Wayne Medical Center. Community Health Needs Assessment

Transcription

1 Wayne Medical Center Community Health Needs Assessment December 2016

2 Table of Contents Executive Summary... iii Introduction... iii Summary of Findings... iii Selected Priority Areas... iii 1 Introduction Wayne Medical Center Definition of Community + Map Evaluation of Progress since Prior CHNA Community Feedback on Prior CHNA or Implementation Strategy Consultants Healthy Communities Institute Methods Secondary Data Sources and Analysis Race/Ethnicity Disparities Primary Data Collection and Analysis Data Considerations Prioritization Demographics Population Age Racial/Ethnic Diversity Social and Economic Determinants of Health Income Poverty Unemployment Education SocioNeeds Index Findings Prioritized Significant Health Need Access to Health Services Children s Health Exercise, Nutrition, and Weight Mental Health & Mental Disorders i

3 5.1.5 Oral Health Substance Abuse Other Significant Health Needs Heart Disease & Stroke Maternal, Fetal, & Infant Health Older Adults & Aging Teen & Adolescent Health Conclusion ii

4 Executive Summary Introduction Wayne Medical Center (WMC) is pleased to present its 2016 Community Health Needs Assessment (CHNA). This CHNA report provides an overview of the health needs in the WMC service area. WMC partnered with Healthy Communities Institute to conduct the CHNA for its community. The goal of this report is to offer a meaningful understanding of the health needs in Wayne County, Tennessee, as well as to guide the hospital in their community benefit planning efforts and development of implementation strategies to address prioritized needs. Special attention has been given to identify health disparities, needs of vulnerable populations, unmet health needs or gaps in services, and input from the community. Summary of Findings The CHNA findings are drawn from an analysis of an extensive set of secondary data (over 100 indicators from national and state data sources) and in-depth primary data from community health leaders and organizations that serve vulnerable populations and/or populations with unmet health needs. Based on the analysis of the primary and secondary data, the following significant health needs emerged: Access to Health Services Children s Health Exercise, Nutrition, & Weight Heart Disease & Stroke Maternal, Fetal, & Infant Health Mental Health & Mental Disorders Older Adults & Aging Oral Health Substance Abuse Teen & Adolescent Health Selected Priority Areas On September 27 th, 2016, WMC conducted a prioritization session and selected the following priority areas for consideration in its implementation strategy: WMC s Prioritized Significant Health Needs Access to Health Services Behavioral Health Includes Mental Health & Mental Disorders and Substance Abuse Children s Health Exercise, Nutrition, & Weight Oral Health iii

5 1 Introduction 1.1 Wayne Medical Center Providing quality health care services for more than 50 years, Wayne Medical Center (WMC) offers residents of Waynesboro, Clifton, Collinwood and the surrounding area a range of inpatient and outpatient services, including 24-hour emergency care. The hospital is licensed for 80 beds, is accredited by The Joint Commission and has approximately 180 employees. WMC is a facility within the Maury Regional Health system. Care and services available at WMC include: Billing Information Diagnostic Imaging Emergency Department Emergency Medical Services Endoscopy Infusion Therapy Laboratory Services Physical Therapy Physician Specialist Clinic Respiratory Care Services Sleep Center Surgical Services Swing Beds (Skilled Nursing Beds) Wellness Screenings Definition of Community + Map The primary community that WMC serves is defined by the geographic boundary of Wayne County, Tennessee Evaluation of Progress since Prior CHNA Please refer to Appendix D for the evaluation of progress since the prior CHNA Community Feedback on Prior CHNA or Implementation Strategy No written comment was received by WMC about the prior posted CHNA. 1.2 Consultants Healthy Communities Institute Based in Berkeley, California, Healthy Communities Institute (HCI) was retained by Maury Regional Health as consultants to conduct community health needs assessments for the health system s facilities. The Institute also collaborated previously with Maury Regional Health to build capacity in 1

6 implementations strategy efforts and to develop a data platform for their service area. HCI provides customizable, web-based information systems that offer a full range of tools and content to improve community health. The organization is composed of public health professionals and health IT experts committed to meeting clients health improvement goals. To learn more about HCI, please visit Report authors from Healthy Communities Institute: Therese Buendia Andrew Juhnke, MPH Rebecca Yae 2

7 2 Methods Two types of data were analyzed for this Community Health Needs Assessment: secondary data (indicators) and primary data (interviews). Each type of data was analyzed using a unique methodology, and findings were organized by health or quality of life topic areas. These findings were then synthesized for a comprehensive overview of the health needs in WMC s Service Area. 2.1 Secondary Data Sources and Analysis Secondary data refers to data that have previously been collected. The main source for the secondary data is an internal data platform maintained by Healthy Communities Institute and spans over 100 health and health-related indicators from over 14 publicly available data sources. For further detail on the data sources included in the analysis, please see Appendix A. On July 5, 2016, data were queried and analyzed for approximately 100 or more indicators for Wayne County. For each indicator, there are several ways (or comparisons) by which to assess each county s status, including comparing to other Tennessee counties, all U.S. counties, the Tennessee state value, the U.S. value, the trend over time, and Healthy People 2020 targets. Each indicator is given a score based on how the county fares in these comparisons. The indicators are categorized into broader health topics, and indicator scores within each health topic are summed and averaged to produce an overall topic score. The score ranges from 0 to 3, with 0 meaning the best possible score and 3 the worst possible score, and summarizes how the county compares to the other counties in Tennessee and in the U.S., the state value and the U.S. value, Healthy People 2020 targets, and the trend over the four most recent time periods of measure. Tennessee Counties US Counties Tennessee State Score range: Good Figure 2.1: Secondary Data Methods US Value HP 2020 Trend Bad Indicator Score Topic Score Please see Appendix A for further details on the secondary data scoring methodology. 3

