Princeton Baptist Medical Center Community Health Needs Assessment

Transcription

1 Community Health Needs Assessment Fiscal Year 2013

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3 Table of Contents Introduction... 4 Princeton Baptist Medical Center at a Glance... 4 Community Overview... 4 Purpose... 6 Community Health Needs Assessment Background... 6 Requirements... 6 CHNA Strategy... 7 Health Profile... 9 Secondary Data Collection and Analysis Methodology... 9 Demographics Socioeconomic Education Social Environment Health Outcomes and Risk Factors Maternal and Child Health Mortality Indicators Access to Care Community Input Interview Methodology Community Leader Interviews Health Needs Prioritization Community Health Priorities Reference List Appendix A: Carnahan Group Qualifications Appendix B: Community Leader Interviewees

4 Introduction Princeton Baptist Medical Center at a Glance Princeton Baptist Medical Center, located in Birmingham, Alabama is part of Baptist Health System, a faith-based, not-for-profit health care system consisting of four hospitals and a network of health centers serving north and central Alabama. Providing services to the greater Birmingham area, Princeton Baptist Medical Center (PBMC) is dedicated to Baptist Health System s faith-based ministry, focusing on whole-body wellness for all of its patients. The medical center has 499 beds and more than 400 physicians representing 30 specialties. In 2012, the American Heart Association/American Stoke Association awarded the Advanced Certification for Primary Stoke Centers to PBMC; this achievement recognizes the hospital s commitment to excellence in improving outcomes for stroke patients. Community Overview For the purpose of this report, Princeton Baptist Medical Center Stark II Phase II service area (SA) was used to define the community. The service area for Princeton Baptist Medical Center includes the following ZIP Codes: ZIP Code Community ZIP Code Community Birmingham Pleasant Grove Bessemer Birmingham Birmingham Jasper Bessemer Dora Birmingham Birmingham Birmingham Adamsville Bessemer Birmingham Birmingham Cordova Gardendale Nauvoo Warrior Birmingham Birmingham Empire Jasper Parrish Mc Calla Carbon Hill Birmingham Quinton Fairfield Mulga Birmingham Oakman Jasper Sumiton Graysville 4

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6 Purpose Community Health Needs Assessment Background On October 25, 2011, Baptist Health System contracted with Carnahan Group to conduct a Community Health Needs Assessment (CHNA) as required by the Patient Protection and Affordable Care Act (PPACA). Please refer to Appendix A: Carnahan Group Qualifications for more information about the Carnahan Group. The PPACA, enacted on March 23, 2010, requires not-for-profit hospital organizations to conduct a CHNA once every three taxable years that meets the requirements the Internal Revenue Code 501(r) set forth by the PPACA. The PPACA defines a hospital organization as an organization that operates a facility required by a state to be licensed, registered, or similarly recognized as a hospital; or, a hospital organization is any other organization that the Treasury s Office of the Assistant Secretary ( Secretary ) determines has the provision of hospital care as its principal function or purpose constituting the basis for its exemption under section 501(c)(3). Additionally, if a hospital organization operates more than one hospital facility, section 501(r)(2)(B)(i) requires the organization to meet all of the section 501(r)(1) requirements, including the CHNA requirements, separately with respect to each hospital facility. Therefore, a separate CHNA is being conducted for each Baptist Health Systems hospital. A CHNA is a report based on epidemiological, qualitative and comparative methods that assesses the health issues in a hospital organization s community and that community s access to services related to those issues. Based on the findings of the CHNA, an implementation strategy for Princeton Baptist Medical Center that addresses the community health needs will be developed and adopted by the end of fiscal year Requirements As required by the Treasury Department ( Treasury ) and the Internal Revenue Service (IRS), this CHNA includes the following: A description of the community served; A description of the process and methods used to conduct the CHNA, including: o o A description of the sources and dates of the data and the other information used in the assessment; and, The analytical methods applied to identify community health needs; 6

7 A description of information gaps that impacted Princeton Baptist Medical Center s ability to assess the health needs of the community served; The identification of all organizations with which Princeton Baptist Medical Center collaborated, if applicable, including their qualifications; A description of how Princeton Baptist Medical Center took into account input from persons who represented the broad interests of the community served by Princeton Baptist Medical Center, including those with special knowledge of or expertise in public health and any individual providing input who was a leader or representative of the community served by Princeton Baptist Medical Center; A prioritized description of all of the community health needs identified through the CHNA and a description of the process and criteria used in prioritizing those needs. CHNA Strategy This CHNA was conducted following the requirements outlined by the Treasury and the IRS, which included obtaining necessary information from the following sources: Input from persons who represented the broad interests of the community served by PBMC, which included those with special knowledge of or expertise in public health; Identifying federal, tribal, regional, state, or local health or other departments or agencies, with current data or other information relevant to the health needs of the community served by PBMC, leaders, representatives, or members of medically underserved, low-income, and minority populations with chronic disease needs in the community served by PBMC; and, Consultation or input from other persons located in and/or serving PBMC s community, such as: o Health care community advocates; o Nonprofit organizations; o Academic experts; o Local government officials; o Community-based organizations, including organizations focused on one or more health issues; o Health care providers, including community health centers and other providers focusing on medically underserved populations, low-income persons, minority groups, or those with chronic disease needs; 7

