Community Health Needs Assessment September 29, 2016

Transcription

1 Community Health Needs Assessment September 29, 2016 Phone: West Laurel Street Suite 204 Tampa, FL

2 Comments about this report can be sent to: Liz Dawson Director of Community Health North Mississippi Medical Center 830 S. Gloster Street Tupelo, MS

3 Table of Contents North Mississippi Medical Center at a Glance 4 Community Overview... 5 Purpose.. 6 Requirements 7 CHNA Strategy. 8 Actions Taken Since 2013 CHNA. 9 Health Profile. 16 Community Leader Surveys 35 Community Health Priorities. 39 Health Resources 42 References 45 Appendix A: Carnahan Group Qualifications 47 Appendix B: Community Leader Organizations. 48 Company Overview

4 North Mississippi Medical Center at a Glance North Mississippi Health Services (NMHS) serves 24 counties in north Mississippi and northwest Alabama from headquarters in Tupelo, MS. NMHS includes acute diagnostic and therapeutic services, offered through North Mississippi Medical Center (NMMC) in Tupelo; a community hospital system with locations in Eupora, Iuka, Pontotoc, and West Point, MS, and Hamilton AL; North Mississippi Medical Clinics, a regional network of more than 30 primary and specialty clinics; and nursing homes, telehealth services and a comprehensive portfolio of managed care plans. NMHS connects patients and their families with convenient access to health care that is cost-effective and of the highest quality. NMHS is a 2012 recipient of the prestigious Malcolm Baldrige National Quality Award, and NMMC, its flagship hospital, is a 2006 Baldrige Award recipient. 4

5 Community Overview Tishomingo Health Services Inc. d/b/a NMMC-Iuka serves residents in in the following counties in northeast Mississippi and northwest Alabama: Colbert, AL, Alcorn, MS, Prentiss, MS, and Tishomingo, MS. Because this community was chosen based on where the hospital draws its patients from, it includes medically underserved, low income, and minority populations. Source: Microsoft MapPoint

6 Purpose Community Health Needs Assessment Background On August 17, 2016, NMHS contracted with Carnahan Group to conduct a Community Health Needs Assessment (CHNA) for NMMC-Iuka as required by the Patient Protection and Affordable Care Act (PPACA). Please refer to Appendix A: Carnahan Group Qualifications for more information about Carnahan Group. The PPACA, enacted on March 23, 2010, requires not-for-profit hospital organizations to conduct a CHNA once every three taxable years that meets the requirements the Internal Revenue Code 501(r) set forth by the PPACA. The PPACA defines a hospital organization as an organization that operates a facility required by a state to be licensed, registered, or similarly recognized as a hospital; or, a hospital organization is any other organization that the Treasury s Office of the Assistant Secretary ( Secretary ) determines has the provision of hospital care as its principal function or purpose constituting the basis for its exemption under section 501(c)(3). A CHNA is a report based on epidemiological, qualitative, and comparative methods that assess the health issues in a hospital organization s community and that community s access to services related to those issues. Based on the findings of the CHNA, an implementation strategy for NMMC-Iuka that addresses the community health needs will be developed and adopted within the timeframe outlines in the final regulations. 6

7 Requirements As required by the Treasury Department ( Treasury ) and the Internal Revenue Service (IRS), this CHNA includes the following: A description of the community served; A description of the process and methods used to conduct the CHNA, including: A description of the sources and dates of the data and the other information used in the assessment; and, The analytical methods applied to identify community health needs. The identification of all organizations with which NMMC-Iuka collaborated, if applicable, including their qualifications; A description of how NMMC-Iuka took into account input from persons who represented the broad interests of the community served by NMMC-Iuka, including those with special knowledge of or expertise in public health, written comments regarding the hospital s previous CHNA, and any individual providing input who was a leader or representative of the community served by NMMC-Iuka; A prioritized description of all of the community health needs identified through the CHNA and a description of the process and criteria used in prioritizing those needs; A description of the resources potentially available to address the significant health needs identified through the CHNA; and, An evaluation of the impact of any actions that were taken, since the hospital facility finished conducting its immediately preceding CHNA, to address the significant health needs identified in the hospital facility's prior CHNA(s). 7

