Community Health Needs Assessment. Final Summary Report

Transcription

1 Community Health Needs Assessment Final Summary Report February 2013

2 COMMUNITY HEALTH NEEDS ASSESSMENT EXECUTIVE SUMMARY Background Backus Health System led a comprehensive Community Health Needs Assessment (CHNA) to evaluate the health needs of individuals living in the hospital s service area defined as New London and Windham Counties, Connecticut. The study was conducted between September 2012 and January Backus Health System engaged Holleran Consulting, a research and consulting firm based in Lancaster, Pennsylvania as its research partner. The purpose of the CHNA was to gather information about local health needs and health behaviors in an effort to ensure hospital community health improvement initiatives and community benefit activities are aligned with community need. The assessment examined a variety of community, household, and health statistics to portray a full picture of the health and social determinants of health in the Backus Health System service area. Research Components Statistical Secondary Data Profile of New London/Windham Counties Household Telephone Surveys: 401 households in 2012; 1,109 households in 2010 Key Informant Interviews with 49 community stakeholders Focus Group Discussions with healthcare consumers The CHNA research was reviewed by Backus Health System and its Advisory Task Force. A review of the research findings and a facilitated Prioritization Session was held with community partners to identify priority needs within the community. Backus Health System reviewed feedback from the Prioritization Session, along with its current services and programs, resources and areas of expertise, and other existing community assets, to determine what identified needs it would address, and those it would play a support role in addressing. The following needs were identified by Backus Health System as its priority areas for the following three-year cycle: Community Health Issues Access to Care Preventative Health, Including Management of Chronic and Infectious Disease, Respiratory Health, and Obesity Mental Health, Including Substance Abuse Page 1

3 COMMUNITY HEALTH NEEDS ASSESSMENT HOSPITAL & COMMUNITY PROFILE Hospital Overview Established in 1893, The William W. Backus Hospital health system includes a not- for- profit, 213- bed hospital in Norwich and numerous off- site locations, including several health centers, Backus Home Health Care and the Backus Outpatient Care Center, also in Norwich. The Outpatient Care Center offers a wide range of services including a weight loss center, diabetes center, arthritis center, physical therapy, radiology, laboratory services, woundcare, a hyperbaric oxygen chamber, anti- coagulation clinic, and more. Backus Health Centers are located in Montville, Ledyard, Colchester and Plainfield, and additional labs for blood draws are available throughout the region. Backus offers the only trauma center in New London and Windham counties and is the only area hospital with LIFE STAR helicopter services, in partnership with Hartford Hospital. A new Backus Emergency Care Center, offering emergency services 24 hours per day, seven days per week, as well as diagnostic imaging and laboratory services, will open in the summer of Backus is accredited as a comprehensive community hospital cancer program, one that offers the best in cancer care close to home for patients. The health system includes a strong minimally- invasive surgery program, offering services from interventional radiology to the da Vinci surgical robot. Backus is the only hospital in New London or Windham counties with robotic capabilities. The Emergency Department serves more than 60,000 people per year, and consistently receives some of the highest patient satisfaction scores in the nation. Backus employs 1,800 people. The Backus Medical Staff includes approximately 300 expert physicians offering a wide range of healthcare services. Definition of Service Area Backus Health System defines the communities it serves as a primary, secondary and ancillary service area. The Primary Service Area represents approximately 75% of the Hospital s inpatient discharges. The Secondary Service Area represents approximately 90% of the Hospital s inpatient discharges. Page 2

4 Acknowledging that the Backus Health System extends beyond the walls of the Hospital, Backus leaders included an ancillary service area encompassing all remaining towns in New London and Windham Counties. Pieces of the Health System, including outpatient health centers, and a full- service, 24/7 satellite emergency department, touch patients residing in all towns in Eastern Connecticut. CHNA Background Backus Health System led a comprehensive Community Health Needs Assessment (CHNA) to evaluate the health needs of individuals living in the hospital s service area defined as New London and Windham Counties, Connecticut. The CHNA included research from a 2010 CHNA combined with research conducted between July 2012 and January Backus Health System engaged Holleran Consulting, a research and consulting firm based in Lancaster, Pennsylvania as its research partner. The purpose of the CHNA was to gather information about local health needs and health behaviors in an effort to ensure hospital community health improvement initiatives and community benefit activities are aligned with community need. The assessment examined a variety of community, household and health statistics to portray a full picture of the health and social determinants of health in the Backus Health System service area. The findings from the CHNA were utilized by Backus Health System to prioritize public health issues and develop a Community Health Implementation Strategy. Backus Health System is committed to the people it serves and the communities they live in. Healthy communities lead to lower health care costs, robust community partnerships, and an overall enhanced quality of life. Page 3

