Memorial Hermann Rehabilitation Hospital Katy Community Health Needs Assessment

Transcription

1 Memorial Hermann Rehabilitation Hospital Katy

2 Memorial Hermann Rehabilitation Hospital Katy Prepared by: Community Hospital Consulting August 2012

3 Table of Contents Executive Summary... Facility Background.. Process and Methodology Study Area Definition.. The Community s Health Status... Demographics. County Health Rankings Findings from Current Research. Health Data Findings Input from People Who Represent the Broad Interests of the Community... Prioritization of the Community s Needs... Priorities that Will Not be Addressed.. Resources and Information Gaps... About Community Hospital Consulting.. Reported Sources.. Appendix.. Written Comments

4 EXECUTIVE SUMMARY 3

5 Executive Summary A (CHNA) was created for Memorial Hermann Rehabilitation Hospital Katy. The CHNA utilizes relevant health data and stakeholder input to identify the main community health needs in the study area. Based on patient origin, Memorial Hermann Rehabilitation Hospital Katy s study area is defined as Fort Bend and Harris Counties. For comparative purposes, the CHNA includes data for two additional counties, Brazoria and Montgomery Counties, which are located in the Houston Baytown Sugar Land metropolitan statistical area (MSA) of Texas. The CHNA Team, consisting of leadership from Memorial Hermann, met with consulting staff from CHC Consulting on December 13, 2012 to review the research findings and prioritize the community health needs. Eight community health needs were identified by assessing the prevalence of the issues identified in the health data findings, including a review of current studies, combined with the frequency and severity of mentions in the interview and survey findings. After a facilitated discussion the CHNA Team utilized a structured matrix to rank the community health needs based on three characteristics: Size and prevalence of the issue Effectiveness of interventions The system s capacity to address the need Once this prioritization process was complete the CHNA Team discussed the results and decided to address the top six of the eight ranked community health needs. The CHNA Team felt that the two lowest ranking priorities, increasing access to dental services and increasing access to transportation were not core business functions of the health system and that resources and efforts would be better spent addressing the top six prioritized needs. Memorial Hermann Rehabilitation Hospital Katy s priorities and rationales are listed below. PRIORITY #1: Education and prevention for diseases and chronic conditions Heart disease Cancer Diabetes Alzheimer s Priority #1 Rationale: Data suggests that there are high rates of various diseases and chronic conditions in the study area and in the Houston Baytown Sugar Land MSA. As of 2009, heart disease and cancer are the first and second leading causes of death in the study area. Harris County has a higher heart disease and a higher cancer mortality rate than Texas, while Fort Bend County s rates are lower than Texas rates for both diseases. There are higher Alzheimer s mortality rates in the study area than there are in Texas. According to the Behavioral Risk Factor Surveillance System (BRFSS), diabetes is also a prevalent condition in the Houston Baytown Sugar Land MSA. In the survey conducted by Memorial Hermann, 4

6 more than 90% of respondents indicated that promoting chronic disease management and improving access to preventive care (screenings for diseases) were important or very important initiatives for residents in the community. Hypertension, heart failure, cancer and diabetes were consistently reported as top conditions in the community (questions ranging from top health problems, most prevalent conditions and top preventable hospitalizations). PRIORITY #2: Address issues with service integration, such as coordination among providers and the fragmented continuum of care Lack of information and record sharing, such as electronic medical records Lack of communication between providers Patient needs for medical homes Inappropriate ED use Priority #2 Rationale: Findings suggest that there are various issues that fall under the service integration category in the communities served by Memorial Hermann Hospitals. The Houston Hospitals Emergency Department Use Study (2010) demonstrates the frequent inappropriate use of emergency departments for primary care related conditions in the community. Many interviewees noted frustrations about the lack of record sharing among providers in the community and many said that patients must be transitioned out of the Emergency Department settings and into primary care settings. Another common concern was that too much of the patient population lacks a viable primary care access point or medical home focused on primary care. PRIORITY #3: Address barriers to primary care, such as affordability and shortage of providers Cost Number of providers Priority #3 Rationale: According to the most recently released (in August of 2012) census data, more than one fourth of residents in Texas are uninsured. Nearly 30% of residents in Harris County and about 20% of residents in Fort Bend County are uninsured. Furthermore, many of the residents (18.8%) in the Houston Baytown Sugarland MSA experience medical cost barriers with regard to accessing healthcare. The Health of Houston Survey 2010: A First Look also indicated that women who didn t receive the appropriate prenatal care often cited cost and insurance barriers (34%). In the CHNA interviews, there was a perception among interviewees that primary care providers are running at full capacity and there is a need for additional primary care providers to serve the communities both in the general population and the safety net population. The Safety Net Review Key Informant Study suggests that lack of availability of primary care services and difficulty accessing primary care are two of the top three problems among the safety net. Finally, in the survey conducted by Memorial Hermann, Lack of 5