8 2.1.1 Race/Ethnicity Disparities Indicator data were included for race/ethnicity groups when available from the source. The race/ethnicity groups used in this report are defined by the data sources. The health needs disparity by race/ethnicity was quantified by calculating the Index of Disparity 1 for all indicators with at least two race/ethnic-specific values available. This index represents a standardized measure of how different each subpopulation value is compared to the overall population value. Indicators for which there is a higher Index of Disparity value are those where there is evidence of a large health disparity. 2.2 Primary Data Collection and Analysis The primary data used in this assessment consist of key informant interviews collected via by Healthy Communities Institute. Key informants are individuals recognized for their knowledge of community health in one or more health areas. Between July and August 2016, six key informants filled in interview questionnaires for their knowledge about community health needs, barriers, strengths, and opportunities (including the needs for vulnerable and underserved populations as required by IRS regulations). In many cases, the vulnerable populations are defined by race/ethnic groups, and this assessment will place a special emphasis on these findings. Interview topics were not restricted to the health area for which a key informant was nominated. Key Informants from: Department of Children s Services Tennessee Department of Health South Central Regional Health Office Wayne County Board of Education Wayne County Health Department National HealthCare Youth Villages Corporation Excerpts from the interview transcripts were coded by relevant topic areas and other key terms using the qualitative analytic tool Dedoose. 2 The frequency with which a topic area was discussed in key informant interviews was one factor used to assess the relative urgency of that topic area s health and social needs. Please see Appendix B for a list of interview questions. 2.3 Data Considerations Several limitations of the data should be considered when reviewing the findings presented in this 1 Pearcy JN, Keppel KG. A summary measure of health disparity. Public Health Reports. 2002;117(3): Dedoose Version , web application for managing, analyzing, and presenting qualitative and mixed method research data (2015). Los Angeles, CA: SocioCultural Research Consultants, LLC ( 4

9 report. Although the topics by which data are organized cover a wide range of health and healthrelated areas, within each topic there is a varying scope and depth of secondary data indicators and primary data findings. In some topics there is a robust set of secondary data indicators, but in others there may be a limited number of indicators for which data is collected, or limited subpopulations covered by the indicators. In addition, many of the secondary data indicators included in the findings are collected by survey, and though methods are used to best represent the population at large, these measures are subject to instability especially among smaller populations. The breadth of primary data findings is dependent on who was selected to be a key informant, as well as the availability of selected key informants to be interviewed during the time period of primary data collection. The Index of Disparity is also limited by data availability: for some indicators, there is no subpopulation data, and for others, there are only values for a select number of race/ethnic groups. Despite these limitations, efforts were made to include as wide a range of secondary data indicators and key informant expertise areas as possible. 5

10 3 Prioritization To prioritize the significant health topics and barriers for Wayne Medical Center s service area, key hospital staff and community stakeholders engaged in multiple rounds of voting and discussion on September 27 th, For each round, prioritization participants were allowed a set number of votes. After each round of voting, participants discussed results and eliminated health topics with the lowest number of votes. Prior to the voting and discussion, prioritization participants were asked to consider how each significant health need fared against the criteria in Table 3.1. Table 3.1: Prioritization Criteria Criteria for Wayne Medical Center s Prioritization Session 1. Alignment of problem with facility s strengths/priorities/mission 2. Severity: rate/risk of morbidity and mortality associated with problem 3. Addresses disparities of subpopulations 4. Opportunity to intervene at prevention level 5. Opportunity for partnership The following health topics were identified as priorities for Wayne Medical Center: 1. Exercise, Nutrition, & Weight 1. Behavioral Health 3. Access to Health Services 4. Children s Health 5. Oral Health *Behavioral health includes both Mental Health & Mental Disorders and Substance Abuse. Prioritization stakeholders chose to combine the two topics into one due to frequent co-occurrence of issues and needs of these areas. A plan for addressing these priority areas will be further considered in the implementation strategy report. For further information on prioritization methods and participants, see Appendix C. 6

11 4 Demographics The demographics of a community significantly impact its health profile. The following section explores the demographic profile of Wayne County in Tennessee. Different age, race/ethnic, and socioeconomic groups may have unique needs and require varied approaches to health improvement efforts. All demographic estimates are sourced from the U.S. Census Bureau s American Community Survey unless otherwise indicated. 4.1 Population Age The age distribution of Wayne County was similar to Tennessee, as shown in Figure 4.1. Figure 4.1: Population by Age Racial/Ethnic Diversity The racial and ethnic makeup of the Wayne County was more homogenous than that of the state of Tennessee. 7

12 Figure 4.2: Population by Race/Ethnicity A higher proportion of residents in the county identified as White compared to the State (92.1% v. 78.0%). In addition, a smaller proportion of residents living in this region identified as Black or African American, Some Other Race, Two or More Races, or Hispanic/Latino. 4.2 Social and Economic Determinants of Health Social determinants are the conditions in which people are born, grow, work, live, and age that affect a wide range of health outcomes and risks. Resources that address the social determinants of health and improve quality of life can have a significant impact on population health outcomes. Examples of these resources include access to education, public safety, affordable housing, availability of healthy foods, and local emergency and health services Income The median household income in Wayne County was relatively low compared to the State