5 Methodology The CHNA was comprised of both quantitative and qualitative research components, and is a combination of 2010 and 2012 data. A brief synopsis of the research components is included below with further details provided throughout the document: Quantitative Data: A Secondary Data Profile was compiled in November 2012 to depict population and household statistics, education and economic measures, morbidity and mortality rates, incidence rates, and other health statistics across New London and Windham Counties. A Statistical Household Telephone Survey was conducted from September to December 2012 with 461 randomly- selected community residents, focusing on the ancillary service area. The survey augmented a 2010 study of 1,109 households in the primary and secondary service area. Between the two studies, Backus Health System created a representative sample of the whole of New London and Windham Counties, broken down by its Primary, Secondary, and Ancillary Service Areas. The survey, modeled after the Center for Disease Control and Prevention s Behavioral Risk Factor Surveillance System (BRFSS), assessed health status, health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury. The same survey instrument was used in the 2010 and 2013 studies. Qualitative Data: Key Informant Interviews were conducted in November 2012 with community representatives. In total, 49 community leaders participated, representing a variety of sectors including public health and medical services, staff and professionals from Federally Qualified Health Centers (FQHC), non- profit and social organizations, children and youth agencies, faith- based institutions, culturally diverse communities, and the business community. The face- to- face interviews were conducted by Holleran. Please refer to Appendix A for the detailed list of key informants. Three Focus Groups were held in December 2012 with 24 healthcare consumers, representing culturally diverse populations, individuals with chronic conditions, and underserved populations within the community. Holleran facilitated all sessions and compiled the reports. LIMITATIONS OF STUDY: It should be noted that limitations of the research may have prevented the participation of some community members. Language barriers, the use of a random digit landline telephone methodology (vs. including cell phone lines), the lack of an online/ internet survey, and the time lag of secondary data may present some research limitations. Backus Health System sought to mitigate limitations by including representatives of diverse and underserved populations in the qualitative research components. Page 4

6 Existing Resources to Address Community Health Needs The William W. Backus Health System Alliance for Living American Ambulance Backus Home Health Care Bethsaida Community Catholic Charities Child & Family Agency City of Norwich Community Health Center, Inc. Connecticut Community Care Incorporated Danielson Homeless Shelter Day Kimball Hospital Department of Children & Family Department of Developmental Services Department of Social Services Gemma Moran Food Bank Generations Hospice of SouthEastern Connecticut Hospitality Center, Norwich Lawrence & Memorial Hospital LEARN Ledge Light Health District Local and State Police Departments Local Fire Departments Madonna Place Natchaug Hospital North East Health District Reliance House Senior Resources SouthEastern Council on Alcohol and Drug Dependence SouthEastern Mental Health Authority SouthEastern Regional Action Council St. James Shelter St. Vincent DePaul Place Soup Kitchen Thames Valley Council for Community Action Uncas Health District United Community & Family Services United Way Visiting Nurse Association of SouthEastern Connecticut Windham Hospital Research Partner Backus Health System contracted with Holleran, an independent research and consulting firm located in Lancaster, Pennsylvania, to conduct research in support of the CHNA. Holleran has more than 20 years of experience in conducting public health research and community health assessments. The firm provided the following assistance: 1) Collected and interpreted secondary data 2) Conducted, analyzed, and interpreted data from Household Telephone Survey 3) Conducted, analyzed, and interpreted data from Key Informant Interviews 4) Conducted Focus Groups with healthcare consumers 5) Facilitated a Prioritization and Implementation Planning Session 6) Prepared the Final Report and Implementation Strategy Community engagement and feedback were an integral part of the CHNA process. Backus Health System sought community input through interviews with key community stakeholders, focus groups healthcare consumers, and inclusion of community partners in the prioritization and implementation planning process, as well as members of an advisory task force. Public health and health care professionals shared knowledge and expertise about health issues, and leaders and representatives of non- profit and community- based organizations provided insight on the community served by Backus Health System including medically underserved, low income, and minority populations. Following the completion of the CHNA research, Backus Health System prioritized community health issues and developed an implementation plan to address prioritized community needs. Page 5

7 RESEARCH OVERVIEW Secondary Data Profile A Secondary Data Profile for New London and Windham Counties was created to depict existing demographic and health statistics. Data sources included the U.S. Census Bureau, Centers for Disease Control and Prevention, National Cancer Institute, Connecticut Department of Health and local health departments, Robert Wood Johnson Foundation, among other sources. The profile details data covering the following areas: Population Statistics Household Statistics Income/Employment Statistics Education Statistics Mortality Statistics Birth Statistics Sexually Transmitted Illness Statistics Injury & Violence Prevention Statistics Communicable Disease Statistics Environmental Health Statistics Health Behaviors Crime Statistics This section serves as a summary of the key takeaways from the secondary data profile. A full report of all of the statistics is available through Backus Health System. Page 6

8 Demographics The table below illustrates the age breakdown of residents in Backus Health System s total service area compared to the state and national proportions. In line with state and national figures the largest percentage of residents are age at 16.9% of the population with a median age of Seventy- eight (78) percent of the population is age 18 or older; 13.8 percent of the population is age 65 or older. Table A1 Population by Age (2010) Backus Total U.S. Connecticut Service Area n % n % n % Under 5 20,201, , , ,348, , , ,677, , , ,040, , , ,585, , , ,063, , , ,070, , , ,006, , , ,664, , , ,817, , , ,713, , , ,061, , , and over 5,493, , , Median Age % 18 years or over 76.0% 77.1% 78.1% % 65 years or over 13.0% 14.2% 13.8% Source: U.S. Census Bureau, 2010 Page 7