7 coverage/financial hardship was ranked first with regard to barriers to access to primary and preventive care for low income residents in the community. The lack of capacity (e.g. insufficient providers/extended wait times), ranked third. PRIORITY #4: Address unhealthy lifestyles and behaviors Obesity Communicable diseases (chlamydia, gonorrhea, AIDS, tuberculosis, syphilis) Accidents Priority #4 Rationale: Findings suggest that there is a need to address unhealthy lifestyles and behaviors in the community, such as obesity, communicable diseases (chlamydia, gonorrhea, AIDS, tuberculosis, and syphilis), and accidents. Harris County has high rates of chlamydia (413.8 per 100,000) and gonorrhea (127.8 per 100,000), while Fort Bend County s chlamydia (196.2 per 100,000) and gonorrhea (52.3 per 100,000) rates are lower. Furthermore, as of 2009, Harris County s tuberculosis, primary and secondary syphilis and AIDS rates have been higher than the state s rates since According to BRFSS, more than 76% of residents in the Houston Baytown Sugar Land MSA do not consume the recommended daily intake of fruits and vegetables and more than 23% do not engage in any leisure time physical activity. Houston youth were more likely than Texas youth to engage in 14 different risky behaviors, ranging from physical violence, to obtaining cigarettes by purchasing them from a store or gas station, to sexual intercourse before 13, to never being taught in school about HIV or AIDS, and various nutrition and physical activity indicators. In the survey conducted by Memorial Hermann, adult and childhood obesity ranked as the third and fourth most important health problems in the community. More than 82% of respondents believe that obesity is the second most prevalent chronic disease in the community and more than 70% rated nutrition and weight management programs as inadequate or very inadequate in the community. PRIORITY #5: Address barriers to mental healthcare, such as access to services and shortage of providers Number of providers Adequacy and access issues Substance abuse services Priority #5 Rationale: Access to mental health services ranked as a top concern over and over again in the survey conducted by Memorial Hermann. For example, 79.5% of respondents indicated that the needs of persons with mental illness were being either inadequately or very inadequately met. Mental health problems ranked as the number one most important health problem in the community, with a little more than 71% of respondents ranking it first. More than 85% of respondents said that access to mental/behavioral healthcare services for low income residents was difficult or very difficult. Finally, more than 80% of respondents indicated inadequate or very inadequate for services provided for mental health screenings. Interviewees also noted the need to address barriers to mental healthcare, 6

8 such as the inadequacy of mental and behavioral health treatment programs available in the community, the limited number of beds for inpatient mental health services and the critical need for substance abuse intervention and rehabilitation programs. PRIORITY #6: Decrease health disparities by targeting specific populations Safety net population (under/uninsured, working poor, indigent) Unemployed Children Elderly and almost elderly (those who are not yet eligible for Medicare) Asian immigrant population Homeless Priority #6 Rationale: Data suggests that there are various health disparities among specific populations in the community. There are disparities among those who face medical cost barriers with regard to gender, race/ethnicity, income and education. The Health of Houston Survey 2010: A First Look indicates that health insurance and access to care is a particular concern for the Houston area, with Hispanic and Vietnamese residents having much higher uninsured rates than the average. The Health of Houston Survey 2010: A First Look also indicates that there are disparities among children s access to insurance. According to BRFSS, there are mental health disparities with regard to gender, race/ethnicity, income and age. There are also disparities among those who report diabetes, those who are overweight or obese and those who do not participate in any leisure time physical activity. Interview data also demonstrates these disparities. The populations most at risk include the safety net population, the unemployed, children, elderly and almost elderly, non English speaking minorities, Asian immigrant populations and the homeless. 7

9 FACILITY BACKGROUND 8

10 About Memorial Hermann Rehabilitation Hospital Katy Since its opening in 2006, Memorial Hermann Rehabilitation Hospital Katy has proudly served west Houston as the only inpatient rehabilitation hospital in the Katy community. Comprehensive programs and services have allowed Memorial Hermann Rehabilitation Hospital Katy to touch the lives of many, and staff continues to focus on improving and expanding available services for individuals recovering from injuries or suffering from chronic diseases that have impaired their physical or cognitive functioning. Memorial Hermann Rehabilitation Hospital Katy offers the latest technologies in diagnostic imaging, along with specialized care for stroke and neurological disorders, hard to heal wounds, orthopedic therapy and sleep disorders. From July 2011 through June 2012, the hospital yielded 792 admissions and 9,829 outpatient diagnostic and therapeutic visits. Currently, the hospital employs approximately 133 administrative, professional and support staff. 9

11 Mission, Vision, Values As part of Memorial Hermann Health System, Memorial Hermann Rehabilitation Hospital Katy operates under the following mission, vision and values. Mission Memorial Hermann is a not for profit, community owned, health care system with spiritual values, dedicated to providing high quality health services in order to improve the health of the people in Southeast Texas. Vision Memorial Hermann will be the preeminent health system in the U.S. by advancing the health of those we serve through trusted partnerships with physicians, employees and others to deliver the best possible health solutions while relentlessly pursuing quality and value. Values In collaboration with others, we are committed to assessing and creating healthcare solutions which meet the needs of individuals in our diverse communities. We are stewards of community resources and are committed to being medically, socially, financially, legally, and environmentally responsible. We are devoted to providing superior quality and cost efficient, innovative, and compassionate care. We collaborate with our patients, families, physicians, employees, volunteers, vendors, and communities to achieve our Mission. We support teaching programs that develop the health care professionals of tomorrow. We support biomedical research and implementation of innovative technology to expand our knowledge and learn how to provide better care. We provide holistic health care which addresses with dignity the physical, social, psychological, and spiritual needs of individuals. We are committed to the growth and development of the intellectual and spiritual capabilities of our employees. We have high ethical standards and expect integrity, fairness, and respect in all our relationships. 10

