2013 Community Health Needs Assessment

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1 April Community Health Needs Assessment Pleasant Valley Hospital Point Pleasant, West Virginia

2 Table of Contents Introduction Assessment Objective...1 Community Health Needs Assessment Market Definition...1 Executive Summary Community Input: Process and Summary Research Process...3 Collecting Community Input...3 Summary of Major Findings and Observations...4 Key Statistics and Research Findings: Population and Demographics Population Information...5 Age Distribution...5 Race and Ethnicity...6 Education...6 Income and Employment...8 Poverty Level...9 Health Insurance Status Key Statistics and Research Findings: Health Status National Health Perspective (United States) Regional Health Perspective (West Virginia) Local Health Perspective (Mason County) Mason County Health Resources Interview, Survey and Focus Group Summary i

3 Summary Interview Findings Survey Results Focus Group Findings Prioritizing Health Needs Appendix Mason County Health Resources CHNA Survey Questions Sources ii

4 Introduction Pleasant Valley Hospital (PVH) was established in 1959 in Point Pleasant, West Virginia and today, cares for over 2,300 inpatients residing in the communities between Southeastern Ohio and West Virginia. PVH is a 101 bed acute care hospital and also owns and operates a 100 bed skilled nursing facility on its campus. The not-for-profit community hospital has grown from its early beginnings to also include Pleasant Valley Home Medical Equipment, Pleasant Valley Home Health, Hospice Services and private duty, Pleasant Valley Physician Practice Services and the Wellness, Rehab Center and Outreach programs. Assessment Objective Pleasant Valley Hospital exists to provide quality healthcare services to the communities we serve and seeks to be the first choice for caring, compassionate and competent quality healthcare throughout the communities we serve. In order for PVH to fulfill its mission and vision, it is essential to understand the needs of the community. PVH engaged Kurt Salmon, a national healthcare consulting company, and together conducted a Community Health Needs Assessment (CHNA) to profile the health of the residents within the greater Point Pleasant community. The following information has been collected and reviewed by the representatives from PVH. Future initiatives will be identified, prioritized, implemented and monitored to ensure health status progress continues, specifically in areas where PVH can be of support. Community Health Needs Assessment Market Definition The assessment focuses on Mason County, where the majority of PVH s inpatients originate and where PVH focuses its mission and core services. The area was determined as the defined service area for the PVH CHNA from analyzing and reviewing PVH s 2012 inpatient origin report. A map of Mason County with PVH s location is listed in the figure below. Fig. 1 PVH CHNA Service Area (Mason County) Pleasant Valley Hospital 1

5 Executive Summary The development of the assessment involved gathering national, state and regional data along with first account perspectives obtained from key community representatives through surveys, interviews and a focus group. These key activities (the data collection, survey and community meeting) occurred between February and March of Apart from the survey and the focus group with community leaders, all other data used in the assessment came from public sources which are footnoted or otherwise identified in the body of the report. Other input for the assessment was obtained through community feedback in the form of a survey, interviews and during the focus group session conducted on March 14, Community representatives were members from local school boards, health departments and area health and government agencies. The objective of the health assessment was three fold: 1. To understand the health status / market context of the PVH CHNA service area 2. To determine the critical health needs and prioritize these needs based on local community input 3. To catalogue existing health care facilities and other resources within the community to identify gaps in providing for the identified health needs The information obtained from the secondary data collection provided the basis for the discussion with the local community members. Together, these two inputs helped address the community s heath situation in order to begin formulating potential health solutions. Through the assessment process, six health priorities were identified within Mason County. These priorities include: 1. Drug and prescription drug abuse 2. Chronic disease 3. Tobacco use 4. Obesity 5. Affordable prescription drugs/healthcare and 6. Sedentary lifestyle These health issues have contributed to the low health status of Mason County. While there are a number of resources to the community, adequate funding, transportation and programs with a therapy, wellness and monitoring aspect are missing to address the root cause of the health issues. The following information will be shared at PVH by the representatives from Senior Management and the Board. Future initiatives (strategies) will be identified, prioritized, implemented and monitored to ensure health status within PVH s CHNA service area improves. 2

