outcomes 31 53 64 4 51 23 57 20

Health Factors 24 56 67 4 40 47 46 27

Mortality 35 60 80 6 40 56 57 18

Morbidity 25 50 50 4 71 1 64 30

Health Behaviors 20 46 59 10 63 30 55 8

Clinical Care 27 50 14 4 35 60 42 111

Social & Economics 43 75 105 8 44 48 51 25

Physical Environment 26 7 27 35 39 100 25 83

Smoking 17% NA NA 14% NA NA 19% 12%

Obesity 27% 28% 28% 27% 27% 26% 29% 27%

Binge Drinking 10% NA NA 15% NA 8% 18% 11%

70

Health Factors: health behaviors, clinical care, social and economic, and the physical environment. Health Outcomes: how long people live (mortality) and how healthy people feel and low birth weight babies (morbidity).

Health Issues Utilization

73

Community Health Issues Utilization

Hypertension, HBP Cardiology, Neurology

Diabetes Endocrinology

Aging Orthopedics

Smoking Oncology

Obesity Bariatrics, Gastroenterology

Behavioral Therapy

Top ER Visits Injury & Poisoning Symptoms, signs, and ill-defined conditions (kitchen sink: everything from a crying baby to abdominal pain, respiratory arrest to decreased libido) ICD9 codes 780 - 799.99

Respiratory System Disease

Musculoskeletal System and Connective Issues

Digestive System Disease

Source: County Health Rankings, Stratasan 73

Where we do go from here… • Augusta County is relatively healthy, but is aging. Need to

engage with Chamber to attract younger, higher wager earners.

• Invest in low cost/free tools and applications to track disease. • The epidemiology is changing and the hospital will need to be

prepared in 5-10 years to handle significantly more Diabetes, Obesity, CHF, and COPD.

• In the future, we will have to care for the WHOLE Community. This will require different tools and skills.

• Think about a Three-Way Marketing strategy for the cities (Waynesboro and Staunton) and the county.

• Think innovatively about how to make the attitudinal changes in the community to create a sense of health.

74

community health needs assessment...•comprehensive report suitable for submission to the irs that...

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