13 Figure 4.3: Median Household Income Poverty A higher proportion of people experience poverty in Wayne County compared to Tennessee, with more than one in five persons (21.3%) in Wayne County below the poverty level. Figure 4.4: Persons Living Below Poverty 9

14 4.2.3 Unemployment Table 4.5: Unemployment Rate (July 2016) According to the U.S. Bureau of Labor Statistics, the unemployment rate in Wayne County was 1.2% higher than that of the state of Tennessee in July Education Figure 4.6: Population 25+ with a High School Degree or Higher High school degree attainment in Wayne County is lower than the overall state value (Figure 4.6). 10

15 Table 4.7: Population 25+ with a Bachelor s Degree or Higher Further, a significantly smaller percentage of residents aged 25 and older within the county had a Bachelor s degree or higher (8.2%) compared to the state of Tennessee (24.4%). This county percentage is only about one third of the state percentage, and it is the lowest in the region SocioNeeds Index Healthy Communities Institute developed the SocioNeeds Index to easily compare multiple socioeconomic factors across geographies. This index incorporates estimates for six different social and economic determinants of health income, poverty, unemployment, occupation, educational attainment, and linguistic barriers that are associated with poor health outcomes including preventable hospitalizations and premature death. Within the county, zip codes are ranked based on their index value to identify the relative levels of need, as illustrated by the map. 11

16 Figure 4.8: SocioNeeds Index by Zip Code In Wayne County, zip code emerged as the area of highest socioeconomic need in the county (Figure 4.8). 12

17 5 Findings Together, secondary and primary data provide a breadth of information on the health needs of residents within WMC s service area. Figure 5.1: Topic Areas Demonstrating Strong Evidence of Need Strong Evidence of Need in Secondary Data Strong Evidence of Need in Primary Data Heart Disease & Stroke Maternal, Fetal, & Infant Health Older Adults & Aging Access to Health Services Exercise, Nutrition, Weight Children s Health Oral Health Mental Health Substance Abuse Teen & Adolescent Health The areas for which there was strong evidence of need across both data types include Children s Health and Mental Health & Mental Disorders. Several areas that scored high in secondary data scoring did not appear frequently in primary data, including Heart Disease & Stroke, Maternal, Fetal, & Infant Health, and Older Adults & Aging. Access to Health Services; Exercise, Nutrition, & Weight; Oral Health, Substance Abuse; and Teen & Adolescent Health were frequently mentioned among key informants, but were not common pressing issues in secondary data. Findings are discussed in the report by topic area, first by prioritized health needs, then by other health needs. When available, the top three indicators in each topic area that scored above a 1.5 were designated as warning indicators. 13

18 Below are figures that list the results of the secondary data scoring, for both Health and Quality of Life topic areas. Topics with higher scores indicate poor comparisons or greater need. Figure 5.2: Secondary Data Scoring for Health Topic Areas Figure 5.3: Secondary Data Scoring for Quality of Life Topic Areas Please see Appendix A for additional details on indicators within these Health and Quality of Life topic areas. 14

19 The word cloud below, created using the tool Wordle, 4 illustrates the themes that were most prominent in the primary data. Themes that were mentioned more frequently are displayed in larger font. Key informants discussed the areas of Access to Health Services; Children s Health; Exercise, Nutrition, & Weight; Mental Health & Mental Disorders; Substance Abuse; and Teen & Adolescent Health frequently. Figure 5.4: Word Cloud of Themes Discussed by Key Informants 4 Wordle [online word cloud applet]. (2014). Retrieved from 15

20 5.1 Prioritized Significant Health Need Access to Health Services 100% Key Informant Interviews Warning Indicators Data Overview Dentist Rate Primary Care Provider Rate Adults with Health Insurance Key Issues Lack of health insurance and providers in the community Particular access issues with oral health and mental health, and care for the elderly Barriers include transportation and financial resources Healthcare coverage and affordability Approximately one in five adults lacked health insurance in Wayne County. Wayne County failed to meet the Healthy People 2020 target of insuring 100% of adults and children (Table 5.1). Table 5.1: Health Insurance Rates among Children and Adults Adults with Health Insurance, 2014 Children with Health Insurance, 2014 Wayne 81.7% 93.7% Tennessee 82.6% 94.7% U.S. 83.7% 94.0% Healthy People 2020 Target 100% 100% Small Area Health Insurance Estimates Several key informants cited lack of health insurance coverage as a concern within the community, corroborating the secondary data and elaborating that limited state Medicaid leaves many people in a coverage gap. Oral health insurance was also identified as a need There is a gap for services for patients aged after they have been dropped from TennCare and before they are eligible for Medicare. 16

21 through primary data. Healthcare providers Table 5.2: Healthcare Providers Too few primary care and oral health providers serve the county, according to secondary data. Primary Care Provider Rate, 2013* Dentist Rate, 2014* Wayne Tennessee *providers per 100,000 population County Health Rankings According to both primary and secondary data, lack of providers within the community is a pressing issue. Compared to the state, Wayne County had approximately half the primary care providers and just more than one tenth of the oral health providers serving every 100,000 individuals, as seen in Table 5.2. Key informant testimony specifically noted the lack of specialty providers in the community, including pediatric, mental health, and obstetrics/gynecology providers. Additionally, key informants discussed access to mental health and substance abuse Barriers services as lacking, especially those serving adolescents. Key informants commonly identified transportation as a major barrier to care. Other barriers noted were lack of childcare, unemployment, financial resources, and language. Several key informants relayed that lowincome families often struggle between prioritizing basic needs and medical needs. Low-income families don t have the necessary resources to maintain daily living activities, much less travel to surrounding counties for services; therefore many do not receive the services that they need. Highly impacted populations Race/ethnic groups: According to key informant testimony, Wayne County is mostly English speaking, but the few Spanish-speaking residents in the county are potentially not aware that language services are provided at facilities within the county. This may result in delayed care for this sub-population due to beliefs that they will not be able to communicate their health issues to providers. 17