6 Community Input: Process and Summary On March 14, 2013, PVH, along with Kurt Salmon, facilitated a community meeting in order to gather key insights and perspectives from community members who provide vital services to the population that PVH serves. PVH administration obtained names of individuals in the community who were considered to have special knowledge or expertise in public health, or who were leaders or representatives of the medically underserved, low-income and minority populations, or who were representatives of federal, tribal, regional, state or local health agencies. These individuals were asked to attend a focus group session to discuss and determine the health priorities for and health resources available in Mason County. An overview of Mason County s health indicators was provided which informed the larger discussion about current health programs and existing health resource gaps. Research Process The findings within this assessment on Mason County health needs came through a variety of different sources: Primary Research conducted through the use of a survey, one-on-one interviews, and a focus group session (Community Meeting), all administered to receive direct input from key community members who have special knowledge or expertise in the health of the community through their current or past roles in public health organizations in the area. Secondary Research conducted using data from the CDC, HHS, Gallup, Americas Health Rankings, West Virginia Department of Health and Human Resources West Virginia, Bureau of Behavioral Health and Health Facilities, and Substance Abuse and Mental Health Services Administration. All sources are identified within the report and detailed within the appendix. Collecting Community Input The community meeting was conducted in a focus group format. It involved individuals who represented 9 different organizations plus community representatives. The organizations and titles of the members in attendance are listed in Table 1 below. Four one-on-one interviews with a subset of these individuals were also conducted prior to the focus group, to garner unbiased feedback. The interviewed attendees are asterisked. Table 1 Participating Organizations to PVH s CHNA Count Organization Title of Attendee 1 City Department of Point Pleasant, WV Mayor, Point Pleasant 2 City Department of Point Pleasant, WV City Clerk 3

7 3 Early Education Station Director 4 Family Resource Network* (Note: did not attend meeting but was interviewed) Executive Director 5 Mason County Health Department* Representative 6 Mason County Schools* Director 7 Mason County Commission Commissioner 8 Mason County Healthy Families* Supervisor, Mountain State Health Families 9 Pleasant Valley Hospital Director, Marketing 10 Pleasant Valley Hospital Radiologist 11 Prestera Center Clinical Psychologist The meeting commenced with introductions followed by highlighting the meeting agenda and objectives, the CHNA process and requirements. Kurt Salmon presented national, state, and county data that was collected using the resources identified within the primary research section above. The presented information provided a national, state and local comparison in population and demographic trends as well as health behaviors such as, but not limited to the following, smoking, obesity, and substance abuse. Additional detail regarding the PVH CHNA service area was also presented. Prior to the presentation, each member was asked to complete a survey to garner initial input on the area s health concerns. Survey results were presented during the end of the meeting to facilitate the prioritization of health concerns identified and to initiate brainstorming of potential solutions to address current healthcare barriers. The group also acknowledged available resources within the community and provided additional input to inform the development of a comprehensive resource list for the CHNA (see Appendix for a comprehensive list of health resources in Mason County). The information collected from the surveys and open discussion was evaluated and analyzed. The CHNA survey questions can be found in the appendix. Summary of Major Findings and Observations Findings from the secondary research, the survey and the focus group session were fairly consistent. The following are the common themes identified through the overall assessment: 1. Mason County ranks towards the bottom in health status relative to the rest of West Virginia. 2. Economic concerns around high unemployment, low income and lack of transportation infrastructure are cited as common problems contributing to healthcare affordability and access concerns in Mason County. 3. Illegal drug use and prescription drug abuse are cited as the top health concerns for the community of Mason County. 4