8 The sources used for PBMC s CHNA are provided in the References and Appendix B: Community Leader Interviewees. Information was gathered by conducting interviews that included various Jefferson County community leaders and elected officials. 8

9 Health Profile Secondary Data Collection and Analysis Methodology A variety of data sources were utilized to gather demographic and health indicators for the community served by Princeton Baptist Medical Center. The PBMC service area ZIP Codes can be found on p 4. The majority of ZIP Codes are completely or partially inside Jefferson County. Other ZIP codes are in Walker County. Data by ZIP Code are used if available. Where ZIP Code data are unavailable, county data for Jefferson and Walker counties are displayed. Jefferson County is the focus of this report, because it is where PBMC is located and accounts for the majority of the population in the service area. For most indicators, Jefferson County data are compared to state level data. Walker County data is displayed for reference, because it accounts for a portion of the service area. 9

10 Demographics Population Change by ZIP Code Populations are expected to decline in the majority of PBMC ZIP Codes over the next five years. The total projected decline for the PBMC service area is 1.6%. Table 1 - Population Change by ZIP Code, ZIP Code Community Population 2012 Population 2017 Percent Change Birmingham 46,683 46, % Bessemer 25,349 25, % Bessemer 26,314 24, % Birmingham 25,626 24, % Bessemer 21,459 23, % Birmingham 19,022 18, % Mc Calla 16,236 18, % Birmingham 16,557 15, % Gardendale 15,653 16, % Warrior 14,877 15, % Birmingham 14,903 14, % Jasper 13,611 13, % Birmingham 11,195 10, % Fairfield 11,177 10, % Birmingham 11,187 10, % Jasper 10,517 10, % Pleasant Grove 9,995 10, % Birmingham 10,170 9, % Jasper 8,908 8, % Birmingham 8,876 8, % Dora 7,840 7, % Adamsville 7,946 7, % Birmingham 7,040 6, % Birmingham 6,334 5, % Nauvoo 5,681 5, % Cordova 5,607 5, % Empire 4,329 4, % Birmingham 4,755 4, % Carbon Hill 4,249 4, % Parrish 3,579 3, % Mulga 3,321 3, % Quinton 3,090 2, % Oakman 3,040 3, % Sumiton 2,722 2, % Graysville 2,596 2, % Total 410, , % Source: Claritas

11 Population Change by Age and Gender Slight population declines are expected for individuals under the age of 65. The population ages 65 and over is expected to grow moderately (6.2%). Table 2 - Population by Age and Gender, Percent Change Age Group Male Female Total Male Female Total Male Female Total Age 0 through 17 51,395 49, ,628 50,825 48,476 99, % -1.5% -1.3% Age 18 through 44 70,836 74, ,303 68,837 71, , % -4.6% -3.7% Age 45 through 64 48,551 56, ,528 47,177 54, , % -3.7% -3.3% Age 65 and over 22,957 36,028 58,985 24,832 37,808 62, % 4.9% 6.2% Total 193, , , , , , % -2.1% -1.6% Source: Claritas 2012 Population by Race and Ethnicity The majority of the population in PBMC s service area is black/african American (50.6%) followed by white (45.0%), Hispanic (2.8%), two races (0.9%), Asian/Pacific Islander (0.4%) and other (0.3%). Figure 1 Race Composition, % 2.8% 0.3% 0.4% 50.6% 45.0% White Black/African American Asian/ Pacific Islander Two Races Hispanic Other 11

12 Population Change by Race and Ethnicity In PBMC s service area, the following populations are expected to grow substantially over the next five years: Asian/Pacific Islander (21.7%) and Hispanic (21.2%). Moderate growth is expected for biracial (7.3%) and other race (5.0%) populations, while the white population is expected to decline moderately (- 5.4%). Table 3 - Population Change by Race and Ethnicity, Population Population Percent Race & Ethnicity Change White 184, , % Black/African American 207, , % Asian/ Pacific Islander 1,781 2, % Two Races 3,661 3, % Hispanic 11,404 13, % Other 1,279 1, % Source: Claritas

13 Black/African American Population Change by ZIP Code The black/african American population is expected to decline in approximately half of PBMC s service area ZIP codes, while population growth is expected for the other half. Large growth is expected in 35111, and Overall, the population is expected to remain largely unchanged over the next five years. Table 4 - Black/African American Population Change by ZIP Code, ZIP Code Community Population 2012 Population 2017 Percent Change Birmingham 33,109 35, % Birmingham 22,667 21, % Bessemer 19,647 18, % Birmingham 14,771 14, % Birmingham 13,661 12, % Birmingham 12,778 12, % Fairfield 10,546 10, % Birmingham 9,158 8, % Birmingham 9,396 8, % Bessemer 6,580 7, % Birmingham 8,086 7, % Bessemer 7,759 9, % Birmingham 7,727 6, % Birmingham 6,532 6, % Pleasant Grove 4,675 5, % Birmingham 4,541 4, % Birmingham 4,058 3, % Adamsville 3,299 3, % Mc Calla 2,172 3, % Jasper 1,712 1, % Gardendale 1,170 1, % Graysville % Warrior % Cordova % Mulga % Jasper % Parrish % Empire % Dora % Carbon Hill % Oakman % Quinton % Jasper % Sumiton % Nauvoo % Total 207, , % Source: Claritas

