Community Health Needs Assessment

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1 Community Health Needs Assessment

2 Five Stage Process STAGE 1 MAPPING Secondary data Online survey of physicians STAGE 2 COMMUNITY HEALTH NEEDS/ANALYSIS Secondary Research STAGE 3 VALIDATE FINDINGS Primary Research: Phone + Online: 302 consumers STAGE 4 COMMUNITY ENGAGEMENT / SUMMIT Leadership Forum with local agency and government leaders STAGE 5 FINAL REPORT Written report/presentation by Stratasan Current/projected demographics Capacity of area physicians to help address community health issues. Overview of the health needs of the area s population and what resources are in place to address these needs Learn what residents see as the greatest unmet health needs of the area Understand the community s sense of health Develop consensus on how we can all work together to meet the health needs of the entire community Comprehensive report suitable for submission to the IRS that outlines community health needs and the role of the hospital in addressing those needs

3 Data Analysis PATIENT ORIGIN 3

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8 Data Analysis AUGUSTA COUNTY DEMOGRAPHICS 8

9 Demographic Dashboard Category Augusta Co Staunton Waynesboro Augusta City City Health Area Virginia USA Population 73,606 23,968 21, ,642 8,064, ,212,863 Median Age Median Income $51,273 $39,219 $38,765 $46,329 $58,234 $50,227 Educ % Assoc/Bach 23.5% 30.9% 26.3% 25.7% 40.3% 34.9% Pop Growth % 0.65% 0.51% 0.51% 0.86% 0.67% Households 28,458 10,583 8,930 47,971 3,080, ,457,661 Businesses 2,041 1,296 1,080 4, ,694 11,699,792 Employees 29,567 13,674 11,918 55,159 3,725, ,274,941 Medical Care Index Average Health $3,660 $3,053 $2,916 $3,386 $4,340 $3,611 Spend Total Spent $104,165,018 $32,309,989 $26,035,456 $162,420,486 $13,369,323,978 $424,173,676,593 The geography analyzed in this report is the Augusta Health Area also known as Augusta County Inclusive Area, which is Augusta County, Staunton, and Waynesboro. Source: Stratasan/ESRI 9

10 Income and Race/Ethnicity The inclusive County has wide ranges of household incomes, but a very homogeneous racial and ethnic population Source: Stratasan/ESRI 10

11 Age Distribution Augusta County Inclusive 20% 15% 10% 5% Augusta Area VA US % 20% 15% Augusta Area VA US 10% 5% 0% Source: Stratasan/ESRI The population is older than Virginia or the US 11

12 2011 Population by ZIP Code 12

13 Population Growth Per Year 13

14 HH Income < $15,000 by census tracts 14

15 Data Analysis BUSINESS ENVIRONMENT 15

16 Augusta Area; North America Industry Classification (NAICS) 16 The Business Community - # of Businesses Ag/Forestry/Fishing & Hunting, 81 Transportation & Warehousing, 115 Education, 101 Arts, Entertainment & Recreation, 76 Unclassified, 45 Information, 76 Utilities, 7 Mining, 5 Management, 2 Administrative & Support & Waste Management & Remediation Services, 183 Real Estate, Rental, & Leasing, 229 Wholesale, 173 Manufacturing, 183 Finance, 189 Finance & Insurance, 240 Professional, Scientific & Tech Services, 269 Accommodation & Food, 297 Retail, 729 Other Services, 657 Construction, 385 Healthcare, 349

17 Augusta Area; North America Industry Classification (NAICS) 17 The Business Community - # of Employees Real Estate, Rental, & Leasing, 1,055 Finance & Insurance, 1,300 Transportation & Warehousing, 1,837 Professional, Scientific & Tech Services, 2,527 Finance, 189 Construction, 2,778 Administrative & Support & Waste Mgt & Remediation Svcs, 886 Arts, Entertainment & Rec, 598 Information, 919 Ag/Forestry/Fishing & Hunting, 424 Unclassified, 144 Management, 51 Mining, 40 Utilities, 46 Healthcare, 8,504 Retail, 7,399 Public Admin., 3,884 Education, 4,149 Accommodation & Food, 4,364 Wholesale Trade, 4,904 Manufacturing, 6,778