8 4. Lifestyle and cultural issues have a major impact on the health status of the county with regards to obesity, diabetes, COPD, etc. 5. While many health resources are available for residents within Mason county, specific resources addressing important health concerns such as mental health, drug abuse, and general wellness within the community are missing. Key Statistics and Research Findings: Population and Demographics Population Information Mason County makes up slightly less than 1.5% of the population of West Virginia. While the population of Mason County increased faster than the overall state population, it was much slower than the overall population growth experienced within the decade for all of the United States projections of the population completed by the Regional Research Institute at West Virginia University indicated that overall population of Mason County is either expected to be stable or if current migration trends from the county persist, it is expected to decline. Table 2 Mason County, West Virginia and the United States Population Year Historic Growth Mason County 25,958 27, % West Virginia 1,808,328 1,852, % United States 281,421, ,745, % Source: United States Census Bureau State and County QuickFacts: Mason County, WV Age Distribution The Mason County population density is people per square mile, which is lower than the state average density of people per square mile and is lower than the national average density of people per square mile 2. The county has a greater population of persons between the ages of 55 to 85 than the state of West Virginia and the United States. Moreover, Mason County has a lower population relative to the rest of the state and the United States, of persons 24 and younger. All age distributions are shown in the graph on the following page. 5

9 Fig. 2 Mason County, West Virginia and the United States Age Distribution 2010 Source: Mason County Population and Races. USA.com Local Data: Mason County Race and Ethnicity Mason County s racial and ethnic characteristics are fairly homogenous as compared to the United States and even relative to the state of West Virginia. The most prevalent race in Mason County is White; slightly over 97% of the population in Mason County is White. Blacks/African Americans and other races made up only 2.3% of the population within the county in Table 3 below highlights the racial characteristics breakdown for Mason County 2. Table 3 Racial Breakdown, Mason County 2010 Breakdown Percentage White 97.73% Black 0.63% Hispanic 0.44% Asian 0.33% Native American 0.19% One Race, Other 0.11% Two or More Races 1.01% Source: Mason County Population and Races. USA.com Local Data: Mason County Education Relative to the United States, Mason County has a lesser educated population according to the USA.com index. In Mason County, approximately 45% of the adult population holds at least a high school diploma, while only 24% of the population holds at least some bachelor s or associate degree. Comparatively, in West Virginia, approximately 41% of the adult population holds at least a high school diploma and about 6

10 23% have some college or associate degree 2. Table 4 below shows the breakdown of education levels for Mason County compared to the state of West Virginia and all of United States. Table 4 Education for the 25 years and over, Mason County, West Virginia and the United States (2010) Mason County West Virginia United States Less than High School 29.96% 18.09% 14.97% High School Graduate 44.49% 41.29% 28.99% Some College or Associate Degree 24.26% 23.37% 28.14% Bachelor Degree 6.38% 10.57% 17.60% Master, Doctorate, or Professional Degree 3.91% 6.59% 10.30% USA.com Education Index (lower value indicates lesser educated population) Source: Mason County Population and Races. USA.com Local Data: Mason County 7

11 Income and Employment Mason County has a lower median household income than the state of West Virginia. Mason County s median household income in 2010 was estimated to be $36,027 while the median income in West Virginia as a whole is estimated to be $38, As reported by the Bureau of Labor Statistics, the unemployment rate in Mason County as of December 2012 is approximately 10.1% compare to the 7.4% in West Virginia as a whole. Mason County s unemployment rate is among the highest in the state. Fig. 3 Historical Unemployment Rate Mason County, WV 3a Source: FRED Economic Data Fig. 4 December 2012: Unemployment Rate West Virginia, BLS 3b Source: United States Bureau of Labor Statistics: Unemployment Rate West Virginia 8

12 Poverty Level In 2010, 18.9% of the Mason County population was below the federal poverty level per the US Census Bureau. While not the lowest within the state, it is higher than the 17.4% poverty rate of the state as a whole 4. The Index Mundi graph below shows the poverty rate of each West Virginia County, with Mason County falling between the rate of 18 and Fig. 5 Poverty Levels, West Virginia: Index Mundi Source: Index Mundi Poverty Rate by County for West Virginia 9