14 Hispanic Population Change by ZIP Code Moderate to substantial growth in the Hispanic population is expected for all but two PBMC ZIP Codes over the next five years. Overall, the Hispanic population is expected to grow by 21.2% in the PBMC service area. The ZIP Codes with the largest population growth are: 35071, 35504, 35023, 35218, 35111, 35180, and Table 5 - Hispanic Population Change by ZIP Code, ZIP Code Community Population 2012 Population 2017 Percent Change Birmingham 2,035 2, % Bessemer 1,886 2, % Birmingham % Birmingham % Bessemer % Jasper % Gardendale % Birmingham % Birmingham % Jasper % Birmingham % Bessemer % Birmingham % Birmingham % Mc Calla % Birmingham % Jasper % Fairfield % Birmingham % Warrior % Adamsville % Nauvoo % Birmingham % Birmingham % Cordova % Empire % Dora % Pleasant Grove % Carbon Hill % Parrish % Mulga % Graysville % Quinton % Oakman % Sumiton % Total 11,404 13, % Source: Claritas

15 Women of Childbearing Age Population Change by ZIP Code Declines in populations of women of childbearing age (women ages 15-44) are expected for most PBMC service area ZIP Codes. An overall decline of 4.9% is expected over the next five years. Table 6 - Women of Childbearing Age Population Change by ZIP Code, ZIP Code Community Population 2012 Population 2017 Percent Change Adamsville 1,558 1, % Bessemer 5,461 5, % Bessemer 4,186 4, % Bessemer 4,562 4, % Dora 1,512 1, % Empire % Fairfield 2,514 2, % Gardendale 2,868 2, % Graysville % Mc Calla 3,192 3, % Mulga % Pleasant Grove 1,923 1, % Quinton % Sumiton % Warrior 2,963 2, % Birmingham 2,306 2, % Birmingham 3,366 2, % Birmingham 1,870 1, % Birmingham 3,362 3, % Birmingham 5,595 5, % Birmingham 2,527 2, % Birmingham 3,765 3, % Birmingham 10,017 9, % Birmingham 1,636 1, % Birmingham 1, % Birmingham 1,299 1, % Birmingham 2,189 2, % Jasper 1,878 1, % Jasper 1,604 1, % Jasper 2,432 2, % Carbon Hill % Cordova 1, % Nauvoo 1,063 1, % Oakman % Parrish % Total 82,668 78, % Source: Claritas

16 Population Change of Individuals Ages 65 and Older by ZIP Code In the majority of PBMC ZIP Codes, the population of individuals aged 65 and older is expected to increase over the next five years. The overall expected growth is 6.2%. Table 7 - Individuals Ages 65 and Older Population Change by ZIP Code, ZIP Code Community Population 2012 Population 2017 Percent Change Birmingham 5,563 5, % Bessemer 3,827 4, % Bessemer 3,858 3, % Birmingham 3,583 3, % Bessemer 2,903 3, % Birmingham 2,975 2, % Gardendale 2,838 3, % Jasper 2,365 2, % Warrior 2,029 2, % Mc Calla 2,024 2, % Birmingham 2,457 2, % Birmingham 2,223 2, % Jasper 1,968 2, % Jasper 1,453 1, % Pleasant Grove 1,565 1, % Birmingham 1,462 1, % Adamsville 1,226 1, % Fairfield 1,527 1, % Birmingham 1,252 1, % Dora 1,067 1, % Birmingham 1,293 1, % Birmingham 1,083 1, % Cordova 1,015 1, % Nauvoo % Birmingham % Carbon Hill % Birmingham % Birmingham % Empire % Parrish % Quinton % Mulga % Oakman % Graysville % Sumiton % Total 58,985 62, % Source: Claritas

17 Socioeconomic Socioeconomic Characteristics According to the 2011 annual average unemployment rates reported by the U.S. Bureau of Labor Statistics, Jefferson County has a similar unemployment rate (8.7%) compared to Alabama (9.0%). Federal poverty thresholds are determined by family size, number of children and age of the head of the household. A family s income before taxes is compared to the annual poverty thresholds. If the income is below the threshold, the family and each individual in it are considered to be in poverty. In 2010, the poverty threshold for a family of four was $22,314. According to the U.S. Census American Community Survey (ACS) estimates, Jefferson County had a slightly lower percentage of individuals below the poverty threshold (16.0%) compared to Alabama (17.4%). Children in Jefferson County are less likely to live in poverty (23.5%) compared to children in Alabama (24.9%). Table 8 - Socioeconomic Indicators Jefferson County Walker County Alabama Unemployment Rate, annual average 1 8.7% 9.5% 9.0% Individuals Below Poverty Level % 18.7% 17.4% Children Below Poverty Level % 28.2% 24.9% 1 Source: Bureau of Labor Statistics 2 Source: Census - American Community Survey 17