18 Largest Employers Source: Stratasan/ ESRI 18

19 Unemployment May 2012 Source: Bureau of Labor Statistics 19

20 Unemployment Augusta County May 2011 May 2012 Change Augusta County 5.7% 5.2% -0.5 Waynesboro City 7.9% 6.5% -1.4 Staunton City 6.5% 6.0% -0.5 Source: VA Economic Development Partnership; Bureau of Labor Statistics 20

21 Commuter In-migration Source: Stratasan /ESRI 21

22 Commuter Out-migration Source: Stratasan/ ESRI 22

23 Leakage/Surplus Factor by Industry Subsector People are going without or leaving the area for furniture & home furnishing stores, electronics & appliance stores, clothing & clothing accessories stores, sporting goods, hobby, book & music stores. Source: Stratasan/ESRI; Augusta County Inclusive 23

24 Psychographics 24

25 Who Report The graph of your community s psychographic profile Augusta Patients Residents

26 Top Tapestry Groups #17 Green Acres 40.7 yrs, $64,480, DIY, fishing, camping, satellite TV, have a garden, own multiple vehicles #25 Salt of the Earth 41.5 yrs, $51,080, married couples, professionals, gardening, CMT, NASCAR #29 Rustbelt Retirees 45.6 yrs, $52,728, married no kids & singles, professionals, bingo, news TV, belong to community groups #33 Midlife Junction 41.5 yrs, $49,139, married couples, preparing to retire, fishing, reading #14 Prosperous Empty Nesters 48.6 yrs, $69,227, professionals, civic clubs, travel, golf & baseball

27 What Health Report: Health Habits The Healthy Habits of Your Patients Things Your Patients Do More-Likely Used prescription drug for arthritis/rheumatism 63% Wear bi-focals 62% Own treadmill 54% Diet control for salt restriction 53% Have life insurance w/total value: <$ % Have life insurance w/total value: $ % Used prescription drug for high blood pressure 47% Used prescr drug for diabetes (non-insulin) 46% Used prescription drug for high cholesterol 46% Used prescription drug for heartburn/acid reflux 43% Visited doctor in last 12 mo: chiropractor 40% Obtained medical insurance: Medicare 37% Have life insurance: separate whole life policy 36% Used prescription drug for depression 36% Own stationary bicycle 35% Diet control for blood sugar level 34% Bought prescription eyewear: from eye doctor 33% Have prescription medicine insurance 32% Have life insurance w/total value: $ % Used prescription drug for anxiety/panic 28% Used doctor`s care/diet for diet method 28% Have accidental death and dismemberment insurance 26% Obtained medical insurance: Medicaid 26% Have life insurance: comb. term/whole life policy 24% Diet control for cholesterol level 24% Things Your Patients Don t Do Less-Likely Have medical insurance: Kaiser Permanente 78% Vitamin/dietary suppl used/6 mo: echinacea 38% Vitamin/dietary suppl used/6 mo: B complex+c 38% Have life insurance w/total value: $ % Used last 6 mo: lactose intolerance product 32% Vitamin/dietary suppl/6 mo: Centrum 32% Exercise at club 2+ times per week 30% Used nutrition/energy bar in last 6 months 28% Vitamin/dietary suppl used/6 mo: A 27% Used egg alternatives in last 6 months 24% Visited doctor in last 12 mo: dermatologist 23% Used butter alternatives in last 6 months 23% Have life insurance w/total value: $ % Visited doctor in last 12 mo: allergist 22% Have medical insurance: Cigna 22% Vitamin/dietary suppl used/6 mo: antioxidant 20% Used prescription drug for eczema/skin itch/rash 20% Drank sports drink/thirst quencher in last 6 mo 18% Have medical insurance - belong to HMO 18% Used last 6 mo: children`s cough syrup 16% Buy foods specifically labeled as natural/organic 16% Drank meal/dietary supplement in last 6 months 15% Visited doctor in last 12 mo: ear/nose/throat 15% Used last 6 mo: children`s cold tablets/liquids 13% Spent on contact lenses in last 12 mo: $ %