13 Health Insurance Status As of December 2012, the percent of uninsured in Mason County, WV are approximately 15% (2,979 persons). Percent uninsured is the percent of the population <65 that is uninsured. Overall in West Virginia, the percent uninsured is 17% and in the United States overall, it is estimated to be 11% 6. On the following page is a summary of key demographics of Mason County as compared to the state of West Virginia: Table 5 Summary Demographics, Mason County and West Virginia Mason County West Virginia Population 27,324 1,852,994 Race White 97.7% 93.9% Black 0.6% 3.4% Other 1.7% 2.7% Median Age Median Household Income $36,027 $38,380 Poverty Rate 18.9% 17.4% Source: West Virginia Department of Health and Human Resources (DHHR): Behavioral Health County Profile Key Statistics and Research Findings: Health Status National Health Perspective (United States) The United States ranks 42 nd in the world in life expectancy 7. Factors such as obesity, racial disparities, inaccessibility of healthcare, and infant mortality are stipulated by experts as contributing factors to the US falling behind life expectancy rankings. Cited by the CDC, the most recent leading causes of death in the United States are 8 : 1. Heart disease 2. Cancer 3. Chronic lower respiratory diseases 4. Stroke (Cerebrovascular diseases) 5. Accidents (unintentional injuries) 6. Alzheimer's disease 7. Diabetes 8. Nephritis, nephrotic syndrome, and nephrosis 9. Influenza and Pneumonia 10. Intentional self-harm (suicide) Per the recent Gallup Poll conducted on health concerns (2012), among the top health concerns for the United States, cited by US residents included, healthcare access, healthcare costs, obesity and cancer 9. 10

14 Regional Health Perspective (West Virginia) West Virginia ranks towards the bottom of the list for the healthiest states in America; it ranks 47 th among other states in overall health (higher ranking indicating greater prevalence of health concern(s)). The state is 48 th in the country for obesity and diabetes, 49 th in the country for smoking and 48 th in overall health outcomes 10. Among the five most common causes of death in the United States, West Virginia has a greater overall death rate (rate per 100,000 population) in each: Heart Disease, All Cancers, Stroke, Chronic Lower Respiratory Disease, and Unintentional Injuries 11. Risk factors such as high tobacco use, lower nutrition, physical activity, obesity, lack of early detection of diseases such as cancers, and lack of health coverage in many areas, all contribute to the poorer health rankings of the state. Fig. 6 Per American Heart Association, the leading causes of death in West Virginia as of 2010 Source: American Heart Association: Leading Causes of Death in West Virginia 2010 Highlights of some of the behavioral risk factors within the state; based on most recent data available 8,12 are below: Tobacco Use: In 2007, 27% of adults and 28% of high school students in West Virginia reported being current smokers. In 2010, the prevalence of smoking among adults in the state had not changed much at 26.8%. Physical Activity: In 2007, 68% of adults in West Virginia were overweight or obese; 67% of the state s high school students did not attend physical education classes and 54% of the adults were not engaged in sufficient moderate or vigorous physical activity. As of statistics collected in 2010, approximately one-third of state adults do not participate in leisure time physical activity or exercise. Obesity and Overweight: The proportion of the obese population among the adult population in the state was 32.9% in 2010, 3 rd highest nationally. During 2009 and 2010, approximately two-thirds of West Virginia adults were identified as being either obese or overweight. 11

15 Hypertension, Cholesterol, Heart Disease and Diabetes: West Virginia ranked highest nationally in 2009 for the prevalence of hypertension; more than one-third of the state s adult population has been diagnosed with high blood pressure. In 2009, approximately 38% of the adults had high cholesterol. West Virginia ranked second highest in the nation in 2010 in the prevalence of heart attack among adults. The state ranked 4 th nationally in the prevalence of diabetes. Preventative Screening: In 2006, 26% of females in West Virginia aged 40 years and older reported not having had a mammogram within the last two years. In 2009, 41.6% of the women reported not having a clinical breast exam in the past year. In 2006, among adults in West Virginia aged 50 years or older, 47% reported never having had a colonoscopy or sigmoidoscopy. In 2009, almost one-third of the men aged 50 and older did not have appropriate prostate cancer screenings. Health Access and Coverage: About one-fifth of West Virginia adults age 18 to 64 have no health coverage (21.4% in 2010). More than one-fifth of adults (all ages) in West Virginia also do not have a personal doctor or health care provider. Local Health Perspective (Mason County) Overall County Health Health varies greatly across West Virginia with the community of Mason County, which PVH serves, and is ranked towards the poor end of the health spectrum. Per County Rankings in 2012, Mason County ranked 44 out of the 55 counties in West Virginia for overall health outcome (lower ranking indicating poorer outcomes). Among the 55 counties, Mason County also ranked 45th in the state for health factors (factors influencing the health of the county, i.e., health behavioral factors: tobacco use, diet and exercise, alcohol use, sexual activity; clinical care factors; socioeconomic factors and physical environment). More specifically, Mason County ranks poorly on many health indicators, such as obesity, diabetes, and asthma. The county also has prevalent drug abuse problems. Per West Virginia Bureau of Public Health, the table below shows the prevalence of specific health conditions in Mason County and the county s ranking compared to the rest of the state 4. The ranking is based on a 36 geographic entities (12 groups of counties and 24 stand-alone counties). Lower rank indicates higher prevalence. Table 6 Summary Demographics, Mason County and West Virginia Health Indicator Mason County Rank in West Virginia Fair or poor health 26.4% 12 No health insurance (age 18-64) 26.1% 6 No leisure exercise 32.6% 6 Obesity 35.9% 6 Diabetes 14.7% 4 Hypertension 31.4% 25 High Cholesterol 38.4% 24 Heart Attack, Angina or Stroke 14.5% 11 Current Asthma 12.0% 6 Arthritis 36.8% 10 12