8 CHNA Strategy This CHNA was conducted following the requirements outlined by the Treasury and the IRS, which included obtaining necessary information from the following sources: Input from persons who represented the broad interests of the community served by NMMC-Iuka, which included those with special knowledge of or expertise in public health; Identifying federal, 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 NMMC-Iuka, leaders, representatives, or members of medically underserved, low-income, and minority populations with chronic disease needs in the community served by NMMC-Iuka; and, Consultation or input from other persons located in and/or serving NMMC-Iuka s community, such as: o Healthcare community advocates; o Nonprofit organizations; o Local government officials; o Community-based organizations, including organizations focused on one or more health issues; o Healthcare providers, including community health centers and other providers focusing on medically underserved populations, low-income persons, minority groups, or those with chronic disease needs. The sources used for NMMC-Iuka s CHNA are provided in the References and Appendix B: Community Leader Organizations. Information was gathered by conducting interviews with individuals representing community health and public service organizations, medical professionals, hospital administration, and other hospital staff members. 8

9 Actions Taken Since 2013 CHNA NMMC publishes annual Live Well Community Health Initiative Progress Reports. The following information provides a description of the actions NMMC has taken since completion of its 2013 CHNA reports. The information presented below highlights the efforts of NMMC s Community Health Department to fulfill the mission of continuously improving the health status of the people it serves Cardiovascular Disease Community CPR classes participants Community blood pressure screening and education 1,265 participants Cholesterol screening and education participants Smoking Cessation visits/107 participants Stroke screening and education participants Lunchtime Learning: Atrial Fibrillation participants Lunchtime Learning: Women and Heart Disease participants Obesity, Healthy Eating and Active Living Assisted with planning and implementing the Families in Transition (F.I.T.) program NMMC School Nurses assisted with sports physicals 1,845 participants NMMC School Nurses provided height and weight screenings Cancer Pretty in Pink Luncheon focused on breast cancer awareness participants Spirit of Women Girls Night Out focused on breast cancer awareness - 71 participants PSA screening and education - 34 participants 9

10 Actions Taken Since 2013 CHNA Lunchtime Learning- Gynecological Cancers - 98 participants Diabetes NMMC School Nurses provided daily support and education for more than 20 diabetic students Glucose screening and education participants Lunchtime Learning: Diabetes participants Reproductive and Maternal Health Wonderful Beginnings Baby Fair participants Children/Adolescent/Teen Health and Safety Mother/Daughter Workshop participants Effects of drug use education, Itawamba Attendance Center by NMMC School Nurse 1,500 participants Hand washing and puberty education, Itawamba Attendance Center by NMMC School Nurse participants Safety education, South Pontotoc Attendance Center by NMMC School Nurse 1,675 participants Nutrition and oral health education, South Pontotoc Attendance Center by NMMC School Nurse participants Drug use prevention and self-esteem, Okolona Elementary and Junior High by NMMC School Nurse participants NMMC School Health Centers Charted Treatments - 11,209 NMMC School Health Centers Screenings 4,701 Two SafeSitter sessions - 40 participants Bone Health Bone density screening and education participants 10

11 Actions Taken Since 2013 CHNA Immunizations Provided free influenza vaccinations 3,300 participants General Health Spirit of Women January event Pure and Simple participants Lunchtime Learning: Spine Health - 95 participants Lunchtime Learning: Muscle and Joint Health participants 2015 Cardiovascular Disease Community CPR classes participants Community blood pressure screening and education 1,162 participants School blood pressure screening and education participants Distributed Blood Clots and Cancer: Know the Risks information produced by Spirit of Women HeartCaring program to all oncology services sites Distributed updated HeartCaring Journals to NMMC Heart Institute Cholesterol screening and education participants Smoking Cessation visits/143 participants Obesity, Healthy Eating and Active Living Body Mass Index screening and education participants by NMMC school nurses Assisted with planning and implementing the Families in Transition (F.I.T.) program Digestive Health Lunchtime Learning program - 96 participants Fitness at Any Age Spirit of Women Girls Night Out program participants 11

12 Actions Taken Since 2013 CHNA NMMC School Nurses assisted with sports physicals 1,845 participants Health and exercise education for Itawamba Attendance Center by NMMC School Nurse participants Cancer Provided colon cancer awareness assessment at Run for Your Buns 5K - 41 participants Pretty in Pink Luncheon focused on breast cancer awareness participants PSA screening and education - 25 participants Diabetes NMMC School Nurses provided daily support and education for more than 25 diabetic students Glucose screening and education participants Reproductive and Maternal Health Wonderful Beginnings Baby Fair participants Children/Adolescent/Teen Health and Safety Mother/Daughter Workshop participants Character Building Skills education for PreK-5 th graders at South Pontotoc Attendance Center by NMMC School Nurse participants Self-esteem education at Okolona Elementary and Junior High by NMMC School Nurse participants Hand hygiene education at Itawamba Attendance Center participants School Shooting Safety for 7 th and 8 th graders at Itawamba Attendance Center participants Safety education for K-5 th graders at Itawamba Attendance Center participants NMMC School Health Centers Charted Treatments - 11,536 12