28 What Summary Report: Behavior Habits The Behavior Habits of Your Patients Things Your Patients Do More-Likely Things Your Patients Don t Do Less-Likely HH owns riding lawn mower 222% HH owns kerosene heater 196% Shopped at grocery store/6 mo: IGA 179% HH owns garden tiller 171% Participated in hunting with shotgun 170% HH owns welder 150% Fam rest/steak hse last 6 mo: Bob Evans Farm 147% Participated in hunting with rifle 144% HH owns chain saw (gas) 139% Shopped at grocery store/6 mo: Shop`N Save 136% Participated in archery 135% Have special Seniors Club account 127% Shopped at grocery store/6 mo: Aldi 126% HH owns stationary radial arm saw 126% HH owns ATV/UTV 121% Purchased vegetable seeds in last 12 months 120% Did birdwatching in last 12 months 114% HH owns stationary drill press 114% Shopped at grocery store/6 mo: Fred Meyer 112% HH owns dehumidifier 110% Appl/hardware/electr store/12 mo: True Value 110% Fam rest/steak hse last 6 mo: Perkins 107% HH has satellite dish: Dish Network 107% HH owns stationary table saw 105% Purchased vegetable plants in last 12 months 104% Radio format listen to: Hispanic 84% Have medical insurance: Kaiser Permanente 78% Visited Disneyland (CA) in last 12 months 75% Dept/clothing/variety store/3 mo: Nordstrom 70% Shopped at grocery store/6 mo: Vons 69% Radio format listen to: all news 68% Fast food/drive-in last 6 mo: Del Taco 68% Drug store shopped at last 6 mo: Longs Drug Store 67% Dept/clothing/variety store/3 mo: Crate & Barrel 65% Shopped at grocery store/6 mo: Pathmark 65% Fam rest/steak hse last 6 mo: Cheesecake Factory 63% Drank cognac in last 6 months 62% Used nectars in last 6 months 62% Shopped at grocery store/6 mo: Whole Foods Market 62% Airline used for domestic trip/12 mo: Continental 61% HH made phone call to foreign country last 30 days 60% Radio format listen to: jazz 59% Spent $100+ at laundries/laundromats in last 6 mo 59% Dept/clothing/variety store/3 mo: Banana Republic 59% Fast food/drive-in last 6 mo: Carl`s Jr. 57% Airline used for domestic trip/12 mo: American 56% Shopped at AM/PM in last 6 months 55% Shopped at grocery store/6 mo: A & P 54% Fast food/drive-in last 6 mo: Popeyes 54% Fast food/drive-in last 6 mo: Chipotle Mex. Grill 54%

29 Health Service Demand Stratasan Health Service Projections 29

30 Health Service Demand Overview Augusta County Staunton City Waynesboro City Augusta Health Area Virginia USA Inpatient Outpatient Emergency The ( _ ) = the rate of occurrence in your combined service area Rate = # Patients / Total Population 30 Source: Stratasan

31 Health Service Demand Overview Augusta County Staunton City Waynesboro City Augusta Health Area Virginia USA Physician Office Visits The ( _ ) = the rate of occurrence in your combined service area Rate = # Patients / Total Population 31 Source: Stratasan

32 Health Service Demand Overview Inpatient Outpatient Emergency Augusta County Staunton City Waynesboro City Augusta Health Area Virginia USA 9,618 3,610 3,177 16,405 1,019,756 40,692,505 (0.134) (0.151) (0.147) (0.140) (0.128) (0.131) 18,453 6,898 5,868 31,219 2,287,388 96,404,868 (0.256) (0.289) (0.272) (0.266) (0.287) (0.310) 31,997 11,624 10,160 53,781 3,710, ,176,760 (0.444) (0.487) (0.472) (0.458) (0.466) (0.438) Physician 296, ,674 89, ,190 28,875,808 1,045,262,266 Office Visits (4.116) (4.220) (4.134) (4.151) (3.625) (3.359) The ( _ ) = the rate of occurrence in your combined service area Rate = # Patients / Total Population 32 Source: Stratasan

33 Data Analysis ENVIRONMENT & HEALTH DATA 33

34 Crime per 100,000 Population 12,000 10,000 8,000 6,000 4,000 Augusta Co Staunton Waynesboro 2, Source: County Sheriff s Offices and City Police Departments Town Police and VA State Police not included 34

35 Source: Stratasan; ESRI 35

36 Chemical Spills and Releases Releases: Manganese Compounds Hydrochloric Acid Lead Trichloroethylene (2) Copper Zinc Lead 36