18 Education Education Indicators The Alabama State Department of Education reported data from the school year indicating fewer Jefferson County students were approved for free or reduced lunch (49.7%) compared to students in Alabama (55.8%). The projected four-year dropout rate reported by Alabama s Education Report Card for Jefferson County (8.0%) is slightly above Alabama s (5.6%). The graduation rate in Jefferson County (64.4%) is similar to Alabama (65.8%). Table 9 - Education Indicators, 2011 Jefferson County Walker County Alabama Students Approved For Free Or Reduced Lunch % 65.8% 55.8% Four-Year Dropout Rate 1 8.0% 11.3% 5.6% High School Graduation Rate % 67.5% 65.8% 1Source: Alabama State Department of Education, Source: Kids Count Data Center, 2010 Educational Attainment The U.S. Census ACS publishes estimates of the highest level of education completed for residents 25 years and older. The ACS estimates indicate that fewer Jefferson County residents have not earned a high school degree or equivalent (13.1%) compared to Alabama residents (18.1%). Jefferson County residents are more likely to have a bachelor s degree than all Alabama residents (28.5% compared to 21.9%). Table 10 - Highest Level of Education Completed by Persons 25 Years and Older, Jefferson County Walker County Alabama Less than a High School Degree 13.1% 24.9% 18.1% High School Degree 58.4% 65.2% 60.0% Bachelor's Degree 28.5% 9.9% 21.9% Source: Census - American Community Survey 18

19 Social Environment Crime Rates According to the Alabama Criminal Justice Information System, in 2010, Jefferson County had higher rates of homicide, assault and robbery compared to the state of Alabama. The homicide rate in Jefferson County (12.6 per 100,000) is more than double Alabama s (5.3 per 100,000). Rape was reported at a lower rate in Jefferson County (44.7 per 100,000) compared to Alabama (56.2 per 100,000). Jefferson County had substantially higher assault and robbery rates compared to Alabama (see table below). Table 11 - Crime Rates, 2010 Jefferson County Walker County Alabama Homicide Rate per 100, Rape Rate per 100, Assault Rate per 100, Robbery Rate per 100, Source: Alabama Criminal Justice Information System 19

20 Health Outcomes and Risk Factors The following heart and stroke data from The Centers for Disease Control and Prevention (CDC) are presented using age-adjusted rates which are preferred because they allow for better comparison of rates across county and state data. The CDC defines age-adjusted rates as disease or mortality rates that have been statistically modified to eliminate the effect of different age distributions among different populations. The CDC reported age-adjusted rates (directly age-adjusted to the standard 2000 United States population) for various health outcomes, which are presented in Tables Heart Disease Mortality Rates Residents aged 65 and older in Jefferson County are less likely to die from heart disease (1,214.0 per 100,000) compared to Alabama (1,420.7 per 100,000). Blacks in Jefferson County are more likely to have heart disease (1,335.5 per 100,000) compared to whites (1,188.9 per 100,000). Males in Jefferson County and Alabama have a substantially higher likelihood of dying from heart disease compared to females (see table below). Table 12 - Age-Adjusted Heart Disease Mortality Rates per 100,000, Adults Ages 65 and Older by Race and Gender, Jefferson County Walker County Alabama Heart Disease, All 1, , ,420.7 Heart Disease, White (Non-Hispanic) 1, , ,422.0 Heart Disease, Black (Non-Hispanic) 1, , ,515.3 Heart Disease, Male 1, , ,710.4 Heart Disease, Female 1, , ,229.0 Source: Centers for Disease Control and Prevention *Insufficient data 20

21 Heart Attack Mortality Rates Deaths from acute myocardial infarctions (AMI), commonly known as heart attacks, are less common in Jefferson County than in Alabama. The overall heart attack mortality rate for residents 65 and older in Jefferson County (209.6 per 100,000) is substantially lower than in Alabama (277.6 per 100,000). In Jefferson County, blacks and whites have similar heart attack mortality rates. Blacks in Alabama have a slightly higher heart attack mortality rate (294.0 per 100,000) compared to whites (278.7 per 100,000). Males in Jefferson County and Alabama are substantially more likely to die from a heart attack compared to females (see table below). Table 13 - Age-Adjusted Heart Attack (Acute Myocardial Infarctions) Mortality Rates per 100,000, Adults Ages 65 and Older by Race and Gender, Jefferson County Walker County Alabama Heart Attack, All Heart Attack, White (Non-Hispanic) Heart Attack, Black (Non-Hispanic) Heart Attack, Male Heart Attack, Female Source: Centers for Disease Control and Prevention *Insufficient data 21