13 Actions Taken Since 2013 CHNA NMMC School Health Centers Screenings-Hearing 2,963; Vision 2,582; Lice 2,351 Three SafeSitter sessions - 50 participants Bus Safety education for PreK-5 th graders at South Pontotoc Attendance Center by NMMC School Nurse participants Fire Safety education for first graders at South Pontotoc Attendance Center by NMMC School Nurse participants Hand hygiene education for 5 th graders at South Pontotoc Attendance Center participants Spirit of Women Internet and Social Media Safety program - 35 participants Bone Health Bone density screening and education participants Orthopedics Lunchtime Learning program participants Oral Health Oral health education for PreK-2 nd graders at South Pontotoc Attendance Center by NMMC School Nurse participants Immunizations Provided free influenza vaccinations 2,874 participants Adult Immunizations Lunchtime Learning program participants NMMC School Nurse taught proper immunization procedure for Summer Health Academy - 20 participants General Health Spirit of Women January event Take a Time Out participants 13

14 Actions Taken Since 2013 CHNA Dementia Lunchtime Learning program - 98 participants Spirit of Women overactive bladder educational program - 46 participants Stress-free Holiday Decorating Lunchtime Learning program - 87 participants Hand washing and Hygiene education for 5 th graders at South Pontotoc Attendance Center by NMMC School Nurse participants 2016 Cardiovascular Disease Community CPR classes participants Community blood pressure screening and education participants Cholesterol screening and education - 63 participants Smoking Cessation visits/119 participants Lunchtime Learning: Conquer Cholesterol - 96 participants Day of Dance for Heart Health - 20 participants Obesity, Healthy Eating and Active Living NMMC School Nurses provided height and weight screenings Spirit of Women January event: Lose the Clutter, Lose the Weight participants Cancer PSA screening and education - 8 participants Run for Your Buns 5K-Colorectal Cancer education participants 14

15 Actions Taken Since 2013 CHNA Diabetes NMMC School Nurses provided daily support and education for more than 25 diabetic students Glucose screening and education - 63 participants Children/Adolescent/Teen Health and Safety NMMC School Health Centers Charted Treatments - 3,161 NMMC School Health Centers Screenings Four SafeSitter sessions - 54 participants Jump Rope for Heart-South Pontotoc Elementary participants Seizure Education-South Pontotoc Elementary by NMMC School Nurse - 45 participants Dental Health-South Pontotoc Elementary by NMMC School Nurse participants Food Allergies-South Pontotoc Elementary by NMMC School Nurse - 26 participants Nutrition-Itawamba Attendance Center by NMMC School Nurse participants Fire Safety-Itawamba Attendance Center by NMMC School Nurse participants Children s Health program at local daycare by NMMC School Nurse - 45 participants Bone Health Bone density screening and education participants General Health Lunchtime Learning: Fighting Fatigue - 75 participants Lunchtime Learning: Understanding Genetics - 63 participants 15

16 Health Profile Secondary Data Collection and Analysis Methodology A variety of data sources were utilized to gather demographic and health indicators for the community served by NMMC- Iuka. Commonly used data sources include Esri, the U.S. Census Bureau, the Centers for Disease Control and Prevention (CDC), the National Cancer Institute, and the Mississippi State Department of Health. As previously mentioned, four counties in northeast Mississippi and northwest Alabama define NMMC-Iuka s community for the purposes of this report. Demographic and health indicators were gathered for each of the four counties. A weighted average was calculated to determine a single indicator for the area served by NMMC-Iuka. Service area indicators are compared to benchmarks for Mississippi and Alabama. Total catchment area data (inclusive of all 24 counties served by NMHS) was calculated using the same method as the service area indicators. These indicators are presented for reference and comparative purposes. 16