37 Current Health Breakouts 37

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

39 Smoked 9+ Packs of Cigarettes per Week 39

40 Used Prescription Drug for Asthma 98 40

41 Used Prescription Drug for High Blood Pressure 41

42 Used Prescription Drug for Diabetes 42

43 Used Prescription Drug for Depression 43

44 Doctor s Care for Diet 44

45 MARKET RESEARCH 45

46 Research Methodology CHR worked closed with the AH team to design a 35-question survey to validate the findings in Stages 1-2 while capturing community attitudes and awareness. Once the questionnaire design was approved, CHR handled all aspects of the surveying process programming the survey, hosting, call center management, data collection, tabulation and analysis. General population data was purchased and screened in order to reach a random sample of the population that was representative of the demographics of AH s primary and secondary service areas. CHR administered this survey through its signature M 3 (MultiMode Methodology) approach, combining landline and cell phone interviews. A total of 302 responses were completed during the period of July 14 26,

47 Community residents have a much rosier view of their health status than do the physicians. 50% 56% 26% 21% 2% 7% 7% 12% 4% 12% 0% 0% Excellent Very Good Just Okay Fair Poor Don't know Community Physician Base: 321 Community Q. Generally, how would you describe your health? Would you say it is? Physician Q. How would you describe the overall health status of the citizens of Augusta County and the surrounding counties? 47

48 Respondents represented a mixture of activity levels from 30% who exercise most every day, to 11% who do not exercise at all. Other mentions include: Expensive I am on oxygen. I am tired after working. I don't like it. I am getting old and tired. I get enough physical activity out of my work. I work third shift and I'm tired. It is too hot. My job engages me to do exercise. On disability I am limited to what I can do. Base: 302 Q26. During the past month, other than on your regular job, about how often did you participate in any physical activities or exercise such as walking, running, weight-lifting, team sports, etc.? 48

49 About two-thirds of these respondents turn to their primary care doctor (68%) and another 22% turn to the hospital for basic healthcare needs. Other Mentions: DaVita My gynecologist Nurse practitioner My wife (she s a nurse) Base: 302 Q23. If you have one person or group you turn to for basic healthcare needs, where do you go most often? 49

50 Physician access and financial issues sometimes prevent people from seeing a doctor. Other Mentions: I don't know. They just had me waiting in waiting in the emergency room. Miscommunication Base: 302 Q24. Was there a time in the past 12 months when you needed to see a doctor but could not? Q25. What are some of the reasons why you could not see a doctor? (base = 47) 50

51 About one-third of respondents (35%) indicated that they currently have some type of chronic disease or condition. Other Mentions: Allergies Anemia Aneurism Carcinoma Degenerative knee Disabled related to an accident Diverticulitis Gastrointestinal Graves disease Liver transplant Low thyroid Lupus PAD Sarcoidosis Vascular issues Base: 302 Q33. Have you ever been told by a doctor you have a chronic disease, condition or challenge? 51

52 Personal accountability, affordable health insurance, and substance abuse are seen as the most impactful health issues here. Other Mentions (1% or fewer each): More specialists Safe neighborhoods Aging Education Information about how to cook healthy foods Information about managing chronic health conditions Dental health services Mental health & behavioral health services More urgent care clinics Abuse and violence Affordable housing Safe/affordable places to relax Base: 302 Q30. What are the top 2 or 3 issues in your community that impact people s health? 52

53 Six out of ten respondents agree that prescription drug abuse is a major problem in the community (60%). Base: 302 Q31. To what extent do you agree or disagree with the following statement?: Prescription drug abuse is a major problem in the community. 53

54 Respondents feel that people in the community may benefit from health programs and information as well as cost-efficient care. Base: 141 (those who answered) Q35. What healthcare, health education or public health services or programs would you like to see offered in your community? 55

55 Diet and exercise top the list of concerns for children s health in the community. Base: 302 Q36. In your opinion, which of these are the top 3 health concerns for children in your community? 56

56 Physician Survey Results 61 Respondents 57

57 What do you think the people in this region need in order to manage their health more effectively? (Select all that apply) More information/education about their Compliance to drug therapies/prescriptions Financial assistance-for doctor visits, medical Insurance that's more affordable for more people A more integrated approach among providers to Easier access to health and wellness services Transportation to doctor, clinic, health center, etc. Health information exchange between providers More specialists Nothing else is needed at this time Other (please specify) 1.6% 4.9% 13.1% 50.8% 47.5% 47.5% 45.9% 44.3% 39.3% 27.9% 32.8% 0% 20% 40% 60% 58