22 5.1.2 Children s Health Data Overview 83% Key Informant Interviews Warning Indicators Child Food Insecurity Rate Low-Income Preschool Obesity Children with Health Insurance Key issues Limited mental health services for children Food insecurity and obesity Lack of pediatric dental providers Mental Health Key informants observed that resources are inadequate for children with serious mental health diagnoses: there is a lack of psychiatric beds and tangible community resources to support those with such debilitating diagnoses. Families often end up exhausting their financial resources. Additionally, key informant feedback cited that there are no Applied Behavior Analysis (ABA) services for children with autism in rural communities, thereby preventing them from getting the care necessary to thriving and becoming independent. Nutrition Table 5.3: Child Food Insecurity Child Food Insecurity Rate, 2014 Wayne 28.9% Tennessee 24.0% U.S. 20.9% Feeding America Over one in four children were food insecure at some point during the year in Wayne County (Table 5.3). Key informant testimony further elucidated on the pressing issue of child food insecurity, as indicated by secondary data: low-income students may not have resources to purchase nutritious foods and thus may come to school hungry, negatively impacting their education. 18

23 Additional contributing factors cited include low access to nutritional foods and exercise opportunities. Table 5.4: Low-Income Preschool Obesity Nearly one in five low-income children aged 2 to 4 in Wayne County were obese. Low-Income Preschool Obesity, Wayne 19.4% U.S. Department of Agriculture - Food Environment Atlas Oral Health According to key informant testimony, Wayne County lacks pediatric dental providers and services, and thus dental needs often go unmet among children. 19

24 5.1.3 Exercise, Nutrition, and Weight 50% Key Informant Interviews Data Overview Warning Indicators Child Food Insecurity Access to Exercise Opportunities Farmers Market Density Key Issues Food insecurity and low access to healthy foods, especially for lowincome families and children Limited access to exercise opportunities Built environment is unsupportive of active lifestyle Obesity and diabetes Nutrition Wayne County experienced low access to a grocery store in households without cars, low-income, and elderly populations, as shown in Table 5.5. Table 5.5: Low Access to a Grocery Store Percentage of given subpopulation living >1 mile (urban) or 10 miles (rural) from a grocery store, 2010 Households 65 Years of Age and Low-Income with No Car Older Wayne 4.4% 8.7% 2.8% U.S. 2.6% 6.2% 2.8% USDA Food Environment Atlas Food insecurity among children and adults was also a pressing issue in secondary data, and corroborated by primary data. In addition, low access to healthy foods, easy access to fast food, and lack of education on nutrition were cited as contributing factors to poor nutrition in the region. Only 39.4% of low-income individuals eligible for SNAP participated in 2007, indicating a potential for harnessing existing resources. However, low store participation in SNAP may be limiting the program s utility. Exercise Opportunities Approximately a third of the region s population lacks access to exercise opportunities, 20

25 Several key informants cited the built environment as a barrier to proper exercise in the region: walking and biking trails are limited and the overall infrastructure promotes driving. Access to exercise opportunities is low. Key Obesity informant testimony corroborates the secondary data: Wayne County lacks free programs and places or facilities to exercise. Although secondary data is lacking for obesity, key informants emphasized obesity as a top need. Key informant testimony also indicated high rates of diabetes as an outcome of poor nutrition and physical inactivity within Wayne County. Highly impacted populations Table 5.6: Access to Exercise Opportunities Access to Exercise Opportunities, 2016 Wayne 32.5% Tennessee 69.3% County Health Rankings Low-income populations: Several key informants observed that low-income families tend to struggle more with access to healthy, nutritious foods. 21

26 5.1.4 Mental Health & Mental Disorders 50% Key Informant Interviews Warning Indicators Data Overview Depression: Medicare Population Alzheimer s Disease or Dementia: Medicare Population Frequent Mental Distress Key Issues Limited mental health providers and services Disproportionate impact on rural and low-income populations High prevalence of depression in Medicare population One in five members of the Medicare population in Wayne County suffers from depression (Table 5.7). Within Wayne County in 2014, 14.5% of residents stated that their mental health was not good for at least 14 out of the 30 days prior to being surveyed. Key informants observed that resources and services within the community are limited, including too few providers, services and psychiatric beds for children, Centers for Medicare and Medicaid Services resources to help parents of children with severe mental health diagnoses, and community knowledge around mental health. Highly Impacted Populations Table 5.7: Depression and Dementia Depression: Medicare Population, 2014 Alzheimer s Disease or Dementia: Medicare Population, 2014 Wayne Tennessee U.S. 20.3% 17.5% 16.2% 10.1% 10.4% 10.0% Children and youth: Several key informants observed that children and youth are negatively impacted due to the low availability of services and resources for them. For example, there are no Applied Behavior Analysis (ABA) services for children in rural communities. 22