12 PROCESS AND METHODOLOGY 11

13 Process and Methodology Background and Objectives This CHNA is designed in accordance with CHNA requirements identified in the Federal Patient Protection and Affordable Care Act and further addressed in the Internal Revenue Service Notice and proposed IRS REG released April 3, The objectives of the CHNA are: Meet Federal Government and regulatory requirements. Research and report on the demographics and health status of the service areas including a review of state and regional data. Gather input, data and opinions from persons who represent the broad interest of the community. Analyze the quantitative and qualitative data gathered and communicate results via a final comprehensive report on the needs of the communities served by Memorial Hermann Rehabilitation Hospital Katy. Prioritize the needs of the communities served by the hospital. Supports an Implementation Plan for the hospital that addresses the prioritized needs. Scope of CHNA Report: The CHNA components include: A description of the process and methods used to conduct this CHNA including a reference section, which details data sources and dates of data Background information including mission, vision and values of Memorial Hermann Rehabilitation Hospital Katy A description of the hospital study area Definition and analysis of the communities served, including both a demographic and a health data analysis Findings from eleven comprehensive interviews conducted with people who represent a broad interest in the communities, including: o Persons with special knowledge of or expertise in public health; o Federal, tribal, regional, state, or local health or other departments or agencies, with current data or other information relevant to the health needs of the community served by the hospital facility; and o Leaders, representatives, or members of medically underserved, low income, and minority populations, and populations with chronic disease needs, in the community served by the hospital facility. 12

14 Findings from an electronic survey distributed to 550 individuals/organizations who are members of the Gateway to Care Collaborative in Houston (107 responses) A prioritized list of community needs identified in the research A description of additional health services and resources available in the community A list of information gaps that impact the health system s ability to assess the health needs of the community served A description of the individuals interviewed for this CHNA Methodology: Memorial Hermann contracted with an outside entity, Community Hospital Consulting (CHC Consulting), to assist in the development of the CHNA for Memorial Hermann Rehabilitation Hospital Katy. Memorial Hermann provided essential data and resources necessary to initiate and complete the process, including the definition of Memorial Hermann Rehabilitation Hospital Katy s study area, the identification of key community stakeholders to be surveyed and/or interviewed, and Memorial Hermann Rehabilitation Hospital Katy s background information. CHC Consulting conducted the following research: A demographic analysis of the study area A study of the most recent health data available Collaborated with Memorial Hermann to create, distribute and analyze a community health needs survey Conducted one on one interviews with individuals who have special knowledge of the communities, and analyzed results Facilitated the prioritization process during the CHNA Team meeting on December 13 th, The methodology for each component of this study is summarized below. In certain cases methodology is elaborated in the body of the report. Study Area Definition o Memorial Hermann Rehabilitation Hospital Katy s study area is based on hospital inpatient discharge data from July 1, 2011 through June 30, 2012 o The CHNA studies data at the county level because the majority of health data indicators are only available at the county or region level. Demographics of the Study Area o Population demographics, including population change by race, ethnicity, age, average and median income analysis, unemployment and economic statistics in the study area. o Demographic data sources include, but are not limited to, Truven Health s Market Expert Demographic Expert 2012 (provided by Memorial Hermann) and the Kids Count Data Center. Health Data Collection Process o A variety of sources, which are all listed in the references section of this report, were utilized in the health data collection process. 13

15 o o Health data sources include, but are not limited to, the Texas Department of State Health Services, the Behavioral Risk Factor Surveillance System and the U.S. Census Bureau. Additionally, research provided by Memorial Hermann was incorporated in this study. This includes the Health of Houston Survey: A First Look 2010, the Houston Hospitals Emergency Department Use Study (2010) and the Safety Net Key Informant Interview Interview Methodology o Memorial Hermann provided CHC Consulting with a list of persons with special knowledge of public health in Brazoria, Fort Bend, Harris and Montgomery Counties including public health representatives, not for profit organization professionals, charities and other individuals who focus specifically on underrepresented groups. o From that list, 11 in depth interviews were conducted using a structured interview guide. o Extensive notes were taken during each interview and then quantified based on responses, communities and populations (minority, elderly, un/underinsured, etc.) served, and priorities identified by respondents. Qualitative data from the interviews was also analyzed and reported. Survey Construction, Distribution, and Collection o An electronic survey was constructed using Survey Monkey software in order to gather opinions and input of those with special knowledge regarding the health needs and priorities of the study area. o The survey was restricted so that respondents could only complete the survey once per computer to protect the integrity of the data. o The survey was initially distributed to 550 representatives and/or organizations from the Gateway to Care Collaborative, which serves the Greater Houston area. Recipients were allowed to forward the survey to other stakeholders who they deemed to be valuable sources of input. The survey remained open for approximately one month. o Responses were quantified and analyzed, including any free form comments. Prioritization Strategy o Eight main needs were determined by assessing the prevalence of the issues identified in the health data findings, including a review of studies provided by Memorial Hermann, combined with the frequency and severity of mentions in the interviews and survey. o A structured matrix was used to rank the eight needs during the CHNA Team meeting on December 13 th, After a facilitated discussion, the list was paired down to six main priorities. o See the prioritization section for a more detailed description of the prioritization methodology. 14