9 The racial breakdown of Backus Health System s service area residents is primarily White (89.4%). The table below shows the racial breakdown of the Backus Health System service area. The percentage of African American (4.8%) and Hispanic/Latino residents (8.9%) is lower when compared to the state and national comparisons. Table A2 Racial Breakdown (2010) a U.S. Connecticut Backus Total Service Area n % n % n % White 223,553, ,772, , Black/African American American Indian/ Alaska Native 38,929, , , ,932, , , Asian 14,674, , , Native Hawaiian or Other Pacific 540, , Islander Two or more races 9,009, , , Hispanic or Latino (of any race) b 50,477, , , Source: U.S. Census Bureau, 2010 a Percentages may equal more than 100% as individuals may report more than one race Page 8

10 Table A3 below shows the primary language(s) spoken at home. As reflected with the racial breakdown, residents in the Backus Health System speak English only at a higher percentage than the state and nation. Table A3 Language Spoken at Home, 5 Years Old and Older (2010) U.S. Connecticut Backus Total Service Area Population 5 years old and over 283,833,852 3,340, ,995 English only 79.9% 79.4% 87.0% Language other than English 20.1% 20.6% 13.0% Speak English less than "very well" 8.7% 8.1% 5.2% Spanish 12.5% 10.2% 6.1% Speak English less than "very well" 5.8% 4.3% 2.6% Other Indo-European languages 3.7% 7.8% 4.4% Speak English less than "very well" 1.2% 2.7% 1.3% Asian and Pacific Islander languages 3.1% 2.1% 2.2% Speak English less than "very well" 1.5% 0.9% 1.2% Source: U.S. Census Bureau, ACS estimates Page 9

11 The household statistics display a majority of family households (66%) and married- couple families (49%); these figures are comparable to the national and state percentages. Also comparable to national and state figures are the percentage of households with a female householder and no husband present (12%) and the percentage of non- family households (34%). The chart below illustrates these statistical household comparisons. Table A4 Households by Type (2010) U.S. Connecticut Total Service Area n % n % n % Total households 116,716, ,371, ,834 Average household size Average family size Family households 77,538, , , Male householder, no wife 5,777, , , With own children under 18 yrs. 2,789, , , Female householder, no husband 15,250, , , With own children under 18 yrs. 8,365, , , Husband-wife families 56,510, , , Nonfamily households 39,177, , , Householder living alone 31,204, , , Source: U.S. Census Bureau, 2010 Page 10

12 Figure A1 displays a comparison of Median Household Income of the Backus Health System Total Service, Primary Service, Secondary Service Area, and Ancillary Service compared to the state and national data. As a whole, the total service displays a lower median household income than the state, which is higher than the U.S. The Ancillary Service Area has the highest Median Household Income ($66,516), with the Primary Service Area next highest ($64,369), and the Secondary Service Area reflecting a lower Median Household Income ($61,690). Figure A1 Median Household Income (2010). Page 11

13 Figure A2 shows Education Rates in the Total Service Area as compared to the state and nation. While High School graduation rates (88.2%) are on par with the state rates (88.4%), the percent of residents with bachelor s degrees or higher (27.6%) lags behind the state results (35.2%). Table A2: Educational Attainment, Population 25 Years and Over (2010) U.S. Connecticut Total Service Area Less than 9th grade 6.2% 4.7% 4.0% 9th to 12th grade, no diploma 8.7% 7.0% 7.8% High school graduate (includes equivalency) 29.0% 28.6% 33.2% Some college, no degree 20.6% 17.3% 19.5% Associate's degree 7.5% 7.3% 7.9% Bachelor's degree 17.6% 19.9% 15.4% Graduate or professional degree 10.3% 15.3% 12.2% Percent high school graduate or higher 85.0% 88.4% 88.2% Percent bachelor's degree or higher 27.9% 35.2% 27.6% Source: U.S. Census Bureau, ACS estimates Page 12

14 Health Statistics A higher percentage of residents in the Backus Health System service area die from the top three leading causes of death in the Nation (diseases of the heart, cancer, and chronic lower respiratory disease). As illustrated in Table B1, the leading cause of death for residents in Backus Health System service area is elevated above the state or national statistics in the following areas: Heart Disease, 26.1% (compared to 25.1% for CT and 24.6% for U.S.), Cancer, 23.8% (compared to 23.6% for CT and 23.3% for U.S.) and Chronic Lower Respiratory Diseases, 6.1% (compared to 5.0% for CT and 5.6% for U.S.). Table B1. Top 10 Leading Causes of Death, All Ages ( ) U.S. a Connecticut Total Service Area The following are the top 10 leading causes of death in ranking order of the United States. Diseases of heart 24.6% 25.1% 26.1% Malignant neoplasms (Cancer) 23.3% 23.6% 23.8% Chronic lower respiratory diseases 5.6% 5.0% 6.1% Cerebrovascular diseases (Stroke) 5.3% 5.0% 4.9% Accidents (Unintentional injuries) 4.8% 4.6% 4.8% Alzheimer s disease 3.2% 2.8% 3.4% Diabetes Mellitus 2.8% 2.2% 2.1% Influenza and pneumonia 2.2% 2.5% 2.3% Nephritis, nephrotic syndrome and nephrosis 2.0% 2.0% 1.8% Intentional self-harm (Suicide) 1.5% 1.0% 1.2% Page 13