27 5.1.5 Oral Health Data Overview 50% Key Informant Interviews Warning Indicators Dentist Rate Key issues Lack of insurance and need for affordable care Limited pediatric dental providers Healthcare Access and Coverage The most pressing issues regarding poor oral health outcomes, as mentioned by key informants, revolved around lack of insurance and financial resources and limited access to pediatric dental providers. Healthcare providers Though there was inadequate secondary data for analysis, the data that was available showed low rates of dentists in Wayne County. People living in communities with low rates of dentists may have difficulty accessing the dental care they need. Table 5.8: Dental Care Providers Dentist Rate, 2014* Wayne 6 Tennessee 51 *Dentists per 100,000 population County Health Rankings Highly impacted populations Low-Income populations: Key informants identified lowincome populations as particularly vulnerable to poor oral health outcomes, citing economic barriers and lack of insurance as a major factor to poor dental care. Children: According to key informant testimonies, children have limited access to pediatric dental providers. This leads to dental needs going unmet and continuing dental issues unaddressed. Children do not have access to a pediatric dental provider so dental needs often go unmet. 23

28 5.1.6 Substance Abuse Data Overview 83% Key Informant Interviews Warning Indicators Alcohol-Impaired Driving Deaths Key Issues Smoking, prescription drug abuse, and other illicit drug use, including marijuana, cocaine, and meth Lack of substance abuse services for adolescents Increasing neonatal abstinence syndrome The percentage of motor vehicle crash deaths with alcohol involvement is over 50% higher in Wayne County than in Tennessee as a whole (Table 5.9). Table 5.9: Motor Vehicle Crashes Involving Alcohol Alcohol-Impaired Driving Deaths, Wayne 44.4% Tennessee 27.9% County Health Rankings Smoking; prescription drug abuse; and other substance use, including marijuana, cocaine, and meth, emerged as needs within the region from key informant interviews. Key informants further commented on parental substance abuse of both prescribed and illegal or non-prescribed drugs as problematic, and observed that increasing numbers of babies in the county are born with Neonatal Abstinence Syndrome, or addicted to drugs. Substance abuse treatment and services are limited in the region: key informants cited a lack of smoking cessation support programs and other aids to help people quit smoking, despite high smoking rates, and a lack of outpatient substance abuse services for adolescents. Key informant testimony also linked violence to drug use. Highly impacted populations Tobacco use is cultural in this area. Race/ethnic groups: Themes from primary data included the observation that White males are more likely to smoke and use tobacco products. Low-income populations: Tobacco use is higher with smoking in populations of lower socioeconomic background and lower educational attainment, according to primary data. 24

29 5.2 Other Significant Health Needs Heart Disease & Stroke Data Overview n/a Primary data unavailable Warning Indicators Age-Adjusted Death Rate due to Coronary Heart Disease Stroke: Medicare Population Hypertension: Medicare Population Key Issues High death rates due to coronary heart disease and stroke High rates of hypertension and stroke in the Medicare population High blood pressure Approximately three in five people within the Medicare population in Wayne County suffer from hypertension, as shown in Table Table 5.10: Hypertension among the Medicare Population Wayne County has a higher percentage of their Medicare population suffering from hypertension than the average U.S. county and the average of Tennessee counties. Hypertension: Medicare Population, 2014 Wayne 62.2% Tennessee 58.5% U.S. 55.1% Centers for Medicare & Medicaid Services Heart disease & stroke The age-adjusted death rates due to coronary heart disease and stroke are consistently higher in Wayne County than both the state and national value (Table 5.11). Wayne County has a higher percentage of its Medicare population suffering from stroke than the U.S. value (Table 5.11). 25

30 Wayne County failed to meet the Healthy People 2020 Target for both Death Rate due to Coronary Heart Disease and Death Rate due to Stroke. Table 5.11: Heart Disease & Stroke Age-Adjusted Death Rate due to Coronary Heart Disease*, Age-Adjusted Death Rate due to Stroke*, Stroke: Medicare Population, Wayne % Tennessee % U.S % Healthy People 2020 Target *Deaths/100,000 population 1 Centers for Disease Control and Prevention 2 Centers for Medicare & Medicaid Services 26

31 5.2.2 Maternal, Fetal, & Infant Health 33% Key Informant Interviews Data Overview Warning Indicators Infant Mortality Rate Teen Birth Rate Preterm Births Key issues Limited access to maternal, fetal, and infant healthcare services High teen birth rate Healthcare providers According to key informant testimony, there is limited access to OB/GYNs in the county. Multiple key informants also observed that there are a lack of pediatricians and pediatric dental services. Teen pregnancy The teen birth rate is noticeably high in Wayne County compared to the Tennessee state value (Table 5.12). The need to address pregnancy prevention was corroborated by key informants. The number of babies born addicted to drugs is increasing in this region. Wayne County failed to meet the Healthy People 2020 Targets for both Infant Mortality Rate and Preterm Births (Table 5.12). Table 5.12: Pregnancy-Related Outcomes Infant Mortality Rate per 1,000 live births, 2013 Teen Birth Rate per 1,000 females aged 15-17, 2013 Preterm Births, 2014 Wayne % Tennessee % Healthy People 2020 Target % Tennessee Department of Health 27

32 Illicit drug use The number of babies born with Neonatal Abstinence Syndrome, or addicted to drugs, is the highest it has been since reporting became mandatory, according to key informant testimony. 28