16 As part of a subsequent CHNA, which will be required within three years, the data collection and survey methodology may be adjusted from this initial assessment to determine the effectiveness of the implementation activities that are addressed in the hospital s Implementation Plan. 15

17 STUDY AREA DEFINITION 16

18 Memorial Hermann Rehabilitation Hospital Katy Study Area Memorial Hermann Rehabilitation Hospital Katy Memorial Hermann Rehabilitation Hospital Katy s study area is defined as the two counties that yield the greatest number of inpatient discharges. These counties have been identified as Fort Bend and Harris Counties. Combined these counties define 86% of Memorial Hermann Rehabilitation Hospital Katy s inpatient discharges. Memorial Hermann Rehabilitation Hospital Katy Patient Origin Map and Distribution Memorial Hermann Rehabilitation Hospital Katy Patient Origin by County: Harris County makes up to 69.5% of discharges Fort Bend County makes up to 86% of discharges *Note: The H icons represent the hospital Memorial Hermann Rehabilitation Hospital Katy Patient Origin County State FY 2012 % of Cumulative Discharges Total % of Total Harris County TX % 69.5% Fort Bend TX % 86.0% Other % 100.0% Total % Source: Hospital Inpatient Discharges by County, Excludes Normal Newborns (DRG 795); EPSI FY12 (July 1, 2011 June 30, 2012) Run Date: July 11,

19 THE COMMUNITY S HEALTH STATUS 18

20 Need in Community Served by Memorial Hermann Rehabilitation Hospital Katy Specific Study Area Information Memorial Hermann Rehabilitation Hospital Katy s study area is defined as Fort Bend and Harris Counties. The CHNA studies data at the county level because the majority of health data indicators are only available at the county, MSA or region level. For comparative purposes, the CHNA includes data for two additional counties, Brazoria and Montgomery Counties, which are located in the Houston Baytown Sugar Land MSA. The following information outlines specific health data pertaining to Brazoria, Fort Bend, Harris and Montgomery Counties. First, a demographic analysis demonstrates the age and racial composition of the community, along with an economic and education analysis. Then a snapshot of the community provides a broad overview of the counties health rankings, followed by a review of current studies. Finally, the detailed health data reflects a deeper look at the most current natality and health statistics. This includes vital health statistics, mortality data, information regarding disease and chronic conditions, other causes of death and communicable diseases. Data regarding mental health, health behaviors, and access to health coverage is also provided in this section. The majority of this data is presented at the county and state levels. However, if county level data was not available, data is presented at the region or metropolitan statistical area (MSA) level. All Texas counties are assigned to one of eleven public health regions. Brazoria, Fort Bend, Harris and Montgomery Counties are all located in public health Region 6, which is often incorporated into Region 6/5 south for administrative purposes. The Houston Baytown Sugar Land MSA is a smaller portion of Region 6/5 south and is used for comparison in much of this section. Please see the maps below for further clarification

21 Demographics 20

22 Demographics of the Study Area Population Change Total Population As of 2012, Texas has almost 25.9 million residents. 3 According to the United States Census Bureau, Texas gained more people than any other state between April 1, 2010 and July 1, 2011 (529,000). 4 Furthermore, Texas [also] had eight of the 15 most rapidly growing large cities between Census Day (April 1, 2010) and July 1, While Houston, located in Harris County, didn t rank as one of the fastest growing cities, it did have the second highest numerical increase (45,716) during that period and is identified as the fourth most populous city in the country. 5 Harris County is comprised of more than 4.2 million residents and is projected to increase 7.5% by The remaining three counties in the study area are much smaller than Harris County, but are also expected to increase by Fort Bend County has slightly more than 583,000 residents and is expected to increase more than any county in the study area with a percent increase of 17.4%. Montgomery County is slightly less populated than Fort Bend (about 489,600 residents) and is followed by Brazoria County, the smallest in the study area, with about 340,500 residents. By the year 2017, Montgomery and Brazoria Counties are expected to increase 15.7% and 10.5% respectively. 6 Overall Population Growth Geographic Location CY 2000 CY 2012 CY Change % Change Brazoria County 241, , ,273 35, % Fort Bend County 354, , , , % Harris County 3,400,578 4,229,784 4,547, , % Montgomery County 293, , ,511 76, % Texas 20,851,400 25,897,170 27,967,065 2,069, % Source: Truvens Market Expert Demographics Expert

23 Racial / Ethnic Composition and Growth 7 The majority of residents in Brazoria and Montgomery Counties racially identify as White (Non Hispanic). In Fort Bend County, Harris County and in the state of Texas there is not an identified racial or ethnic majority. As of 2012, the two largest racial or ethnic populations in the study area and in Texas are White (Non Hispanic) and Hispanic. It is projected that by 2017 the Hispanic population will represent the largest ethnicity in both Harris County (more than 2 million people) and in Texas (about 11.5 million people). Nearly 70% of residents in Montgomery County identify as White (Non Hispanic), compared to about 51% in Brazoria, about 34% in Fort Bend and 31.5% in Harris County. Fort Bend has the largest percentage of Black (Non Hispanic) residents (21.8%) and Asian and Pacific Islander (Non Hispanic) residents (17.3%) in the study area. Harris County also has a substantial percentage of Black (Non Hispanic) residents (18.4%), compared to only 12.6% in Brazoria and less than 5% in Montgomery. Population by Race/Ethnicity 2012 Source: Truvens Market Expert Demographics Expert 2012 Brazoria County Fort Bend County Harris County Montgomery County Texas 22