17 Demographics Population in NMMC-Iuka s Community Sources: Esri 2016; Microsoft MapPoint

18 Population Change by County The overall projected population growth for the community is 1.4% over the next five years. Current and Projected Population by ZIP Code Projected 5- County Current Population year Population Percent Change Alcorn 37,505 37, % Colbert 54,102 54, % Prentiss 20,578 20, % Tishomingo 22,838 23, % Total 135, , % Source: Esri

19 Population Change by Age and Gender The population of residents aged 20 through 44 is expected to decline slightly (-4.6%). Marginal population growth is expected for children and young adults aged 0 through 19 (0.7%) and adults aged 45 through 64 (0.9%). Substantial population growth is expected among residents aged 65 and older (13.1%). Iuka Service Area Current and Projected Population Change by Age and Sex Age Group Male Female Total Male Female Total Male Female Total Age 0 through 19 16,757 15,744 32,501 16,897 15,841 32, % 0.6% 0.7% Age 20 through 44 20,262 20,245 40,507 19,377 19,247 38, % -4.9% -4.6% Age 45 through 64 18,172 18,926 37,098 18,460 18,961 37, % 0.2% 0.9% Age 65 and older 10,712 14,205 24,917 12,393 15,789 28, % 11.2% 13.1% Total 65,903 69, ,023 67,127 69, , % 1.0% 1.4% Source: Esri Percent Change 19

20 Population by Race and Ethnicity The most common race/ethnicity in NMMC-Iuka s service area is white (83.1%), followed by black/african American (12.2%), Hispanic (2.6%), individuals of two races (1.3%), Asian/Pacific Islanders (0.4%), and other races (0.4%). Race Composition 2015 Two Races 1.3% Hispanic 2.6% Other 0.4% Asian/Pacific Islander 0.4% Black/African American 12.2% White 83.1% Source: Esri

21 Population Change by Race and Ethnicity Substantial population growth is expected for Asian/Pacific Islanders (35.8%), individuals of two races (23.8%), Hispanics (17.8%), and other races (12.9%). Slight population growth is expected for black/african Americans (3.8%). There is no expected change for the white population (0.0%). Iuka Service Area Current and Projected Population by Race Race Percent Change White 112, , % Black/African American 16,453 17, % Asian/Pacific Islander % Two Races 1,754 2, % Hispanic 3,475 4, % Other % Source: Esri

22 Socioeconomic Characteristics According to the U.S. Bureau of Labor Statistics, the 2014 annual unemployment average for NMMC-Iuka s service area (7.2%) was lower when compared to Mississippi (7.6%), but higher than in Alabama (6.8%). The U.S. Census American Community Survey (ACS) publishes median household income and poverty estimates. According to estimates, the median household income in NMMC-Iuka s service area ($33,966) is substantially lower than Mississippi s ($39,464) and Alabama s ($43,511). Poverty thresholds are determined by family size, number of children and age of the head of the household. A family s income before taxes is compared to the annual poverty thresholds. If the income is below the threshold, the family and each individual in it are considered to be in poverty. In 2014, the poverty threshold for a family of four was $24,008. The ACS estimates indicate that NMMC-Iuka s service area residents are less likely to live in poverty (21.4%) compared to Mississippi residents (22.6%), but more likely compared to residents in Alabama (18.9%). Children in NMMC-Iuka s service area are less likely to be living below the poverty level (29.4%) compared to all children in Mississippi (32.2%); however, they are more likely to be living below poverty level when compared to all children in Alabama (27.5%). NMMC-Iuka Service Area Total Catchment Area Mississippi Alabama United States Unemployment rate, 2014 annual average 1 7.2% 7.9% 7.6% 6.8% 6.2% Median household income 2 $ 33,966 $ 36,722 $ 39,464 $ 43,511 $ 53,482 Individuals below poverty level % 22.9% 22.6% 18.9% 15.6% Children below poverty level % 30.7% 32.2% 27.5% 21.9% 1 Source: U.S. Bureau of Labor Statistics 2 Source: U.S. Census: ACS estimates 22