33 5.2.3 Older Adults & Aging Data Overview 17% Key Informant Interviews Warning Indicators Key issues Depression: Medicare Population Stroke: Medicare Population Chronic Kidney Disease: Medicare Population High prevalence of chronic diseases in Medicare population Need for affordable, coordinated care Transportation as a barrier to care Chronic diseases Table 5.13: Health Issues Among the Medicare Population Approximately 1 in 5 people within the Medicare population in Wayne County suffer from chronic kidney disease and depression, while 1 in 20 have been treated for a stroke, as shown in Table Chronic Kidney Disease, 2014 Depression, 2014 Stroke, 2014 Wayne 18.7% 20.3% 4.3% Tennessee 17.5% 17.5% 3.5% U.S. 16.6% 16.2% 3.7% Centers for Medicare & Medicaid Services Chronic diseases are a significant public health burden, as they reduce one s ability to perform activities of daily living. The percentages of Medicare beneficiaries who were treated for the chronic conditions are much higher than the U.S. and Tennessee values and rank in the bottom quartile of U.S. counties and Tennessee counties. Poverty More than 1 in 10 people aged 65 years and over are living below the federal poverty level in Wayne County (Table 5.14). Table 5.14: Older Adults Living in Poverty People 65+ Living Below Poverty Level, Wayne 13.7% Tennessee 10.0% U.S. 9.4% American Community Survey 29

34 According to key informant testimony, affordable services and coordinated care of all providers are needs that impact elderly adults in Wayne County. According to secondary data, older adults who identify as Black or African American experienced extreme and significantly higher rates of poverty (84.2%) compared to the overall population. 30

35 5.2.4 Teen & Adolescent Health Data Overview 50% Key Informant Interviews Warning Indicators Teen Birth Rate Key issues Key informants noted that high rates of teen pregnancy are a concern in the community Limited access to services for adolescents, particularly those with mental health needs Diabetes and substance abuse among adolescents both need to be addressed Wayne County has a particularly high teen birth rate, exceeding both the state and national values by over 50%, as shown in Table According to key informant testimony, Wayne County is in need of more mental health care and services for youth. Applied Behavior Analysis (ABA) services are unavailable, especially in rural communities. Outpatient substance abuse services are lacking for adolescents despite a growing substance abuse problem among teens. Key informants also noted that teens and adolescents face health issues such as diabetes. Other adolescent needs that were identified by key informants include oral and vision screenings. Table 5.15: Teen Birth Rate Teen Birth Rate: 15-17, 2013* Wayne Tennessee U.S *Live births per 1,000 females in age group 1 Tennessee Department of Health 2 Centers for Disease Control and Prevention Teen health and pregnancy prevention is not discussed openly within the school system or other networks driving up teen pregnancy rates. 31

36 6 Conclusion This report provides an understanding of the major health and health-related needs in WMC s service area and guidance for community benefit planning efforts and positively impacting the community. Further investigation may be necessary for determining and implementing the most effective interventions. Thank you for reading the Community Health Needs Assessment (CHNA). Your views and feedback are important to the health of our community. If you have feedback about the information in the CHNA and you would like to share, please your information to CHNAFEEDBACK@mauryregional.com or mail to Maury Regional Medical Center, which is collecting input on behalf of Wayne Medical Center, an affiliate of Maury Regional Health, at: Maury Regional Medical Center Attention: Jill Gaddes CHNA Feedback 1224 Trotwood Avenue Columbia, Tennessee

37 Table of Contents Appendix A: Secondary Data... 1 A.1 Methodology... 1 Secondary Data Scoring... 1 Index of Disparity... 2 A.2 Data... 3 Appendix B: Primary Data... 4 B.1 Methodology... 4 B.2 Community Resources Cited... 5 Appendix C: Prioritization... 6 C.1 Prioritization Methodology... 6 C.2 Prioritization Participants... 6 Appendix D: Evaluation of CHNA... 8

38 Appendix A: Secondary Data A.1 Methodology Secondary Data Scoring Each indicator was assessed for Wayne County using up to six comparisons as possible. Each one is scored from 0-3 depending on how the county value compares to the relevant benchmarks as described below. Comparison to Other Tennessee Counties Values for all 95 Tennessee counties are ranked from best to worst and the score is determined by where Wayne County falls in the ranking. Comparison to Distribution of U.S. County Values A distribution is created by taking all county values, ordering them from low to high, and dividing them into four equally sized groups based on their order. The comparison score is determined by which of these four groups (quartiles) the county falls in. Comparison to Tennessee value and U.S. value For the comparisons to a single value, the scoring depends on whether the county has a better or worse value, and the percent difference between the two values. The same method is used to score the comparison to the value for the State of Tennessee and for the comparison to the U.S. value. Comparison to Healthy People 2020 Target For a comparison to a Healthy People 2020 target, the scoring depends on whether the target is met or unmet, and the percent difference between the indicator value and the target value. 1

39 Comparison to Trend The Mann-Kendall statistical test for trend is used to assess whether the indicator value is increasing over time or decreasing over time, and whether the trend is statistically significant. The trend comparison uses the four most recent comparable values for the county, and statistical significance is determined at the 90% confidence level. For each indicator with values available for four time periods, scoring was determined by direction of the trend and statistical significance. Missing Values Indicator scores are calculated using the comparison scores, availability of which depends on the data source. All missing comparisons are substituted with a neutral score for the purposes of calculating the indicator s weighted average. Indicator and Topic Scores Indicator scores are calculated by averaging all comparison scores. Topic scores are calculated as an average of all relevant indicator scores, and indicators may be included in multiple topics as appropriate. Index of Disparity To identify indicators with the largest disparities by gender or race/ethnicity, the Index of Disparity 1 measure was used to calculate the average of the absolute differences between rates for each subgroup within a sub-population category and the overall county rate, divided by the county rate. The index of disparity summarizes disparities across groups within a population that can be applied across indicators. The measure is expressed as a percentage. Across all indicators, an Index of Disparity score that ranked in the top 25% of all disparities scores in either gender or race/ethnicity category was identified as having a high disparity. The availability of sub-population data varies by source and indicator. In this example to the right, Age-Adjusted Death Rate due to Diabetes by Gender has county values for the female and male subgroups that are closer to each other and close ±3.3 ±11.4 ±4.8 ±2.8 1 Pearcy, J. & Keppel, K. (2002). A Summary Measure of Health Disparity. Public Health Reports, 117,