15 As depicted in Table B2, the incidence rate for lung cancer is higher in the Backus Health System service area (78.2) than in Connecticut (74.3) and the Nation (69.6). Additionally, the mortality rate for lung cancer and all cancer sites combined is higher in the Backus Health System service area (55.2 and respectively) than in Connecticut (49.9; 192.3), the Nation (52.1; 185.8), and Healthy People 2020 (45.5; 160.6). Table B2. Cancer Mortality by Site ( ) a Healthy People 2020 U.S. Connecticut Total Service Area Rate n Rate n Rate n Rate Female breast 20.6 N/A 23.0 b 1,488 * 151 * Colorectal , , Lung , , Prostate , ,092 * 115 * All Sites ,695, , , Sources: Center for Disease Control and Prevention, 2009; Connecticut Department of Public Health, 2009; National Cancer Institute, a Crude rates per 100,000 population b Statistic represents data *Crude rates cannot be calculated for aggregated data Related to respiratory health, the annual hospitalization rates for Asthma are higher for both children and adults in the Backus Health System service area (18.5 and 15.1 respectively) than in Connecticut (17.8; 11.1). Table B3 presents the findings. Table B3. Annual Hospitalizations for Asthma ( ) a, b Connecticut Total Service Area n Rate n Rate Adults 18 years and over 2, , Children 0-17 years old 1, Source: Connecticut Department of Public Health, a Crude rates per 10,000 population based on 2000 Census b The towns of Ashford, Brooklyn, Canterbury, Chaplin, Eastford, Franklin, Hampton, Lebanon, North Stonington, Pomfret, Scotland, Sterling, Voluntown, and Woodstock are not included due to insufficient counts Page 14

16 Turning to Communicable Disease, the Acute Hepatitis C rate is higher in the Backus Health System service area (2.8) compared to Connecticut (1.3), the Nation (0.3), and Healthy People 2020 (0.2). See table B4. The rate of confirmed Lyme disease cases is higher in the Backus Health System service area (82.2) than in Connecticut (56.0) and the Nation (7.3). See table B5. Table B4. Hepatitis Cases (2011) a Healthy People 2020 U.S b Connecticut Total Service Area Rate n Rate n Rate n Rate Acute Hepatitis A 0.3 1, * Acute Hepatitis B N/A 3, * Chronic Hepatitis B N/A N/A N/A Acute Hepatitis C Sources: Center for Disease Control and Prevention, 2010; Connecticut Department of Public Health, 2011 a Crude rates per 100,000 population b Statistics represent 2010 data * Rate not calculated for counts less than 5 Table B5. Confirmed Lyme Disease Cases (2011) a U.S b Connecticut Total Service Area Primary Service Area Secondary Service Area Ancillary Service Area Number of cases 22,561 2, Crude rate Sources: Center for Disease Control and Prevention, 2010; Connecticut Department of Public Health, 2011 a Crude rates per 100,000 population b Statistics represent 2010 data Health Factors New London and Windham Counties have more adult smokers (19.0% and 20.0% respectively) than Connecticut (16.0%) and the National Benchmark (14.0%). Windham County has more obese adults and physical inactivity (30.0% and 26.0% respectively) than New London County (24.0%; 23.0%), Connecticut (23.0%; 23.0%) and the National Benchmark (25.0%; 21.0%). Windham County has a higher motor vehicle crash death rate and teen birth rate (17.0 and 29.0 respectively) than New London County (11.0; 26.0), Connecticut (9.0; 24.0), and the National Benchmark (12.0; 22.0). The patient to primary care physician ratio is greater in New London County (1,098:1) and Windham County (1,333:1) than in Connecticut (729:1) and the National Benchmark (631:1). Page 15

17 The preventable hospital stays rate is higher in New London County (70.0) and Windham County (75.0) than in Connecticut (63.0) and the National Benchmark (49.0). Nine (9) percent of residents in New London County have limited access to healthy foods. This is in comparison to Windham County (0.0%), Connecticut (5.0%), and the National Benchmark (0.0%). Forty (40) percent of restaurants in Windham County are fast food establishments. This is in comparison to New London County (35.0%), Connecticut (38.0%), and the National Benchmark (25.0%). The following Table C1. Health Behaviors (2012) National New London Windham Connecticut Benchmark c County County Adult smoking 14.0% 16.0% 19.0% 20.0% Adult obesity 25.0% 23.0% 24.0% 30.0% Physical inactivity 21.0% 23.0% 23.0% 26.0% Excessive drinking 8.0% 18.0% 18.0% 17.0% Motor vehicle crash death rate a Chlamydia rate a Teen birth rate b Source: County Health Rankings, 2012 a Rates per 100,000 population b Rates per 1,000 population c National Benchmark represents the 90 th percentile and is not an average Table C2. Clinical Care (2012) National New London Windham Connecticut Benchmark a County County Uninsured adults 12.0% 10.0% 9.0% 11.0% Patient to primary care physician ratio 631:1 729:1 1,098:1 1,333:1 Preventable hospital stays b Diabetic screening c 89.0% 83.0% 84.0% 85.0% Mammography screening c 74.0% 71.0% 76.0% 71.0% Source: County Health Rankings, 2012 a National Benchmark represents the 90 th percentile and is not an average b Hospitalization rate for ambulatory- care sensitive conditions per 1,000 Medicare enrollees c Percent of Medicare enrollees receiving screenings Page 16