23 Educational Attainment The U.S. Census ACS publishes estimates of the highest level of education completed for residents aged 25 years and older. The ACS estimates indicate that more NMMC-Iuka s service area residents have earned a high school degree or equivalent (35.6%) compared to Mississippi residents (30.2%) and Alabama residents (31.1%); however, residents aged 25 and older in NMMC-Iuka s service area are less likely to have a bachelor s degree (8.7%) compared to adults aged 25 years and older in Mississippi (12.9%) and in Alabama (14.5%). NMMC-Iuka Service Area Total Catchment Area Mississippi Alabama United States Less than a high school degree 7.8% 7.4% 6.2% 5.4% 5.8% High school degree or equivalent 35.6% 31.7% 30.2% 31.1% 28.0% Some college 18.5% 21.2% 22.8% 22.0% 21.2% Bachelor's degree 8.7% 11.4% 12.9% 14.5% 18.3% Graduate or professional degree 5.0% 7.2% 7.5% 8.6% 11.0% Source: U.S. Census: ACS estimates The high school graduation rate is lower in NMMC-Iuka s service area (77.0%) when compared to Mississippi (81.9%) and Alabama (83.7%). NMMC-Iuka Total Catchment Service Area Area Mississippi Alabama United States High school graduation rate 77.0% 81.2% 81.9% 83.7% 86.3% Source: U.S. Census: ACS estimates 23

24 Mortality Indicators The Institute for Health Metrics and Evaluation publishes life expectancies by county and gender. The life expectancy for males in NMMC-Iuka s service area (70.8 years) is lower than Mississippi s and Alabama s (71.8 years and 72.4 years, respectively). The life expectancy for females is also lower in NMMC-Iuka s service area (77.2 years) compared to Mississippi and Alabama (77.9 years and 78.2 years, respectively). NMMC-Iuka Service Area Total Catchment Area Mississippi Alabama United States Male life expectancy at birth, Female life expectancy at birth, Source: Institute for Health Metrics and Evaluation 24

25 Leading Causes of Death Availability of mortality data varies by state. Due to the unavailability of data for certain counties in NMHS s service area, the cause of death indicators below are approximated based on data from Heart disease and cancer are the first and second leading causes of death, respectively, in NMMC-Iuka s service area, Mississippi, and Alabama. Chronic lower respiratory disease (CLRD), accidents, and stroke are among the top five leading causes of death for NMMC-Iuka s service area, Mississippi, and Alabama. Other leading causes of death in NMMC-Iuka s service area, Mississippi, and Alabama include diabetes and influenza and pneumonia. It is important to note that the accident mortality rate in NMMC-Iuka s service area is substantially higher (71.0 per 100,000 population) than the rates in Mississippi (55.6 per 100,000 population) and Alabama (49.9 per 100,000 population). Diabetes and influenza and pneumonia mortality rates are substantially lower in NMMC-Iuka s service area compared to Mississippi and Alabama. NMMC-Iuka Service Area Total Catchment Area Mississippi Alabama United States Heart Disease Cancer CLRD Accidents (including motor vehicle) Stroke Diabetes Influenza and pneumonia Sources: Mississippi State Department of Health - County Health Profiles; Report on the Burden of Chronic Diseases in Mississippi, 2014; CHSI, U.S. Department of Health and Human Services, CDC; ADPH - County Health Profiles 2014 Rates are per 100,000 population 25

26 Cardiovascular Outcomes The CDC reports mortality rates for cardiovascular outcomes for individuals aged 65 and older during The following tables represent mortality rates for select cardiovascular outcomes for individuals aged 65 and older. Heart disease mortality is more common in NMMC-Iuka s service area when compared to Mississippi and Alabama. NMMC-Iuka Service Area Total Catchment Area Mississippi Alabama United States Heart Disease, All 1, , , , ,098.5 Heart Disease, White (Non-Hispanic) 1, , , , ,122.1 Heart Disease, Black (Non-Hispanic) 1, , , , ,263.1 Heart Disease, Male 1, , , , ,340.2 Heart Disease, Female 1, , , , Source: Interactive Atlas of Heart Disease and Stroke, Centers for Disease Control and Prevention Heart attack mortality rates are higher in NMMC-Iuka s service area compared to Alabama, but lower than the rates in Mississippi. NMMC-Iuka Service Area Total Catchment Area Mississippi Alabama United States Heart Attack, All Heart Attack, White (Non-Hispanic) Heart Attack, Black (Non-Hispanic) Heart Attack, Male Heart Attack, Female Source: Interactive Atlas of Heart Disease and Stroke, Centers for Disease Control and Prevention 26