58 In your opinion, what are the top three (3) health and community issues that need to be addressed in Augusta County and the surrounding area? (Please select up to three responses) Lifestyle: People taking more responability for their own health Access: More primary care professionals Access: Affordable health insurance Access: Mental health and behavioral health services Community Issue: Jobs/Employment Access: Affordable services and programs Lifestyle: Information on managing chronic health conditions Access: Dental health services Lifestyle: Affordable healhy lifestyle of fitness programs Community Issue: Education Lifestyle: Waling or bike paths or trails Lifestyle: Information on nutrition and healthy cooking Access: Substance abuse services Community Issue: Poverty Community Issue: Transportation LIfestyle: Safe and affordable places to exercise Access: More specialists Access: Health care services for seniors Lifestyle: More sidewalks Lifestyle: Affordable, fresh foods Community Issue: Affordable Housing Access: Vision health services 0% 20% 40% 60% 59

59 Community Focus Group Summary On June 29, 20 community members participated in a focus group for input into community health needs Two other people were interviewed via telephone 22 Total Input 60

60 Most Important Health Issues Mental/behavioral health; lack of psychiatrists Substance abuse: Salts, prescription drugs, methamphetamine Economic issues: jobs and employment, public housing, culture Diet and nutrition fast food diet, affordable fresh, natural foods Lifestyle Access to services based on knowledge services exist Lack of access to dental services Abuse and violence, particularly elder abuse-self neglect, financial exploitation Chronic Diseases Diabetes Heart Disease High Blood Pressure Smoking Obesity Teen pregnancy 61

61 How to Collaborate Targeted outreach smaller is better Communication Nurturing Neighboring Networks Grassroots Community Health Forum in existence 62

62 Barriers/Political Issues There are pockets and subcultures in the County Need for more relationships across groups and geographies Some elderly and poor people do not have access to computers There is no transportation, cell phones or financial resources in part of the County, therefore difficulty communicating Lack of internal willingness to change Agencies stepping over each other for funding Communication always too many people not knowing what is going on 63

63 The Health Status of the Community 64

64 Virginia State Health Rankings - 20 In the past year, the % of children in poverty decreased from 15% to 12% In the past year, binge drinking increased from 14 to 15% of adults In the past 5 yrs, diabetes increased from 7% to 9%. 535,000 VA adults have diabetes In the past 10 yrs, obesity increased from 18% to 26% of adults. 1.6 M Virginians are obese While smoking decreased from 21% to 19% of adults in last 10 yrs, this is a much smaller reduction than other states. More than 1.1 M adults still smoke in VA. America s Health Rankings 65

65 Source: Virginia

66 Source: CDC BRFSS DIABETES Virginia

67 Source: Virginia

68 How do we rank for health? Source: County Health Rankings 69

69 County Health Rankings Category Augusta Staunton Waynesboro Albemarle Bath Nelson Rockbridge Rockingham Overall Rank (1 to 134) #31 #53 #64 #4 #51 #23 #57 #20 Health Outcomes Health Factors Mortality Morbidity Health Behaviors Clinical Care Social & Economics Physical Environment Smoking 17% NA NA 14% NA NA 19% 12% Obesity 27% 28% 28% 27% 27% 26% 29% 27% Binge Drinking 10% NA NA 15% NA 8% 18% 11% Health Factors: health behaviors, clinical care, social and economic, and the physical environment. Health Outcomes: how long people live (mortality) and how healthy people feel and low birth weight babies (morbidity). County Health Rankings

70 71

71 72

72 Health Issues Utilization Community Health Issues Hypertension, HBP Diabetes Aging Smoking Obesity Behavioral Utilization Cardiology, Neurology Endocrinology Orthopedics Oncology Bariatrics, Gastroenterology Therapy Top ER Visits Injury & Poisoning Symptoms, signs, and ill-defined conditions (kitchen sink: everything from a crying baby to abdominal pain, respiratory arrest to decreased libido) ICD9 codes Respiratory System Disease Musculoskeletal System and Connective Issues Digestive System Disease Source: County Health Rankings, Stratasan 73

73 Where we do go from here Augusta County is relatively healthy, but is aging. Need to engage with Chamber to attract younger, higher wager earners. Invest in low cost/free tools and applications to track disease. The epidemiology is changing and the hospital will need to be prepared in 5-10 years to handle significantly more Diabetes, Obesity, CHF, and COPD. In the future, we will have to care for the WHOLE Community. This will require different tools and skills. Think about a Three-Way Marketing strategy for the cities (Waynesboro and Staunton) and the county. Think innovatively about how to make the attitudinal changes in the community to create a sense of health. 74