40 to the overall county value when compared to the subgroup values for Age-Adjusted Death Rate due to Diabetes by Race/Ethnicity. The absolute difference between the Black or African American value and the overall value is much larger than the difference between the White value and overall value, resulting in a higher Index of Disparity score than the score calculated for the gender subgroups. A.2 Data The following tables present the data used in the secondary data analysis. The first table on the next page presents topic scores for health and quality of life topics, with higher scores indicating higher need, followed by a list of secondary data sources used. The tables following the data sources contain a comprehensive list of the indicators that comprise each topic. For individual indicators, values for specific race/ethnic groups are presented if they were poorer than the overall indicator value, and if the indicator had a high index of disparity. 3

41 WAYNE&COUNTY Appendix&A:&Secondary&Data&Analysis& Health&Topic Score Heart&Disease&&&Stroke 2.10 Mental&Health&&&Mental&Disorders 2.06 Maternal,&Fetal&&&Infant&Health 1.89 Older&Adults&&&Aging 1.87 Children's&Health 1.84 Other&Chronic&Diseases 1.83 Exercise,&Nutrition,&&&Weight 1.82 Access&to&Health&Services 1.77 Substance&Abuse 1.69 Cancer 1.67 Respiratory&Diseases 1.65 Immunizations&&&Infectious&Diseases 1.24 Prevention&&&Safety 1.24 Quality&of&Life&Topic Score Economy 1.99 Education 1.75 Transportation 1.73 Social&Environment 1.65 Environment 1.57 Public&Safety 1.40

42 Secondary*Data*Sources American)Community)Survey American)Lung)Association Annie)E.)Casey)Foundation Centers)for)Disease)Control)and)Prevention Centers)for)Medicare)&)Medicaid)Services County)Health)Rankings Feeding)America Institute)for)Health)Metrics)and)Evaluation National)Cancer)Institute National)Center)for)Education)Statistics Small)Area)Health)Insurance)Estimates Tennessee)Department)Of)Education Tennessee)Department)of)Health Tennessee)Department)of)HealthG)Communicable)and)Environmental)Disease)Services Tennessee)Department)of)HealthG)Sexually)Transmitted)Diseases Tennessee)Secretary)of)State U.S.)Bureau)of)Labor)Statistics U.S.)Census)G)County)Business)Patterns U.S.)Department)of)Agriculture)G)Food)Environment)Atlas U.S.)Environmental)Protection)Agency

43 WAYNE&COUNTY Data&Scoring&Appendix:&Indicator&Scores&by&Topic SCORE ACCESS&TO&HEALTH&SERVICES UNITS WAYNE-COUNTY HP2020 TENNESSEE U.S Dentist-Rate dentists/100,000+population Primary-Care-Provider-Rate providers/100,000+population Adults-with-Health-Insurance percent Clinical-Care-Ranking Children-with-Health-Insurance percent NonRPhysician-Primary-Care-Provider-Rate providers/100,000+population SCORE CANCER UNITS WAYNE-COUNTY HP2020 TENNESSEE U.S AgeRAdjusted-Death-Rate-due-to-Lung-Cancer deaths/100,000+population ; Lung-and-Bronchus-Cancer-Incidence-Rate cases/100,000+population ; Colorectal-Cancer-Incidence-Rate cases/100,000+population ; Cancer:-Medicare-Population percent AgeRAdjusted-Death-Rate-due-to-Cancer deaths/100,000+population ; Breast-Cancer-Incidence-Rate cases/100,000+females ; All-Cancer-Incidence-Rate cases/100,000+population ; Prostate-Cancer-Incidence-Rate cases/100,000+males ;2012 SCORE CHILDREN'S&HEALTH UNITS WAYNE-COUNTY HP2020 TENNESSEE U.S Child-Food-Insecurity-Rate percent LowRIncome-Preschool-Obesity percent ; Children-with-Health-Insurance percent Children-with-Low-Access-to-a-Grocery-Store percent Child-Abuse-Rate cases/1,000+children SCORE DIABETES UNITS WAYNE-COUNTY HP2020 TENNESSEE U.S AgeRAdjusted-Death-Rate-due-to-Diabetes deaths/100,000+population ; Diabetes:-Medicare-Population percent SCORE ECONOMY UNITS WAYNE-COUNTY HP2020 TENNESSEE U.S. Households-with-Cash-Public-Assistance Income percent ; Child-Food-Insecurity-Rate percent Children-Living-Below-Poverty-Level percent ; Families-Living-Below-Poverty-Level percent ;2014 Black-(36.4)-White-(18.5)-Asian- (41.7)-AIAN-(0)-Mult-(0)-Other-(100)- Hisp-(46.2) 2.61 Median-Household-Income dollars ; People-Living-200%-Above-Poverty-Level percent ; Young-Children-Living-Below-Poverty-Level percent ; Per-Capita-Income dollars ; People-65+-Living-Below-Poverty-Level percent ;2014 Black-(84.2)-White-(13.3)-AIAN-(0)- Mult-(0)-Hisp-(0) 2.33 People-Living-Below-Poverty-Level percent ;2014 Black-(61.3)-White-(20.5)-Asian- (73.5)-AIAN-(44)-Mult-(13.6)-Other- (76)-Hisp-(53.2) 2.33 Unemployed-Workers-in-Civilian-Labor-Force percent February LowRIncome-Preschool-Obesity percent ; Students-Eligible-for-the-Free-Lunch-Program percent ; LowRIncome-and-Low-Access-to-a-Grocery- Store percent Food-Insecurity-Rate percent LowRIncome-Persons-who-are-SNAP- Participants percent SNAP-Certified-Stores stores/1,000+population Social-and-Economic-Factors-Ranking Severe-Housing-Problems percent ; Homeownership percent ; Renters-Spending-30%-or-More-of-Household- Income-on-Rent percent ;2014 SCORE EDUCATION UNITS WAYNE-COUNTY HP2020 TENNESSEE U.S. People-25+-with-a-High-School-Degree-or Higher percent ; People-25+-with-a-Bachelor's-Degree-or-Higher percent ; Students-Proficient-in-Reading:-Grades-3R8 percent Students-Proficient-in-Math:-Grades-3R8 percent StudentRtoRTeacher-Ratio students/teacher ; High-School-Graduation percent SCORE ENVIRONMENT UNITS WAYNE-COUNTY HP2020 TENNESSEE U.S Access-to-Exercise-Opportunities percent Farmers-Market-Density markets/1,000+population Households-with-No-Car-and-Low-Access-to-a- Grocery-Store percent Recreation-and-Fitness-Facilities facilities/1,000+population Food-Environment-Index LowRIncome-and-Low-Access-to-a-Grocery Store percent