22 Stroke Mortality Rates Jefferson County residents ages 65 and older are slightly more likely to die from a stroke (372.7 per 100,000) than residents in Alabama (351.2 per 100,000). Black residents in Jefferson County and Alabama are substantially more likely to die from a stroke compared to white residents (see table below). There is a slightly higher stroke mortality rate among women in Jefferson County (370.4 per 100,000) compared to men (353.8 per 100,000). Table 14 - Age-Adjusted Stroke Mortality Rates per 100,000, Adults Ages 65 and Older by Race and Gender, Jefferson County Walker County Alabama Stroke, All Stroke, White (Non-Hispanic) Stroke, Black (Non-Hispanic) Stroke, Male Stroke, Female Source: Centers for Disease Control and Prevention *Insufficient data Hypertension Mortality Rates Hypertension mortality in persons ages 65 and older in Jefferson County (743.9 per 100,000) is higher than in Alabama (636.9 per 100,000). Blacks in Jefferson County and Alabama are almost twice as likely to die from hypertension compared to whites. In Jefferson County, hypertension mortality is similar in males than females. Table 15 - Age-Adjusted Hypertension Mortality Rates per 100,000, Adults Ages 65 and Older by Race and Gender, Jefferson County Walker County Alabama Hypertension, All Hypertension, White (Non-Hispanic) Hypertension, Black (Non-Hispanic) 1, ,044.9 Hypertension, Male Hypertension, Female Source: Centers for Disease Control and Prevention *Insufficient data 22

23 Age-Adjusted Diabetes Adults in Jefferson County and in Alabama have a similar likelihood of being diagnosed with diabetes. Table 16 - Age-Adjusted Diabetes in Adults Ages 20 and Older, 2009 Jefferson County Walker County Alabama Adults with Diagnosed Diabetes 11.7% 13.0% 12.3% Source: Centers for Disease Control and Prevention Health Risk Factors An adult with a body mass index of 30 or higher is considered obese. Obesity and overweight substantially increase the risk of morbidity from hypertension; dyslipidemia; type 2 diabetes; coronary heart disease; stroke; gallbladder disease; osteoarthritis; sleep apnea and respiratory problems; and endometrial, breast, prostate, and colon cancers. Higher body weights are also associated with increases in all-cause mortality. 1 According to CDC s National Diabetes Surveillance System, adult obesity is similar in Jefferson County (31.9%) and Alabama (31.6%). Physical inactivity in this report is defined as not participating in any physical activities or exercises such as running, calisthenics, golf, gardening or walking for exercise in the past month. Jefferson County (28.8%) and Alabama (31.0%) are similar with respect to adult physical inactivity. Table 17 - Health Risk Factors in Adults Ages 20 and Older, 2009 Jefferson County Walker County Alabama Adult Obesity 31.9% 35.0% 31.6% Physical Inactivity 28.8% 36.9% 31.0% Source: Centers for Disease Control and Prevention 1 Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Accessed 9/12/

24 Recreational Facilities According to the USDA Food Environment Atlas in 2009, there were 11.1 recreational facilities per 100,000 population in Jefferson County. There is no Alabama data available for comparison. Table 18 - Recreational Facilities by County, 2009 Jefferson County Walker County Alabama Recreational Facility Rate (per 100,000 population) N/A Source: USDA Food Environment Atlas Communicable Diseases Data on reportable communicable diseases are available through the Auburn Montgomery Center for Demographic Research. In 2010, Jefferson County s reported HIV incidence and prevalence rates were approximately double Alabama s (see table below). Jefferson County has a substantially higher chlamydia rate (812.5 per 100,000) compared to Alabama (574.6 per 100,000). The gonorrhea and syphilis rates in Jefferson County are roughly double Alabama s (see table below). Of the 146 tuberculosis cases reported to the Alabama Department of Public Health (ADPH) in 2010, twenty-nine occurred in Jefferson County. Table 19 - Reported Communicable Disease Rates and Cases, 2010 Jefferson County Walker County Alabama HIV Incidence per 100, HIV Prevalence per 100, Chlamydia per 100, Gonorrhea per 100, Syphillis per 100, Tuberculosis cases* Source: Auburn Montgomery - Center for Demographic Research *Source: Alabama Department of Public Health, 2010 County Health Profiles 24

25 Maternal and Child Health Maternal and Child Health Indicators A birth rate is defined as the number of live births per 1,000 persons in a given year. According to the ADPH 2010 County Health Profiles, the birth rate in Jefferson County (13.5 per 1,000) was similar to the birth rate in Alabama (12.5 per 1,000). The teen birth rate in Alabama is defined as the number of births per 1,000 persons aged Jefferson County had a slightly lower teen birth rate (20.8 per 1,000) compared to Alabama (22.9 per 1,000). Women in Jefferson are about as likely to receive prenatal care in the first trimester (81.1%) as women in Alabama (79.8%). Adequate prenatal care in this report is defined as receiving 80% or more of the expected prenatal visits based on the Kotelchuck Index; whereas, inadequate care in this report is defined as 79% or less of expected prenatal visits. The percentage of women in Jefferson County who receive adequate prenatal care (77.2%) is slightly higher than Alabama (73.0%). Women in Jefferson County are less likely to receive inadequate care (22.8%) compared to women in Alabama (27.0%). Low birthweight is defined as less than 2,500 grams (5 lbs 8oz). Low birthweight births were about as likely to occur in Jefferson County (11.3%) as in Alabama (10.3%). Teen women in Jefferson County were as likely to have low birthweight babies (7.6%) than teen women in Alabama (11.6%). The infant mortality rate in Jefferson County (11.6 per 1,000) is slightly higher than in Alabama (8.7 per 1,000). Table 20 - Maternal Child Health Indicators, 2010 Jefferson County Walker County Alabama Birth Rate (per 1,000 population) Teen Birth Rate (per 1,000 population aged years) Women Receiving Prenatal Care in First Trimester 81.1% 83.6% 79.8% Women Receiving Adequate Prenatal Care 77.2% 87.2% 73.0% Women Receiving Inadequate Care 22.8% 12.8% 27.0% Low Weight Births* 11.3% 10.7% 10.3% Low Weight Births to Teen Women (10-19 years old) 11.9% 7.6% 11.6% Infant Mortality Rate (per 1,000 births) Source: Alabama Department of Public Health, 2010 County Health Profiles * Percent of all births w ith know n status 25