18 Table C3. Physical Environment (2012) National Benchmark b Connecticut New London County Windham County Air pollution- particulate matter days Air pollution- ozone days Limited access to healthy foods 0.0% 5.0% 9.0% 0.0% Access to recreational facilities a Fast food restaurants 25.0% 38.0% 35.0% 41.0% Source: County Health Rankings, 2011 a Rates per 100,000 population b National Benchmark represents the 90 th percentile and is not an average Crime Statistics The larceny and rape rates in the Backus Health System Hospital service area (1,066.4 and 24.7 respectively) are lower than the national comparison of 2,003.5 and However, they are notably larger than in Connecticut (586.6 and 16.8 respectively). Table D1. Crime Offenses (2010) a U.S Connecticut Total Service Area n Rate n Rate n Rate Murder 14, Rape 84, Robbery 367, , Aggravated Assault 778, , Burglary 2,159, , , Larceny 6,185,867 2, , ,329 1,066.4 Motor Vehicle Theft 737, , Arson 56, Sources: Federal Bureau of Investigation, 2010; Connecticut Department of Public Safety Public Safety, 2010 a Crude rates per 100,000 population * Rate not calculated for counts less than 5 Page 17

19 HOUSEHOLD TELEPHONE SURVEY OVERVIEW A household survey was conducted among residents of Backus Health System service area. The telephone survey was based on the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a national initiative, headed by the Centers for Disease Control and Prevention (CDC) that assesses health status and risk factors among U.S. citizens. The following pages illustrate the key findings from the 2012 survey of 401 adults in the Ancillary Service Area and the 2010 study of 1,109 adults in the Primary and Secondary Service Areas. References to the Backus Health System Total Service Area refer to the aggregated results of the Primary, Secondary, and Ancillary Service Areas. A full report of the survey is available from Backus Health System. Areas of Strength The following are areas where Backus Health System residents fare better, or healthier, than the state of Connecticut and/or the Nation as a whole. The Total Service Area is referenced, but only those areas in which all three service areas (Primary, Secondary, and Ancillary) fare better than Connecticut and/or the Nation are included unless otherwise noted. Significant differences among the Primary, Secondary, and Ancillary Service Areas are noted when they exist. General health status: The proportion of residents in the Total Service Area who reported very good or excellent health in general (57.7%) is higher compared to the Nation (51%) and is in line with the state benchmark. Health care access: The proportion of residents in the Total Service Area who have health care coverage is greater (90.1%) when compared to the Nation (83.2%) and in line with the state benchmark of 90.6%. Fewer residents in the Total Service Area (11.7%) compared to the Nation (16.8%) reported that cost prohibited them from seeking healthcare when they needed it. However, while the outcomes for all three service areas are more favorable than the Nation, only the Primary and Secondary Service Areas are significantly different than the Nation. All figures for cost prohibitive health care are in line with the state benchmark of 11%. The proportion of residents in the Total Service Area who visited a doctor for a routine checkup within the past year (74.1%) is higher when compared to the Nation (67.9%), and in line with the state (72.8%). However, differences exist by service area. The outcomes for all three service areas are more favorable than the Nation, but only the Ancillary and Primary Service Areas are significantly different than the Nation. Healthy days: The proportion of residents in the Total Service Area who reported that they felt sad, blue, or depressed on zero days of the past 30 days (65.3%) is higher compared to the Nation (60.8%). All three service areas have more favorable outcomes than the Nation, but only the Ancillary Service Area is significantly different than the Nation. Page 18

20 Exercise in previous month: A higher proportion of residents in the Total Service Area (83.6%) exercised in the previous month when compared to the state (75.8%) and the Nation (74.4%). Diabetes and Pre- diabetes: Residents in the Total Service Area are more likely to have never been diagnosed with pre- diabetes or borderline diabetes (94.5%) when compared to the state (92.1%) and the Nation (91.1%). Related, residents are more likely to have never been diagnosed with diabetes (90.4%) when compared to the state (87.7%) and the Nation (87.2%). However, while the outcomes for all three service areas are more favorable than the state and the Nation for diabetes and pre- diabetes, only the Ancillary Service Area is significantly different than the state and the Nation. Flu Shot: A higher proportion of residents in the Total Service Area (44.7%) had a seasonal flu shot during the past 12 months compared to the Nation (39.9%). However, only the Ancillary and Secondary Service Areas are more favorable than the Nation. The proportion of residents in the Primary Service Area who received a seasonal flu shot during the past 12 months (40.0%) is in line with the National benchmark and is significantly less than the proportion in the Ancillary Service Area (49.1%). Women s Preventive Health: Female residents in the Total Service Area are more likely to have had a clinical breast exam (94.3%) compared to females across the Nation (89.8%); however, only the proportion for the Ancillary Service Area is significantly different than the Nation. More women in the Total Service Area (96.8%) also report having had a Pap Test than in Connecticut (93.6%) and the U.S. (93.8%). However, the only significant difference is between the Secondary Service Area and Connecticut. Men s Preventive Health: Male residents in the Total Service are more likely to have had a PSA test (62.3%) compared to males across the Nation (53.5%); however, only the Ancillary Service Area is significantly different than the Nation. Likewise, 79% of males have had a digital rectal exam as compared to the Nation (73.4%). All three service areas have more favorable outcomes than the Nation for this factor, but none are significantly different than the Nation. Colonoscopy Screening: A higher proportion of residents age 50 and over in the Total Service Area reported that they have had a sigmoidoscopy or colonoscopy (75.1%) compared to residents across the Nation (62.0%). However, only the Secondary and Ancillary Service Areas are significantly different than the Nation. HIV: The proportion of residents in the Total Service Area between the ages of 18 and 64 who have ever been tested for HIV (54.8%) is higher when compared to the state (32.6%) and the Nation (35.9%). In addition, the proportion of residents in the Secondary Service Area who have ever been tested for HIV (59.2%) is higher when compared to the Primary Service Area (49.3%). Page 19