24 Various racial and ethnic groups in Texas are expected to experience a dramatic increase by 2017 including, Hispanic, Asian and Pacific Islander, and Other populations. As previously mentioned, the Hispanic population is projected to increase 15.1% by 2017, exceeding the number White (Non Hispanic) residents. The Asian and Pacific Islander population is expected to experience the largest percentage growth (22.6%), followed by the Other population, which is projected to increase by 13.8% (about 62,700 people). Across the study area and in Texas, the White (Non Hispanic) population is expected to increase the least, or even decrease in some areas, among the five racial/ethnic categories by The White (Non Hispanic) population is projected to: Decrease in Brazoria County by 2,448 people, or 1.4%. Increase in Fort Bend County by 3,346 people, or 1.7%. Decrease in Harris County by 85,901 people, or 6.4%. Increase in Montgomery County by 28,195 people, or 8.3% Decrease in Texas by 9,685 people, or 0.1% While the Hispanic population is expected to experience substantial growth across the study area and in Texas, the Asian and Pacific Islander population is expected to have the greatest percentage increase in Brazoria (39.2%), Fort Bend (35.3%), Montgomery (38.2%), and Texas (22.6%). Brazoria, Fort Bend and Montgomery Counties are also expected to see a larger percentage increase in Black (Non Hispanic) residents than Harris County and Texas. *Please note that the highest percentage increase in a particular race or ethnicity does not always correspond to the highest numerical increase in residents. For a complete population distribution by race/ethnicity see the table on the next page. 23

25 Population by Race/Ethnicity 2000, 2012, 2017 Brazoria County Race/Ethnicity Change % White (Non Hispanic) 158, , ,735 2, % Black (Non Hispanic) 20,183 42,906 53,121 10, % Hispanic 55,063 96, ,930 18, % Asian and Pacific Islander (Non Hispanic) 4,830 21,251 29,588 8, % All Others 3,639 6,602 7,899 1, % Total 241, , ,273 35, % Fort Bend County Race/Ethnicity Change % White (Non Hispanic) 163, , ,323 3, % Black (Non Hispanic) 69, , ,923 26, % Hispanic 74, , ,942 32, % Asian and Pacific Islander (Non Hispanic) 39, , ,750 35, % All Others 6,572 12,648 15,885 3, % Total 354, , , , % Harris County Race/Ethnicity Change % White (Non Hispanic) 1,432,264 1,333,982 1,248,081 85, % Black (Non Hispanic) 619, , ,706 62, % Hispanic 1,119,751 1,775,927 2,069, , % Asian and Pacific Islander (Non Hispanic) 174, , ,968 43, % All Others 54,451 67,137 71,851 4, % Total 3,400,578 4,229,784 4,547, , % Montgomery County Race/Ethnicity Change % White (Non Hispanic) 239, , ,638 28, % Black (Non Hispanic) 10,076 19,946 24,315 4, % Hispanic 37, , ,384 37, % Asian and Pacific Islander (Non Hispanic) 3,247 10,531 14,554 4, % All Others 4,145 9,174 11,620 2, % Total 293, , ,511 76, % Texas Race/Ethnicity Change % White (Non Hispanic) 10,933,313 11,425,721 11,416,036 9, % Black (Non Hispanic) 2,364,255 2,983,485 3,258, , % Hispanic 6,669,666 9,985,964 11,492,117 1,506, % Asian and Pacific Islander (Non Hispanic) 565,202 1,046,150 1,282, , % All Others 319, , ,573 62, % Total 20,851,820 25,897,170 27,967,065 2,069, % Source: Truvens Market Expert Demographics Expert

26 Age Composition and Growth 8 The Youth, Adolescent and Young Adult Population For the purposes of this demographic analysis the youth, adolescent and young adult population is categorized by three age cohorts: the 0 14, and years of age populations. More than 36% of Brazoria, Fort Bend, Harris, Montgomery and Texas are youth, adolescents, or young adults ranging from ages 0 to 24. Various segments of this population are expected to grow by Fort Bend and Montgomery Counties show a large percentage increase the year old cohort, increasing 35.1% (17,433 residents) and 26.7% (11,129 residents) respectively. Harris County shows the smallest projected increase among the year old population, increasing only 1.5% (2,716 residents). The Adult Population For the purposes of this demographic analysis the adult population is categorized by three age cohorts: the 25 to 34, 35 to 54 and 55 to 64 years of age populations. The 35 to 54 year old population is the single largest age cohort in each county in the study area and in Texas, representing 30.1% of Brazoria County, 32.1% of Fort Bend County, 28.0% of Harris County, 29.2% of Montgomery County and 27.4% of Texas. Excluding Harris County, Texas has a higher composition of adults ages than each county in the study area, but a lower composition of adults ages 35 to 54 years old than each county in the study area. The year old population is expected to decline in Brazoria and Harris County by 2017, 3.0% (1,438 residents) and 4.4% (30,530 residents) respectively. This is the only population that is expected to decline in any county or the state by Furthermore, across the study area and in Texas the year old population is the only group to show a consistently low projected increase. The year old age cohort shows a substantial projected increase in each county in the study area and Texas. For example, Fort Bend County s year old population is projected to increase 42.3% (26,308 residents) by This increase represents not only the largest percent increase in that age cohort, but also the second largest percent increase in any age cohort in the study area, second only to the 65+ population in Texas. 25