26 Mortality Indicators The ADPH 2010 County Health Profile for Jefferson County reported that its residents have a similar life expectancy at birth (75.3 years) compared to Alabama (75.5 years). The death rate in Jefferson County (10.3 per 1,000) is similar to Alabama s (10.0 per 1,000). Table 21 - Mortality Indicators, 2010 Jefferson County Walker County Alabama Life Expectancy at Birth in Years Death Rate (per 1,000 population) Source: Alabama Department of Public Health, 2010 County Health Profiles Age-Specific Mortality Rates Among individuals aged 0-14, mortality rates in Jefferson County (1.0 per 1,000) and Alabama (0.8 per 1,000) are similar. Jefferson County and Alabama have similar mortality rates for individuals in all other age groups (see table below). Table 22 - Age Specific Mortality Rates per 100,000 Persons, 2010 Jefferson County Walker County Alabama 0-14 years old years old years old years old years and older Source: Alabama Department of Public Health, 2010 County Health Profiles 26

27 Select Causes of Death Heart disease, cancer and stroke are the three leading causes of death respectively in Jefferson County, while heart disease, cancer and chronic lower respiratory disease (CLRD) are the top three in Alabama. Heart disease and cancer death rates are slightly lower in Jefferson County than in Alabama. Mortalities from CLRD, stroke, Alzheimer s disease, diabetes and influenza and pneumonia are similar in Jefferson County and Alabama. Suicide in Jefferson County is lower than in Alabama while homicide is substantially higher. Table 23 - Select Causes of Death Rates per 100,000 Population, 2010 Jefferson County Walker County Alabama Heart Disease Cancer Chronic Lower Respiratory Disease Accidents Stroke Alzheimer's Disease Diabetes Influenza and Pneumonia Suicide Homicide HIV Source: Alabama Department of Public Health, 2010 County Health Profiles 27

28 Access to Care Health Insurance Coverage The U.S. Census American Community Survey estimates for indicated that health insurance coverage is similar in Jefferson County (86.5%) and Alabama (86.0%). Percentages of residents with private and public health insurance coverage in Jefferson County and Alabama are similar (see table below). Jefferson County and Alabama are similar with respect to uninsured adults and children (see table below). Table 24 - Health Insurance Coverage, Jefferson County Walker County Alabama Health Insurance Coverage 86.5% 85.2% 86.0% Private Insurance 67.9% 63.8% 67.2% Public Coverage 30.0% 38.4% 31.6% No Health Insurance Coverage 13.5% 14.8% 14.0% No Health Insurance Coverage (Children) 6.7% 4.7% 6.5% Source: Cenus - American Community Survey 28

29 Community Input The interview data is qualitative in nature and should be interpreted as reflecting the values and perceptions of those interviewed. This portion of the CHNA process is meant to gather input from persons who represent the broad interest of the community serviced by the hospital facility, as well as individuals providing input who have special knowledge or expertise in public health. It is meant to provide depth and richness to the quantitative data collected. The most commonly discussed health issues identified by PBMC physicians, community healthcare organization employees, and faith-based employees are presented here. Interview Methodology Interviews were conducted by phone based on the availability of the interviewee. Interviews required approximately 30 minutes to complete. Interviewers followed the same process for each interview, which included documenting the interviewee s expertise and experience related to the community. Additionally, the following community focused questions were used as the basis for discussion: Interviewee s name Interviewee s title Interviewee s organization What are the top three strengths of the community? What are the top three health concerns of the community? What are the health assets and resources available in the community? What are the health assets or resources that the community lacks? What assets or resources in the community are not being used to their full capacity? What are the barriers to obtaining health services in the community? What is the single most important thing that could be done to improve the health in the community? What changes or trends in the community do you expect over the next five years? What other information can be provided about the community that has not already been discussed? 29