44 WAYNE&COUNTY Data&Scoring&Appendix:&Indicator&Scores&by&Topic SCORE ENVIRONMENT&(CONTINUED) UNITS WAYNE-COUNTY HP2020 TENNESSEE U.S People-65+-with-Low-Access-to-a-Grocery-Store percent SNAP-Certified-Stores stores/1,000+population Children-with-Low-Access-to-a-Grocery-Store percent Houses-Built-Prior-to-1950 percent ; Grocery-Store-Density stores/1,000+population Drinking-Water-Violations percent FY+2013; Physical-Environment-Ranking Recognized-Carcinogens-Released-into-Air pounds Fast-Food-Restaurant-Density restaurants/1,000+population Severe-Housing-Problems percent ;2012 SCORE ENVIRONMENTAL&&&OCCUPATIONAL&HEALTH UNITS WAYNE-COUNTY HP2020 TENNESSEE U.S Physical-Environment-Ranking Asthma:-Medicare-Population percent SCORE EXERCISE,&NUTRITION,&&&WEIGHT UNITS WAYNE-COUNTY HP2020 TENNESSEE U.S Child-Food-Insecurity-Rate percent Access-to-Exercise-Opportunities percent Farmers-Market-Density markets/1,000+population LowRIncome-Preschool-Obesity percent ; Households-with-No-Car-and-Low-Access-to-a- Grocery-Store percent Recreation-and-Fitness-Facilities facilities/1,000+population Food-Environment-Index LowRIncome-and-Low-Access-to-a-Grocery- Store percent Health-Behaviors-Ranking Food-Insecurity-Rate percent LowRIncome-Persons-who-are-SNAP- Participants percent People-65+-with-Low-Access-to-a-Grocery-Store percent SNAP-Certified-Stores stores/1,000+population Children-with-Low-Access-to-a-Grocery-Store percent Grocery-Store-Density stores/1,000+population Fast-Food-Restaurant-Density restaurants/1,000+population SCORE FAMILY&PLANNING UNITS WAYNE-COUNTY HP2020 TENNESSEE U.S. live+births/1,000+females+aged Teen-Birth-Rate 15; SCORE GOVERNMENT&&&POLITICS UNITS WAYNE-COUNTY HP2020 TENNESSEE U.S Voter-Turnout percent SCORE HEART&DISEASE&&&STROKE UNITS WAYNE-COUNTY HP2020 TENNESSEE U.S. AgeRAdjusted-Death-Rate-due-to-Coronary Heart-Disease deaths/100,000+population ; Stroke:-Medicare-Population percent Hypertension:-Medicare-Population percent AgeRAdjusted-Death-Rate-due-to- Cerebrovascular-Disease-(Stroke) deaths/100,000+population ; Heart-Failure:-Medicare-Population percent Atrial-Fibrillation:-Medicare-Population percent Ischemic-Heart-Disease:-Medicare-Population percent Hyperlipidemia:-Medicare-Population percent SCORE IMMUNIZATIONS&&&INFECTIOUS&DISEASES UNITS WAYNE-COUNTY HP2020 TENNESSEE U.S. AgeRAdjusted-Death-Rate-due-to-Influenza-and Pneumonia deaths/100,000+population ; Chlamydia-Incidence-Rate cases/100,000+population Tuberculosis-Incidence-Rate cases/100,000+population Gonorrhea-Incidence-Rate cases/100,000+population SCORE MATERNAL,&FETAL&&&INFANT&HEALTH UNITS WAYNE-COUNTY HP2020 TENNESSEE U.S Infant-Mortality-Rate deaths/1,000+live+births Teen-Birth-Rate live+births/1,000+females+aged+ 15; Preterm-Births percent Babies-with-Low-Birth-Weight percent Babies-with-Very-Low-Birth-Weight percent SCORE MEN'S&HEALTH UNITS WAYNE-COUNTY HP2020 TENNESSEE U.S Life-Expectancy-for-Males years Prostate-Cancer-Incidence-Rate cases/100,000+males ;2012