27 Overall, NMMC-Iuka s service area residents aged 65 and older are substantially less likely to die from hypertension when compared to all residents in Mississippi; however, the rate in NMMC-Iuka s service area is higher than the rate in Alabama. It is important to note that blacks in NMMC-Iuka s service area are more than twice as likely to die from hypertension compared to whites. NMMC-Iuka Service Area Total Catchment Area Mississippi Alabama United States Hypertension, All , , Hypertension, White (Non-Hispanic) , , Hypertension, Black (Non-Hispanic) 1, , , Hypertension, Male , , Hypertension, Female , , Source: Interactive Atlas of Heart Disease and Stroke, Centers for Disease Control and Prevention NMMC-Iuka s service area residents aged 65 and older are more likely to die from a stroke when compared to all Mississippi and Alabama residents aged 65 and older. NMMC-Iuka Service Area Total Catchment Area Mississippi Alabama United States Stroke, All Stroke, White (Non-Hispanic) Stroke, Black (Non-Hispanic) Stroke, Male Stroke, Female Source: Interactive Atlas of Heart Disease and Stroke, Centers for Disease Control and Prevention 27

28 Cancer Incidence The tables on the following pages show select cancer incidence and mortality rates reported by the National Cancer Institute for Prostate cancer incidence is lower in NMMC-Iuka s service area (100.5 per 100,000 males) compared to Mississippi (142.7 per 100,000 males) and Alabama (139.1 per 100,000 males). Breast cancer incidence is lower in NMMC-Iuka s service area (105.7 per 100,000 females) when compared to Mississippi (116.1 per 100,000 females) and Alabama (123.3 per 100,000 females). Lung and bronchus cancer incidence in NMMC-Iuka s service area (78.4 per 100,000 population) is higher than in Mississippi (76.4 per 100,000 population) and Alabama (71.3 per 100,000 population). The colon and rectum cancer incidence rate in NMMC-Iuka s service area (44.2 per 100,000 population) is similar to the rate in Alabama (44.1 per 100,000 population); however, the rate is lower than the rate in Mississippi (49.8 per 100,000 population). The pancreas cancer incidence rate in NMMC-Iuka s service area (13.2 per 100,000 population) is similar to the rate in Mississippi (13.5 per 100,000 population); however, the rate is higher than the rate in Alabama (12.5 per 100,000 population). 28

29 NMMC-Iuka Service Area Total Catchment Area Mississippi Alabama United States Prostate Breast Lung and bronchus Colorectal Pancreas Sources: State Cancer Profiles, National Cancer Institute 1 Rates are per 100,000 population 2 Rates are per 100,000 females 3 Rates are per 100,000 males 29

30 Cancer Mortality Lung and bronchus cancer mortality in NMMC-Iuka s service area (64.7 per 100,000 population) is higher than in Mississippi (60.0 per 100,000 population) and in Alabama (57.3 per 100,000 population). The breast cancer mortality rate in NMMC-Iuka s service area (27.1 per 100,000 females) is higher than the rate in Mississippi (24.1 per 100,000 females) and Alabama (22.2 per 100,000 population). Prostate cancer mortality is lower in NMMC-Iuka s service area (22.9 per 100,000 males) compared to Mississippi s (27.4 per 100,000 males) and Alabama s (25.2 per 100,000 males). Colorectal cancer mortality in NMMC-Iuka s service area (19.1 per 100,000 females) is similar to Mississippi (19.5 per 100,000 females); however, the rate is lower than the rate in Alabama (21.1 per 100,000 females). Pancreas cancer mortality in NMMC-Iuka s service area (12.3 per 100,000 population) is similar to Mississippi (12.5 per 100,000 population), but slightly lower than in Alabama (13.3 per 100,000 population). NMMC-Iuka Service Area Total Catchment Area Mississippi Alabama United States Lung and bronchus Breast Prostate Colorectal Pancreas Sources: State Cancer Profiles, National Cancer Institute 1 Rates are per 100,000 population 2 Rates are per 100,000 females 3 Rates are per 100,000 males 30

31 Sexually Transmitted Infections Reported rates of sexually transmitted infections (STIs) for 2013 are available through the Mississippi State Department of Health, the Centers for Disease Control and Prevention, and the Alabama Department of Public Health. The chlamydia rate in NMMC-Iuka s service area (272.5 per 100,000 population) is similar to the rate in Mississippi (273.9 per 100,000 population), but lower than Alabama s (590.7 per 100,000 population). The gonorrhea rate in NMMC-Iuka s service area (48.5 per 100,000 population) is substantially lower than the rates in Mississippi and Alabama (81.7 per 100,000 population and per 100,000 population, respectively). In NMMC-Iuka s service area, the syphilis rate is substantially lower (1.2 per 100,000) when compared to the rates in Mississippi (4.6 per 100,000) and Alabama (10.9 per 100,000). The HIV rate in NMMC-Iuka s service area (13.0 per 100,000 population) is substantially higher than the rate in Mississippi (7.8 per 100,000 population), but slightly lower than the rate in Alabama (14.0 per 100,000 population). NMMC-Iuka Service Area Total Catchment Area Mississippi Alabama United States Chlamydia Gonorrhea Syphilis HIV Sources: Mississippi State Department of Health; Centers for Disease Control and Prevention; ADPH County Health Profiles Rates are per 100,000 population 31