27 The Aging Population The aging population is defined as the 65 years and older age cohort. The aging population represents between 7% and 10.5% of each county in the study area and Texas. This population also shows the largest projected increase of any age group by 2017 in Fort Bend County, Harris County, Montgomery County and Texas. It is the second largest projected increase in Brazoria County. *Please note that the highest percentage increase in a particular age group does not always correspond to the highest numerical increase in residents. For a complete population distribution by age group see the table on the next page. 26

28 Population by Age (2012 & 2017) Source: Truvens Market Expert Demographics Expert 2012 Brazoria County Age Cohort 2012 % of Total 2017 % of Total Change % , % 88, % 8, % , % 16, % 1, % , % 34, % 5, % , % 46, % 1, % , % 106, % 4, % , % 43, % 9, % , % 40, % 8, % Total 340, % 376, % 35, % Fort Bend County Age Cohort 2012 % of Total 2017 % of Total Change % , % 157, % 16, % , % 34, % 2, % , % 67, % 17, % , % 76, % 6, % , % 197, % 10, % , % 88, % 26, % , % 63, % 21, % Total 583, % 684, % 101, % Harris County Age Cohort 2012 % of Total 2017 % of Total Change % ,038, % 1,125, % 86, % , % 187, % 2, % , % 420, % 16, % , % 655, % 30, % ,183, % 1,242, % 59, % , % 490, % 94, % , % 426, % 88, % Total 4,229, % 4,547, % 318, % Montgomery County Age Cohort 2012 % of Total 2017 % of Total Change % , % 127, % 14, % , % 26, % 3, % , % 52, % 11, % , % 68, % 5, % , % 151, % 8, % , % 71, % 15, % , % 69, % 19, % Total 489, % 566, % 76, % Texas Age Cohort 2012 % of Total 2017 % of Total Change % ,092, % 6,600, % 507, % ,154, % 1,183, % 28, % ,591, % 2,782, % 190, % ,735, % 3,792, % 57, % ,090, % 7,302, % 211, % ,575, % 3,095, % 520, % 65+ 2,656, % 3,210, % 553, % Total 25,897, % 27,967, % 2,069, % 27

29 Economic and Education Comparison Median Household Income 9 Each county in the study area has a higher median household income and average household income than Texas. Fort Bend County appears to be the wealthiest county in the study area with a median household income of $77,127 and an average household income of $98,242. Harris County has the most similar income rates to Texas in the study area. The median household income in Harris County is $49,900, compared to $48,573 in Texas. The average income in Harris County is $70,384, compared to $65,250 in Texas. These trends are projected to continue into the year

30 Economic Status, Poverty and Educational Attainment 10 Following that Fort Bend County has the highest median household and average incomes in the study area, it also has the smallest percentage (6%) of families living below poverty in the study area. Brazoria County has 7.9% of families living below poverty, compared to 8.5% in Montgomery County, 13.7% in Harris County and 13.2% in Texas. A higher percentage of residents in each county in the study area compared to Texas have received a Bachelor s or advanced degree. For example, nearly 38% (37.9%) of residents in Fort Bend County have received a Bachelor s or advanced degree. This compares to about one fourth of Texas residents who have attained the equivalent. Medicaid Covered Births 11 As of 2008, more than half of births in Harris County (56.8%) are Medicaid covered births, compared to 39.8% in Brazoria County, 29.7% in Fort Bend County and 43.3% in Montgomery County. More than half of births in Texas (55.3%) are also Medicaid covered births. 29

31 Drop Out Rates 12 In 2010, 7.3% of Texas students between ninth grade and graduation dropped out of high school, compared to 2.9% in Brazoria County, 3.0% in Montgomery County, 5.0% in Fort Bend County and 9.8% in Harris County. Both Texas and the study area s rates were down from the previous year. High School Drop Out Rates County Number Percent Number Percent Brazoria County % % Fort Bend County % % Harris County 5, % 4, % Montgomery County % % Texas 28, % 22, % Source: datacenter.kidscount.org (utilizing data from the Texas Education Agency) Definitions: The number and percent of students who dropped out between ninth grade and graduation. Year indicates the graduating year of the cohort. English as a Second Language 13 An increasing percentage of students in the study area and Texas are enrolled in Bilingual/ESL programs at school. Harris County has the highest percentage of students enrolled in bilingual/esl programs in the study area, with 22.2% in the school year. Free and Reduced Price Lunch 14 As of the school year, Harris County has the highest percentage of children receiving free and reduced price lunch in the study area. About 67% of children in Harris County receive free or reduced price lunch, compared to 48.2% in Brazoria County, 41.0% in Fort Bend County, 44.6% in Montgomery and 63.1% in Texas. 30