21 Areas of Opportunity The following are areas where Backus Health System residents in at least one of the three service areas fare worse, or less healthy, than the state of Connecticut and/or the Nation as a whole. Differences between service area outcomes are noted. Calculated BMI: More residents in the Total Service Area (27.8%) are considered obese when compared to the state (23.3%). In addition, more individuals in the primary (30.4%) and secondary (30.3%) service areas are obese than the Ancillary Service Area (21.3%), and more residents in the Primary Service Area (43.3%) are considered to be overweight than in the Secondary (34.4%) and Ancillary (34.8%) Service Areas. Depressive disorder: The proportion of residents in the Total Service Area who have been told by a health professional that they have a depressive disorder (18.7%) is higher when compared to the state (16.3%). However, the proportion of residents in the Ancillary Service Area who have been told by a health professional that they have a depressive disorder (14.1%) is lower when compared to the state. Permanent teeth removal: More residents in the Total Service Area have had their teeth removed because of tooth decay or gum disease than in Connecticut. Specifically, 57.1% report no teeth removed versus 62.3% in the state. Likewise, Total Service Area residents are more likely to report having had six or more but not all teeth removed (10.3% vs. 7.2% for the state) and all of their permanent teeth removed (5.3% vs. 2.6% for the state). Individually, residents in the Ancillary Service Area are more likely to have had their teeth removed than residents throughout Connecticut. Asthma: The proportion of residents in the Total Service Area who reported having ever been told that they have asthma (19.1%) is higher compared to the state (13.9%) and the Nation (13.5%). However, while the outcomes for all three service areas are less favorable than the state and the Nation, only the outcomes for Ancillary and Secondary Service Areas are significantly different. For those that have asthma, a higher percentage (41.2% in the Total Service Area as compared to 35.6% in the Nation) had an asthma attack in the past 12 months and 21.2% visited an emergency room or urgent care center more than three (3) times because of their asthma. Residents in the Secondary Service Area are more likely to have had an asthma attack in the past 12 months compared to residents in the Ancillary Service Area and the Nation. They are also more likely to have visited an emergency room or urgent care center than residents across the Nation. Pneumonia shot: A lower proportion of residents in the Total Service Area (31%) had a pneumonia shot during the past 12 months as compared to the state (35.2%). Residents in the Primary Service Area were less likely to receive a pneumonia shot than residents in the Secondary and Ancillary Service Areas, Connecticut, and the Nation. Page 20

22 Seatbelt use: The proportion of residents in the Total Service Area who always use seat belts when driving or riding in a car (87.7%) is lower when compared to Connecticut (90.0%). In particular, the proportion of residents in the Ancillary Service Area who always use seat belts when driving or riding in a car (86.3%) is lower when compared to Connecticut (90.0%). Smoking habits: The proportion of residents in the Total Service Area who have smoked at least 100 cigarettes in their entire life is higher (51.1%) when compared to the state (45.3%) and the Nation (45.0%). In addition, the proportion of residents who now smoke every day (29.9%) is higher when compared to the state (21.9%). In particular, residents in the Primary and Ancillary Service Areas are more likely to have smoked at least 100 cigarettes in their life compared to residents across the state and the Nation. Binge drinking: More residents in the Total Service Area report binge drinking during the past 30 days when compared to Connecticut (66.6% report no days of binge drinking versus 77.6% for Connecticut). In addition, the proportion of residents who participated in binge drinking on two or more occasions during the past 30 days (23.4%) is higher when compared to the state (12.9%). Health Status In line with Connecticut and more favorable than the Nation, 86.2% of residents in the combined total service are self- report that their general health is very good or excellent. Related, residents in the Ancillary Service Area were more likely than residents in the Primary and Secondary Service area to report that there were no days in the last 30 days that their mental and physical health was not good. Page 21

23 The proportion of residents who have been told by a health professional that they have a depressive disorder (18.7%) is higher when compared to the state (16.3%). However, the proportion of residents in the Ancillary Service Area who have been told by a health professional that they have a depressive disorder (14.1%) is lower when compared to the state. Page 22

24 Access to Care Residents in the Backus Health System service area are more likely to have health insurance coverage than the U.S. benchmark. However, residents in the Total Service Area are less likely to report that they have one person they think of as their primary care provider. When comparing the individual service areas, residents in the Ancillary Service are more likely to report one health care provider than residents in the Primary or Secondary Service Areas. Page 23