16 Source: West Virginia Department of Health and Human Resources: Behavioral Health County Profile Mason County Behavioral Risk Factor Prevalence 1. Substance Abuse: The Bureau of Behavioral Health and Health Facilities, in a project funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) led the statewide systematic process to gather, review, analyze, translate and disseminate information about substance abuse and mental health in West Virginia. Through this project, most current data available on substance abuse and its related consequences was identified for Mason County. The results indicate substance abuse as a key concern in Mason County. Prevalence of cigarette smoking in Mason County is 36.4% (ranked 2 nd highest in the state of West Virginia). The use of smokeless tobacco has a prevalence of 9.4% (ranked 16 th in the state of West Virginia). With regards to use of pain killers, Mason County has seen a 300% increase in prescription drug overdose deaths since In 2010, the death rate due to prescription drug overdose in Mason County was 6.2 per 10,000 compared to 5.3 per 10,000 in West Virginia 4. Fig. 7 Drug use in the state of West Virginia between 2006 and 2008 Table 7 Selected causes of death attributable to smoking; number of deaths per 10,000 Health Indicator Mason County West Virginia Lung/Bronchitis/Trachea Cancer COPD Major Cardiovascular Disease Source: West Virginia Department of Health and Human Resources: Behavioral Health County Profile Mason County Interviews indicated smoking as a major concern for the Mason County community. Interviews also suggested that the health concern has been difficult to overcome due to deeply rooted cultural and social norms regarding tobacco use within the community. The county also suffers from a prevalent and growing substance use problem. According to Drug Abuse Warning Network (DAWN), Mason County, WV reported a total of 31.3% drug-related deaths in the county in Interviews indicate that 80% of births at the PVH facility are to drug- 13

17 addicted mothers. Law enforcement data also reveal that Mason County has the second highest number of clandestine methamphetamine labs in the state of West Virginia, with 90 labs that were discovered at the last crime statistics report of the state. When adjusted for population, the county has one known meth lab for every 303 residents. 2. Obesity and Overweight: Between 1999 and 2003, only six of the 55 counties in West Virginia had obesity rates higher than 30% of the adult population. By 2004 and 2008, 35 counties reported that rate and 28 counties reported a rate between 20% and 24%. Within that same time period, Mason County reported a rate of 35.9% (ranking 6 th in prevalence within the state). Fig. 8 Obesity prevalence in West Virginia between 2004 and 2008 Source: West Virginia Department of Health and Human Resources: Obesity in West Virginia Interviews with community health leaders indicate that physical activity for the community is lacking, leading to growing concerns in obesity. Many indicated that the prevalence of obesity in the community may also be a function of the Appalachian culture and habits along with limited availability of nutritious foods. Within interviews, community leaders indicated that efforts are underway in this area for school children. For example, the Local Wellness Committee set by the Board of Education is working to address physical education programs at schools. Furthermore, school lunch efforts are underway working to incorporate salad bars and increasing use of fresh produce in cooking lunch meals. 14