32 Maternal and Child Health The birth rate in NMMC-Iuka s service area (13.9 per 1,000) is higher than the birth rates in Mississippi (12.9 per 1,000) and Alabama (12.3 per 1,000). Infant mortality in NMMC-Iuka s service area (8.2 per 1,000 live births) is lower than the rates in Mississippi and Alabama (9.7 per 1,000 live births and 8.7 per 1,000 live births, respectively). NMMC-Iuka Service Area Total Catchment Area Mississippi Alabama United States Birth rate (per 1,000 population) Infant mortality rate (per 1,000 births) Sources: Mississippi State Department of Health, Vital Statistics Report 2013; ADPH, Alabama Vital Statistics 2014; Centers for Disease Control and Prevention, 2014 Women in NMMC-Iuka s service area are as likely to receive prenatal care in first trimester (73.9%) when compared to all women in Mississippi (74.3%), but more likely when compared to all women in Alabama (68.2%). Low birthweight births are less common in NMMC-Iuka s service area (10.7% per 1,000 live births) when compared to Mississippi (11.5% per 1,000 live births), but more common when compared to Alabama (10.0% per 1,000 live births). NMMC-Iuka Service Area Total Catchment Area Mississippi Alabama United States Women receiving prenatal care in first trimester 73.9% 74.5% 74.3% 68.2% 73.7% Low birthweight 10.7% 11.0% 11.5% 10.0% 8.0% Sources: Mississippi State Department of Health, Vital Statistics Report 2013; ADPH, Alabama Vital Statistics 2014; Centers for Disease Control and Prevention,

33 Health Risk Factors and Behaviors Health status is defined as the percentage of adults who reported their general health as fair or poor. Adults in the NMMC- Iuka service area are more likely to report fair or poor genera health (24.3%) compared to all Mississippi (23.4%), but less than Alabama adults (25.0%). Current smoking is the percentage of adults who reported smoking at least 100 cigarettes in their lifetime and currently smoke. Adults in the NMMC-Iuka service area are less likely to report smoking (22.6%) compared to all Mississippi (24.0%) and Alabama adults (23.8%). Binge drinking is the percentage of adult males having five or more drinks, or adults females having four or more drinks on one occasion, one or more times in the past 30 days. Binge drinking is less common among adults in the NMMC-Iuka service area (9.5%) compared to Mississippi (12.1%) and Alabama (12.3%). Adults in the NMMC-Iuka service area are more likely to have been diagnosed with diabetes (15.1%) compared to adults in Mississippi (12.9%) and Alabama (13.8%). Adults in the NMMC-Iuka service area are less likely to be obese (31.8%) as all Mississippi adults (34.6%), but slightly more likely compared to all Alabama adults (33.0%). Total NMMC-Iuka Service Area Catchment Area Mississippi Alabama United States Health status, % 21.9% 23.4% 25.0% 16.9% Current smoking, % 22.8% 24.0% 23.8% 19.6% Binge drinking, % 10.8% 12.1% 12.3% 16.9% Diagnosed diabetes, % 13.8% 12.9% 13.8% 9.7% Obesity, % 34.1% 34.6% 33.0% 28.1% Sources: County Health Rankings & Roadmaps; CDC, Diabetes Data and Statistics; CDC SMART BRFSS 33