32 15 16 Unemployment In 2011, Texas ranked 23 rd in the country (1 being the best) in unemployment rates. Texas annual average unemployment rate was 7.9% in 2011, one percentage point lower than the national average. Each county in the study area has a lower unemployment rate than the country, but only Fort Bend and Montgomery Counties have lower unemployment rates than the state. Texas unemployment rate is 7.9%, compared to 8.6% in Brazoria County, 7.3% in Fort Bend County, 8.2% in Harris County and 7.2% in Montgomery County. Nationally, statewide, and throughout the study area the unemployment rates have increased since All of the counties in the study area increased between 2 and 4 percentage points between 2008 and However, each county in the study area, Texas and the United States saw a slight drop in unemployment rates between 2010 and

33 County Health Rankings 32

34 A Snapshot of the Community About the County Health Rankings 17 The County Health Rankings measure the health of nearly all counties in the nation and rank them within states. The Rankings are compiled using county level measures from a variety of national and state data sources. These measures are standardized and combined using scientifically informed weights. They look at a variety of measures that affect health such as the rate of people dying before age 75, high school graduation rates, unemployment, limited access to healthy foods, air and water quality, income, and rates of smoking, obesity and teen births. This project is a collaborative effort between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The Rankings are based on a model of population health that emphasizes the many factors that, if improved, can help make communities healthier places to live, learn, work and play. How the Study Area Compares 18 The 2012 County Health Rankings rank six subcategories: mortality, morbidity, health behaviors, clinical care, social & economic factors, and physical environment. These groups fall into two larger categories, Health Outcomes (mortality and morbidity) and Health Factors (health behaviors, clinical care, social & economic factors, and physical environment). The Rankings rank 221 counties in Texas and all counties in the study area fall into either the 1 st or 2 nd (better rankings) quartiles in mortality, morbidity, health behaviors and clinical care. Brazoria, Fort Bend and Montgomery Counties are ranked in the 1 st quartile of social & economic factors, while Harris County is in the 4 th quartile. All of the counties in the study area are ranked in the 4 th quartile for physical environment. Health Outcomes Brazoria County ranks 30 th out of 221 Texas counties (1 st quartile). Fort Bend County ranks 9 th out of 221 Texas counties (1 st quartile). Harris County ranks 53 rd out of 221 Texas counties (1 st quartile). Montgomery County ranks 41 st out of 221 Texas counties (1 st quartile). Mortality Brazoria County ranks 43 rd out of 221 Texas counties (1 st quartile). Fort Bend County ranks 6 th out of 221 Texas counties (1 st quartile). Harris County ranks 39 th out of 221 Texas counties (1 st quartile). Montgomery County ranks 37 th out of 221 Texas counties (1 st quartile). Morbidity Brazoria County ranks 38 th out of 221 Texas counties (1 st quartile). 33

35 Fort Bend County ranks 60 th out of 221 Texas counties (1 st quartile). Harris County ranks 97 th out of 221 Texas counties (2 nd quartile). Montgomery County ranks 67 th out of 221 Texas counties (2 nd quartile). Health Factors Brazoria County ranks 27 th out of 221 Texas counties (1 st quartile). Fort Bend County ranks 9 th out of 221 Texas counties (1 st quartile). Harris County ranks 160 th out of 221 Texas counties (3 rd quartile). Montgomery County ranks 12 th out of 221 Texas counties (1st quartile). Health Behaviors Brazoria County ranks 28 th out of 221 Texas counties (1 st quartile). Fort Bend County ranks 4 th out of 221 Texas counties (1 st quartile). Harris County ranks 38 th out of 221 Texas counties (1 st quartile). Montgomery County ranks 10 th out of 221 Texas counties (1 st quartile). Clinical Care Brazoria County ranks 34 th out of 221 Texas counties (1 st quartile). Fort Bend County ranks 10 th out of 221 Texas counties (1 st quartile). Harris County ranks 48 th out of 221 Texas counties (1 st quartile). Montgomery County ranks 29 th out of 221 Texas counties (1 st quartile). Social & Economic Factors Brazoria County ranks 45 th out of 221 Texas counties (1 st quartile). Fort Bend County ranks 18 th out of 221 Texas counties (1 st quartile). Harris County ranks 187 th out of 221 Texas counties (4 th quartile). Montgomery County ranks 31 st out of 221 Texas counties (1 st quartile). Physical Environment Brazoria County ranks 213 th out of 221 Texas counties (4 th quartile). Fort Bend County ranks 220 th out of 221 Texas counties (4 th quartile). Harris County ranks 221 st out of 221 Texas counties (4 th quartile). Montgomery County ranks 214 th out of 221 Texas counties (4 th quartile). *For a detailed description of data regarding each indicator, sourcing information and national benchmarks please see the following three pages. 34