18 3. Current Asthma: According to data collected by the West Virginia Department of Health and Human Resources, although lower than some other states in the United States, Mason County showed the greatest prevalence of asthma in West Virginia. The asthma rate studied between 2006 and 2010 period was approximately 12.0% for the county. Fig. 9 Asthma prevalence in West Virginia between 2009 Source: West Virginia Department of Health and Human Resources: West Virginia Behavioral Risk Factor Survey Report In 2009, the county showed an unusually high rate of pediatric asthma cases. While research is ongoing, it is unclear why there is a rise in pediatric asthma cases, as it is hard to link it to pollution levels in the county that has much lower traffic levels than many cities around the United States Health Access and Coverage: As indicated previously, unemployment is high within Mason County, especially when compared to the rest of the state. As per a Community Health Survey conducted in 2009 by the Mason County Health Department, unemployment continues to be the most concerning issue for the residents of Mason County. Interviews indicated that there continues to be a large Medicaid population within the county. Furthermore, approximately 26% of the residents between the age of 18 and 64 in Mason County, WV do not have access to health insurance 4. Healthcare access can be challenging for many of the residents within the county due to lack of public transportation within the region and the state overall. Apart from health insurance coverage and transportation concerns, the community leaders interviewed also indicated that county residents are facing longer wait times to see providers, factors indicative of a general lack of primary care within the county. The Community Health Survey conducted in 2009 by the Mason County Health Department also showed that the top three health issues indicated by the residents of the county were health insurance, affordable health care and affordable prescription drugs. 15

19 Mason County Health Resources Many health resources specific to Mason County, West Virginia were identified as important resources for the community. The list is detailed within the appendix. These resources were validated during other parts of the assessment (interviews and focus group). Other existing resources were also identified during the focus group sessions along with resource needs within the community. Interview, Survey and Focus Group Summary Summary Interview Findings Interviews with local leaders of Mason County were conducted prior to the focus group session. The interviews provided additional detail to inform the CHNA process and many of the themes were echoed during the onsite community needs input meeting. In summary, the interview findings suggest that Mason County s health behaviors originate from an array of social, economic and environmental causes and while many resources provide relief to its citizens, there continues to be a gap in the effective enhancement of overall health within the community. The use of physician extenders (nurse practitioners, physician assistants) is a possible solution that could create more affordable primary care access for the community. The following are highlights from the interviews conducted: Social and Economic Factors Unemployment is very high within Mason County and there continues to be a large Medicaid population The area is not growing but aging in place with many Medicare beneficiaries Income levels around $36,000 limit degree to which people seek and pay for healthcare services No public transportation in Mason County and this hinders access to available health care resources Health Behaviors Tobacco and Drug Use The county suffers from a major substance use problem; the county has the second highest number of clandestine meth labs in the state Smoking is one of the top most health concerns for the community; it is a largely rooted habit within the community Diet and Exercise Physical activity for the community is lacking leading to growing concerns in obesity 16

20 Access Prevalence of obesity is also a function of the Appalachian culture and habits Efforts underway with beta program, Cardiac Kids, to measure BMI of 5th graders at one elementary school preliminary results indicate that BMI of this cohort of children is higher than the norm Local wellness committee (Board of Education to address physical education programs in schools); wellness plan to be available summer 2013 School lunch efforts o o Return to traditional cooking methods, use of less salt, fresh produce, whole pizza dough Incorporation of salad bars and emphasis on portion control Lack of primary care and the urgent care model is not perceived favorably o o Longer wait times to see providers timeliness and follow-up with some providers is perceived as slow Urgent care is perceived less favorably than primary care because the patient will see different providers between episodic events at urgent care centers versus having a consistent care provider at a local primary care practice School nurse critical needs (6 school nurses within Mason County school system) o o Dental Care: Smile Program (caring for 400 kids) has made an improvement for dental care for kids, but dental care remains a needed service in the community. Nurse Practitioner/Physician oversight/assistance with school nurses: Currently school nurses cannot prescribe medications and can only call parents to suggest treatment and feel they lack the ability to enable the next step of needed care. Additional clinical oversight with the authority to prescribe medications is needed at school health clinics 17

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