30 Community Leader Interviews Interviewees discussed that the Birmingham area is very rich in health care assets and services. There are a wide range of quality providers, excellent medical education and research facilities, and a surplus of hospital beds in the region. The Mpower Clinic is a not-for-profit medical clinic that provides acute care and dispenses medication free of charge. Other organizations that provide health services and programs in the area include: The Birmingham-Jefferson Red Cross, the YMCA of Greater Birmingham, American Heart Association, American Lung Association and American Cancer Association. Despite a wealth of health assets and services in many areas, there were some resources that interviewees felt the community could use more of. There was concern that there is not adequate access to care across all socioeconomic levels, and that while there has historically been good indigent care, the resources for this were diminishing and would be a future challenge. Cooper Green Hospital is scheduled to close by December 1, 2012, which will affect a source of care that was relied upon by many low income individuals. Additionally, the delivery of psychiatric care in Alabama is in a state of reform, which will likely increase the burden on all other facilities. A lack of detox beds was discussed. There is also a need for better coordination of care for geriatric patients and persons with dementia and Alzheimer s disease. Transportation for doctor s appointments is a barrier that prevents some residents from accessing health care services, in part because there is not an effective public transportation system for residents to use. Another barrier is a lack of health insurance; however, even when individuals have health insurance the cost of health care may be prohibitive. Addressing obesity in adults and children was considered one of the most important health issues to address to broadly affect the health of residents. Other common health concerns discussed by interviewees that affect residents in Birmingham were: asthma and lung health, diabetes, cardiovascular disease (CVD), physical activity, nutrition, mental health and access to health care. Less commonly mentioned health issues were: air quality, disaster preparedness, cancer, smoking, maternal child health and STIs. Interviewees had several suggestions on ways to improve health in the community by development of new programs and expansion of existing ones. One suggestion was to improve communication between healthcare systems, and also between healthcare systems and the public, because the public are unaware lots of good programs that provide services. A related suggestion was to develop educational programs that inform people how to interact with the healthcare system, for example, there was previously a program that worked to provide information about health insurance forms and requirements. It had a 30

31 train-the-trainer program that educated people who were at clinics to help people with their insurance questions. In addition to education about health insurance, it was suggested that there be more education about how the healthcare system works at a fundamental level. Examples of topics were: medical homes, the differences between seeing a physician at an office and in the emergency department (ED), what services are available and what the eligibility requirements are. Similarly, traditional health education methods focusing on topics such as hypertension, diabetes and obesity was also recommended. Programs that improve healthy behaviors and promote healthy lifestyle habits were also discussed. A current program is the walking school bus where once a week children are dropped off a mile from school and parents meet the children to walk them safely to school. One interviewee would like to see a walking track built in the neighborhood, and though there are some plans for this project, so far it has been stalled. Greater access to healthy foods and expansion of a food truck program that drives health food throughout communities was suggested. Building upon community garden programs was also discussed as a way to improve access to healthy foods. Currently, there is a partnership between West End Community Gardens (WECG) and Princeton Hospital and Hemphill Elementary where WECG holds community markets to sell fresh produce. 31

32 Health Needs Prioritization Community Health Priorities The overarching goal in conducting this Community Health Needs Assessment is to identify those health needs perceived by the community as important, and consequently to assess the comprehensiveness of PBMC s strategies in addressing these needs. For the purpose of identifying health needs for PBMC, a health priority is defined as a medical condition or factor that is central to the state of health of the residents in the service area. Through a mixed methods approach, an exhaustive list of health needs was compiled, and utilizing a high, medium and low ranking system, 11 of these were identified as priorities. Part of this approach involved comparing service area indicators to the Healthy People 2020 (HP 2020) objectives. The HP 2020 goals are science-based, ten-year national objectives for improving the health of all Americans. The 11 priorities included on this list that fell in the high or medium rank include cancer, cardiovascular disease, tuberculosis, diabetes, health care, maternal and child health, mental health, nutrition, overweight/obesity, smoking and sexually transmitted infections (STIs). These needs are ordered alphabetically. Cancer Cancer is the second leading cause of death in the service area. Additionally, the cancer death rate is substantially higher in Jefferson County than the HP 2020 objective. Some interviewees mentioned that cancer and prevention of breast, lung and colorectal cancer, specifically, is important in the community. Cardiovascular Disease Included in the cardiovascular disease category are hypertension, stroke, heart disease and heart attacks. Heart disease is the leading cause of death in the service area, while stroke ranks third. In residents ages 65 and older, there are health disparities among blacks compared to whites with respect to heart disease, stroke and hypertension mortalities. Cardiovascular disease was commonly mentioned among interviewees. Other health concerns contributing to cardiovascular disease mentioned in the interviews were obesity, diabetes, physical activity and nutrition. 32

33 Tuberculosis Of the 146 cases of tuberculosis in Alabama in 2010, approximately 20% (29 cases) occurred in Jefferson County. Diabetes Jefferson County has a high burden of disease with respect to diabetes (11.7%) Diabetes was a common health concern discussed in the interviews. Behaviors related to diabetes such as physical activity and nutrition were also common themes among interviewees. Health Care The percentage of insured individuals is below the HP 2020 goal of 100%. Interviewees feel the community has a wealth of resources in the community, but there is not adequate access to care across all socioeconomic levels. Barriers such as transportation, lack of health insurance and cost of health care were expressed as health concerns in the interviews. Because the community has an abundance of resources, interviewees suggested that programs designed to educate community residents and promote interaction may help bridge the gap in access to care. Maternal and Child Health Included in the maternal and child health category are infant mortality, teen birth rate, prenatal care and low birthweight. Infant mortality in Jefferson County is higher than in Alabama and the HP 2020 objective. Jefferson County has a higher percentage of low weight births compared to Alabama and the HP 2020 goal. Mental Health The potential closing of psychiatric hospitals statewide was expressed as a concern due to the burden it will place on other facilities. Interviewees also expressed concern for the care of elderly residents with dementia and Alzheimer s disease. 33