36 2012 County Health Brazoria Fort Bend Harris Montgomery Texas Rankings County County County County Health Outcomes MORTALITY Premature death 7,186 7,257 4,871 7,099 7,077 MORBIDITY Poor or fair health 19% 13% 16% 19% 17% Poor physical health days Poor mental health days Low birthweight 8.2% 8.1% 8.3% 8.4% 7.7% Health Factors HEALTH BEHAVIORS Adult smoking 19% 19% 11% 17% 16% Adult obesity 29% 27% 26% 29% 27% Physical inactivity 25% 26% 21% 23% 23% Excessive drinking 16% 12% 13% 17% 17% Motor vehicle crash death rate Sexually transmitted infections Teen birth rate CLINICAL CARE Uninsured 26% 22% 19% 29% 21% Primary care physicians 1,050:1 924:1 891:1 962:1 987:1 Preventable hospital stays Diabetic screening 81% 79% 82% 80% 81% Mammography screening 62% 58% 63% 59% 60% SOCIAL & ECONOMIC FACTORS High school graduation 84% 88% 90% 81% 91% Some college 56% 62% 70% 53% 61% Unemployment 8.2% 9.0% 8.0% 8.5% 7.6% Children in poverty 26% 15% 13% 27% 16% Inadequate social support 23% 24% 21% 25% 24% Children in single parent households 32% 26% 22% 34% 24% Violent crime rate PHYSICAL ENVIRONMENT Air pollution particulate matter days Air pollution ozone days Access to recreational facilities Limited access to healthy foods 12% 15% 10% 8% 17% Fast food restaurants 53% 52% 56% 52% 51% Source: The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute ( 35

37 2012 County Health Rankings Sources and Years Health Outcomes Focus Area Measure Weight Source Year(s) Mortality (50%) Premature death (years of potential life lost before age 75 per 50% Vital Statistics, National Center for Health Statistics ,000 pop) (NCHS) Morbidity (50%) Poor or fair health (percent of adults reporting fair or poor 10% Behavioral Risk Factor Surveillance System (BRFSS) health) Poor physical health days (average number in past 30 days) 10% BRFSS Poor mental health days (average number in past 30 days) 10% BRFSS Low birthweight (percent of live births with weight < 2500 grams) 20% Vital Statistics, NCHS Health Behaviors (30%) Focus Area Measure Weight Source Year(s) Tobacco use (10%) Adult smoking (percent of adults that smoke) 10% BRFSS Diet and exercise (10%) Adult obesity (percent of adults that report a BMI >= 30) 7.5% National Center for Chronic Disease Prevention and Health Promotion, calculated from BRFSS 2009 Physical inactivity (percent of adults that report no leisure time physical activity) 2.5% National Center for Chronic Disease Prevention and Health Promotion, calculated from BRFSS 2009 Alcohol use (5%) Sexual activity (5%) Excessive drinking (percent of adults who report heavy or 2.5% BRFSS bringe drinking) Motor vehicle crash deaths per 100,000 population 2.5% Vital Statistics, NCHS Sexually transmitted infections (chlamydia rate per 100, % CDC, National Center for Hepatitis, HIV, STD, and TB 2009 population) Prevention Teen birth rate (per 1,000 females ages 15 19) 2.5% Vital Statistics, NCHS Clinical Care (20%) Focus Area Measure Weight Source Year(s) Access to care (10%) Uninsured (percent of population < age 65 without health insurance) 5% Census/American Community Survey (ACS) Small Area Health Insurance Estimates (SAHIE) 2009 Quality of care (10%) Ratio of population to primary care physicians 5% Health Resources and Services Administration, Area 2009 Resource File (ARF) Preventable hospital stays (rate per 1,000 Medicare enrollees) 5% Medicare claims/dartmouth Atlas 2009 Diabetic screening (percent of diabetics that receive HbA1c 5% Medicare claims/dartmouth Atlas 2009 screening) Mammography screening 5% Medicare claims/dartmouth Atlas

38 Social and Economic Environment (40%) Focus Area Measure Weight Source Year(s) Education (10%) High school graduation 5% State sources and the National Center for Education Varies by state, 2008 Statistics 2009 or Some college (Percent of adults aged years with some 5% ACS post secondary education) Employment (10%) Unemployment rate (percent of population age % Local Area Unemployment Statistics, Bureau of 2010 unemployed) Labor Statistics Income (10%) Children in poverty (percent of children under age 18 in 10% Census/CPS Small Area Income and Poverty 2010 poverty) Estimates (SAIPE) Family and social Inadequate social support (percent of adults without 2.5% BRFSS support (5%) social/emotional support) Percent of children that live in single parent household 2.5% ACS Community safety (5%) Violent crime rate per 100,000 population 5% Uniform Crime Reporting, Federal Bureau of Investigation State data sources for Illinois Physical Environment (10%) Focus Area Measure Weight Source Year(s) Air pollution particulate matter days (average number of 2% CDC Environmental Protection Agency (EPA) 2007 unhealthy air quality days) Collaboration Data not available for Alaska and Air pollution ozone days (average number of unhealthy air 2% Hawaii quality due to ozone) Limited access to health foods (percent of population who lives in poverty and more than 1 or 10 miles from a grocery store) 2% (all but AK & HI) United States Department of Agriculture, Food Environment Atlas Data not available for Alaska and Hawaii 2006 Environmental quality (4%) Built environment (6%) Access to healthy foods (percent of zip codes with healthy 2% Census Zip Code Business Patterns 2009 food outlets) for Alaska and Hawaii (AK & HI) Access to recreational facilities 2% Census County Business Patterns 2009 Fast food restaurants (percent of all restaurants that are fast Census County Business Patterns 2009 food) 2% Source: The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute ( 37