25 Residents in the Total Service Area are more likely to have had a routine check- up in the last 12 months when compared to Connecticut or U.S. However, differences exist by service area. Residents in the Ancillary Service Area (76.5%) and the Primary Service Area (74.1%) are more likely to have had check- up in the last year than the U.S. Benchmark (67.9%). Page 24

26 Residents in the Secondary Service Area were more likely to seek care at the hospital Emergency Department because they could not get an appointment with a doctor or clinic. Physical Activity and Overweight Residents in the Total Service Area were more likely to report regular physical activity than the Connecticut and U.S. benchmarks. However, the proportion of obese residents in the Total Service is 27.8% compared to 23.3% in Connecticut, and 27.2% in the U.S. Page 25

27 A breakdown of Calculated BMI shows that the Primary and Secondary Service Area are more overweight or obese than the Ancillary Service Area. Page 26

28 Diabetes Residents in the Backus Health System Service Area are less likely to have been told by a health care professional they have diabetes or pre- diabetes. However, those residents who report having diabetes are less likely to regularly check their blood sugar levels or feet for sores. They are also less likely to have seen a health care professional for care for their diabetes. In particular, diabetic residents in the Primary and Secondary Service Areas are less likely to properly care for their chronic disease. Page 27

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30 Women s Health Women in the Backus Health System Service Area are more likely than women across the U.S. to have had a mammogram in the last 12 months and to have ever had a clinical breast exam. They are also more likely than U.S. or state respondents to have had a Pap test. In particular, women in the Ancillary Service Area are more likely to have had a clinical breast exam and women in the Secondary Service Area are more likely to have had a Pap test. Page 29

31 Men s Health Men in the Backus Health System Total Service Area are more likely to have had a PSA test than the U.S. (62.3% versus 53.5%, respectively) and are in line with the state figure of 81.1%. They are also more likely than the U.S. comparison group to have received a digital rectal exam (79% versus 73.4%). Men in the Ancillary Service Area are more likely to have had a PSA test than men across the Nation. Page 30

32 Risk Factors A greater percentage of residents in the Backus Health System service area (51.1%) report having smoked at least 100 cigarettes in their lifetime when compared to the state (43.3%) and U.S. (45%). Furthermore, 29.9% of residents report that they still smoke every day, a higher percentage than state residents (21.9%). More people in the Primary and Ancillary Service Areas have smoked at least 100 cigarettes in their lifetime compared to the state and the Nation. Residents in the total service area are also more likely than Connecticut or U.S. residents to report using chewing tobacco, snuff, or snus every day. Respondents were also asked how often they were exposed to secondhand tobacco smoke. Residents in the Ancillary Service Area were more likely to report being exposed to secondhand smoke at their workplace on one to two of the last seven days. Anecdotal feedback from community leaders suggests this may be related to workers within the casino industry. Page 31

33 Other risk factors of note include seatbelt use and binge drinking. Residents in the Total Service Area are less likely to always wear a seatbelt when driving or riding in a car (87.7%) when compared to Connecticut (90.0%). In particular, residents in the Ancillary Service Area are less likely to never wear a seatbelt when driving or riding in a car. More residents in the Total Service Area also report binge drinking during the past 30 days when compared to Connecticut (66.6% report no days of binge drinking versus 77.6% for Connecticut). In addition, the proportion of residents who participated in binge drinking on two or more occasions during the past 30 days (23.4. %) is higher when compared to the state (12.9%). Page 32

34 KEY INFORMANT INTERVIEWS Face- to- face interviews were held with 49 key community stakeholders. The questionnaire focused on perceptions of community needs and strengths across three key domains: Access to care Key health issues and challenges Quality of life Key Informants included public health experts, representatives of underserved populations, chronic disease conditions, and other special populations. The goal of the research was to better understand leaders perception of community health and to uncover health disparities, barriers to accessing health care, and other areas of opportunities, and to gather recommendations and feedback. Among the questions asked of the interviewees was What do you perceive as the three most significant (most severe or most serious) health issues in the community? Figure G1 shows the Key Informants opinions of key health issues for the Backus Health System. Obesity and Mental Illness were selected most frequently as an issue. Obesity was ranked as the most urgent need, followed by Substance Abuse. 70.0% Key Health Issues 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Obesity Mental Illness Heart Disease Diabetes Substance Abuse Cancer Domestic/Family Violence/Abuse of Children Sexually Transmitted Diseases Stroke Percent of respondents selecting the issue Percent of respondents (selecting this issue) who marked it as most urgent Figure G1: Informant opinions of key health issues for Backus Health System service area. Page 33