34 Nutrition Nutrition was a commonly discussed health concern among interviewees. Interviewees also discussed new programs enhancing access to healthy foods and the expansion of a current program that utilizes a food truck to deliver healthy food throughout communities. Overweight/Obesity According to the World Health Organization, obesity (BMI 30) and overweight (BMI= ) refer to abnormal or excessive fat accumulation. Overweight/obesity is a health condition contributing to the development of cardiovascular disease and diabetes. In Jefferson County, cardiovascular disease is the leading cause of death, while diabetes ranks sixth. Nearly one in three (31.6%) Jefferson County adults reported a BMI greater than or equal to 30. This percentage is slightly higher than the HP 2020 objective. Interviewees commonly discussed various health concerns related to overweight/obesity such as physical activity, nutrition, diabetes and cardiovascular disease. Smoking Interviewees mentioned smoking as a health concern in the community. STIs Included in the STI category are reported HIV incidence and prevalence, chlamydia, gonorrhea and syphilis. In Jefferson County, HIV prevalence and gonorrhea rates are more than double the Alabama rates. HIV incidence and syphilis rates in Jefferson County are nearly double Alabama s rates. Chlamydia is also substantially higher in Jefferson County compared to Alabama. 34

35 Reference List 1. INTELLIMED International. (2012). Claritas United States Department of Labor, Bureau of Labor Statistics. (2012). Labor force data by county, 2011 annual average. Retrieved from website: ftp://ftp.bls.gov/pub/special.requests/la/laucnty11.txt 3. U.S. Department of Commerce, U.S. Census Bureau. (2010). Poverty thresholds by size of family and number of children. Retrieved from website: 4. U.S. Census Bureau, American Fact Finder. (2010) American Community Survey 3- Year Estimates. Retrieved from website: 5. Alabama State Department of Education. (2012). Alabama's Education Report Card Retrieved from website: 6. The Annie E. Casey Foundation, Kids Count Data Center. (2012). Profile for Walker County. Retrieved from website: 7. The Annie E. Casey Foundation, Kids Count Data Center. (2012). Profile for Jefferson County. Retrieved from website: 8. Alabama Criminal Justice Information System. (2012). Crime in Alabama Retrieved from website: 9. Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention. (n.d.). Interactive Atlas of Heart Disease and Stroke Tables. Retrieved from website: 35

36 10. Centers for Disease Control and Prevention, Division of Diabetes Translation. (n.d.).county Level Estimates of Diagnosed Diabetes. Retrieved from website: U.S. Department of Agriculture, (2012). Food Environment Atlas. Retrieved from website: Djamba, Y. K., & Brown, E. K. Auburn University at Montgomery, Center for Demographic Research. (2011) Alabama HIV/AIDS & STDs Data Sheet. Retrieved from website: Poster.pdf 13. Alabama Department of Public Health, Center for Health Statistics. (n.d.) County Health Profiles. Retrieved from website: 36

37 Appendix A: Carnahan Group Qualifications Carnahan Group is an independent and objective healthcare consulting firm that focuses on the convergence of regulations and planning. For nearly 10 years, Carnahan Group has been trusted by healthcare organizations throughout the nation as an industry leader in providing Fair Market Valuations, Medical Staff Demand Analyses, Community Health Needs Assessments and Strategic Planning. Carnahan Group serves a variety of healthcare organizations, such as, but not limited to, hospitals and health systems, large and small medical practices, imaging centers and ambulatory surgery centers. Carnahan Group offers services through highly trained and experienced employees, and Carnahan Group s dedication to healthcare organizations ensures relevant and specific insight into the needs of our clients. Our staff members offer diverse capabilities and backgrounds, including: CPAs, JDs, Ph.Ds., and others with medical and clinical backgrounds; Degrees that include Masters of Business Administration, Masters of Science, Masters of Public Health, Masters of Accounting and Masters of Health Administration; and, Serving as members of the American Institute of CPAs (AICPA), Medical Group Management Association (MGMA), and the National Association of Certified Valuation Analysts (NACVA). 37

38 Appendix B: Community Leader Interviewees Name Title Organization Rosemary Blackmon Executive Diractor Alabama Hospital Association Joe Acker Executive Director Birmingham Emergency Medical Services System (BREMSS) Nena Sanders Dean Ida V. Moffett School of Nursing, Samford University Ama Shambulia Director WE Community Gardents, Urban Ministry RG Lyons Minister Urban Ministries Janice Tyson Counselor Hemphill Elementary School Michael Wesley Pastor Greater Shiloh Baptist Church Naomi Truman Executive Director Housing Authority of Birmingham Cedric Sparks Executive Director Division of Youth Services Shauntice Allen Associate Clarus Consulting Group Gus Heard-Hughes Director of Initiatives Community Foundation of Greater Birmingham 38