35 Strengths It was made clear by numerous Key Informants that Backus Health System is held in high regard in the greater Norwich community. There is a real sense of pride of the local health system. It was also clear that the hospital had improved over the years, was moving in the right direction, and genuinely cared about the community and the health of its residents. The interviews showed a high level of dedication among the community- based agency directors and staff. Respondents were glad to share their expertise and offer suggestions to improve the quality of life for their patients and clients. Barriers to Care Key Informants identified cost, transportation, and the lack of health insurance as the three main barriers to care. Additionally, many medical specialists in the Norwich area do not accept Husky (Medicaid) public health insurance, forcing individuals to travel to New Haven or Hartford to seek providers who accept the insurance. Large minority populations including Latino/Hispanic, Chinese, and Haitian, in and around Norwich, present challenges for the healthcare system, community service providers and the public schools to provide culturally competent services. The economic downturn of the nearby casino industry is a likely a contributor to the issue of cost as a barrier to care. Transportation was listed as a barrier to accessing care throughout the study. Key Informants acknowledged that the current transportation infrastructure does not adequately and efficiently aid residents in getting to the health services they need, when they need them. When transportation is a barrier, residents are forced to use more costly health care delivery options, such as the emergency department. It may also impede them from keeping health appointments that could help them prevent disease or better manage chronic conditions. Recommendations for Community Health Improvement Survey respondents saw opportunities for policy change to encourage healthier lifestyles. A greater investment in upstream prevention and more widespread education were at the top of their suggestions. They saw promise in increasing community collaborations, in better engaging the faith community, and in Backus Health System using its good name and reputation as a convener to stimulate more community dialogue and advocacy. They see a need for more affordable recreation, more access to fresh fruits and vegetables, more health screenings, and more employee wellness programs. Survey respondents saw opportunities for policy change to encourage healthier lifestyles. A greater investment in upstream prevention and more widespread education were at the top of their suggestions. They saw promise in increasing community collaborations, in better engaging the faith community, and in Backus Hospital using its good name and reputation as a convener to stimulate more community dialogue and advocacy. They see a need for more affordable recreation, more access to fresh fruits and vegetables, more health screenings, and more employee wellness programs. Page 34

36 FOCUS GROUPS Three Focus Groups were conducted with healthcare consumers December in Norwich, Connecticut. The groups lasted 90 minutes each. Participants received a $50 Wal- Mart gift card in appreciation for their time and participation. In total 24 individuals participated in the group. In consultation with Backus Health System representatives, Holleran created a discussion guide, consisting of 15 questions designed to illicit responses and group discussion around barriers to care, cultural competency, and communication channels. The following section provides a summary of the focus group discussions including key themes and select comments. A full report of the study can be obtained from Backus Health System. Strengths Most participants were aligned with a medical home and see their family doctor regularly. It was acknowledged that area health care providers had made positive inroads to improve multi- language communications. The availability, awareness, and success of health improvement programs were consistent throughout the discussion. Partnerships between health providers and social services were seen as positive and an important framework for community health improvement. Health information is distributed widely across the community and participants listed a variety of sources ranging from family and friends to media, community organizations, and their physician. Respondents in the group actively sought out health and wellness opportunities (a tendency that may be elevated due to some participant s involvement in a health care advisory capacity). Backus Health System was seen as a health leader and recognized for its outreach efforts. A variety of Backus- supported services were recognized by the group as examples of programs and services that are working well. Participants encouraged Backus to continue these partnerships and seek out additional opportunities. Opportunities While improvements were noted by the participants, a common theme was the need for continued cultural competency training. Limited access to care due to provider capacity, as well as few specialists accepting Husky Insurance, was discussed. Some participants thought the Husky drug formulary was limited. Participants recommended extending office hours, particularly for primary care providers. Individuals who seek health information are able to access it through a variety of local resources. The library was seen as a free resource to access health information that could be improved by training staff about accessing health information and providing a welcoming environment for all residents. Some in the group saw the variety of health care system options as confusing and disjointed. The opportunity to provide additional health and wellness programs including integrated medicine, employee wellness, and physician talks were noted. Page 35

37 Continued use of a variety of channels to disseminate information was encouraged, as well as the creation of a speakers bureau or similar opportunity to tap into experts from across health and human services organizations to provide community education. A specific need for drug and alcohol abuse and gambling awareness was noted. Participants viewed Norwich as a car community and observed there were limitations for opportunities to be active, despite several parks and organized activities. Transportation and cost were seen as the biggest barriers to accessing recreational activities. In general, respondents had a positive view of Backus Health System and its work to improve community health. Building on past successes, focus group participants offered a wide variety of ways that Backus can continue to improve its community health efforts. Participants offered suggestions that ranged from improved interaction with physicians to health literacy and cultural competency to using foreign- trained professionals to provide services. FINAL RESEARCH CONCLUSIONS The Backus Health System CHNA provided a comprehensive view of community health needs and an unbiased lens through which the Health System could view community health needs. The methodology included a secondary data profile of New London and Windham Counties, a 1,500-household telephone study (1,109 conducted in 2010; 461 conducted in 2012), 49 key informant interviews, and three focus groups. Holleran collected all data. The following Key Themes emerged throughout the Community Health Needs Assessment: Prevalence of Obesity Prevalence of Respiratory Disease: Asthma/Lung Cancer and Smoking Less Prevalence of Diabetes, but those diagnosed are less likely to manage their condition well Access to Care issues exist, specifically, physician/patient ratio, Medicaid health insurance acceptance, and transportation Increased Cultural Competency is needed in delivering care to ethnic groups Increased diagnosis of Depression Need for increased preventative health measures: mammograms, pneumonia shots, seatbelt usage Need for more widely available Oral Health Care Need to reduce Preventable Hospitalizations Increased rates of Lyme Disease, Hepatitis B Increased Binge Drinking Page 36