34 Access to Care According to the ACS estimates, NMMC-Iuka s service area residents are less likely to have health insurance coverage (82.4%) compared to all Mississippi and Alabama residents (83.2 and 86.5%, respectively). Private insurance coverage is less common among NMMC-Iuka s service area residents (53.0%) compared to all Mississippi and Alabama residents (57.0% and 65.4 %, respectively). Public insurance coverage is more common among NMMC-Iuka s service area residents (41.5%) than among all Mississippi and Alabama residents (36.9% and 33.9%, respectively). Residents in NMMC-Iuka s service area are more likely to be uninsured (17.6%) compared to all Mississippi and Alabama residents (16.8% and 13.5%). Children in NMMC-Iuka s service area are less likely to be uninsured (6.8%) compared to all children in Mississippi (7.3%), however the children in NMMC-Iuka s service area are more likely to have no health insurance when compared to all children in Alabama (4.6%). NMMC-Iuka Total United Service Area Catchment Area Mississippi Alabama States Health Insurance Coverage 82.4% 84.3% 83.2% 86.5% 85.8% Private Insurance 53.0% 58.5% 57.0% 65.4% 65.8% Public Coverage 41.5% 37.6% 36.9% 33.9% 31.1% No Health Insurance Coverage 17.6% 15.7% 16.8% 13.5% 14.2% No Health Insurance Coverage (Children) 6.8% 6.0% 7.3% 4.6% 7.1% Source: U.S. Census: ACS estimates 34

35 Community Leader Surveys Survey Methodology Six online surveys were completed from August 26 to September 21, Surveys required approximately 10 minutes to complete. Each survey documented the community leader s expertise and experience related to the community. Additionally, the following community-focused questions were used as the basis for the survey: Community leader s name Community leader s title Community leader s organization Overview information about the community leader s organization What are the top three strengths of the community? What are the top three health concerns of the community? What are the health assets and resources available in the community? What are the health assets or resources that the community lacks? What are the barriers to obtaining health services in the community? What is the single most important thing that could be done to improve the health in the community? What other information can be provided about the community that has not already been discussed? 35

36 Community Leader Survey Summary Topic Discussion Points/Highlights Health Strengths Several community leaders mentioned the hospital as the top health strength in the community. Other health strengths mentioned include community wellness programs, health clinics, and recreation opportunities. Health Concerns Commonly mentioned health concerns include obesity, drug abuse, smoking, heart disease, high rates of disability, and access to physicians and specialized care. Resources Available Community leaders mentioned the hospital, the wellness center, several health clinics, Head Start, assisted living centers, physical therapy offices, smoking cessation groups, the County Health Department, senior citizen centers, and transportation as health resources in the community. 36

37 Community Leader Survey Summary (continued) Resources Needed Several community leaders noted that organized exercise opportunities are greatly needed in the community. One individual noted that greater access to walking paths is needed as well. Medically Underserved Population Community leaders also noted that resources to address access issues such as increasing the number of physicians and specialists in the community are needed. Other resources that are needed include mental health resources, obesity education, substance abuse education, rural health clinics, and access to public transportation. Low income individuals Aging population Disabled individuals Children 37

38 Community Leader Survey Summary (continued) Barriers to Obtaining Health Services Ways to Improve the Overall Health in the Community Cost of services Transportation Knowledge of services available Insurance issues Several community leaders noted that education opportunities and programs focused on healthy lifestyles can potentially improve the overall health of the community. Access to free or low-cost clinics for services such as eye care, dental, medical, and nutrition was widely discussed as well. 38

39 Community Health Priorities The overarching goal in conducting this Community Health Needs Assessment is to identify significant health needs of the community, prioritize those health needs, and identify potential measures and resources available to address the health needs. For the purpose of identifying health needs for NMMC-Iuka, a health priority is defined as a medical condition or factor that is central to the state of health of the residents in the community. An exhaustive list of health needs was compiled based on the health profile and survey data. Concerns that did not fall within the definition of an identified health priority, such as social determinants of health, are discussed in conjunction with the health priorities where applicable. A modified version of Fowler and Dannenberg s Revised Decision Matrix was developed to capture priorities from the primary and secondary data. This matrix tool is used in health program planning intervention strategies, and uses a ranking system of high, medium and low to distinguish the strongest options based on effectiveness, efficiency and sustainability. As the CHNA is meant to identify the community s most significant health needs, only the health needs falling under the high and medium categories are highlighted. The three health priorities identified through the CHNA are: cancer, chronic health conditions, and social determinants of health. 39

40 Cancer Cancer is the second leading cause of death in NMMC-Iuka s service area. Lung and bronchus cancer mortality is more common in NMMC-Iuka s service area than in Mississippi and Alabama. Breast cancer mortality is more common in NMMC-Iuka s service area than in Mississippi and Alabama. Chronic Health Conditions Heart disease is the leading cause of death in NMMC-Iuka s service area. Chronic lower respiratory disease is the fourth leading cause of death in NMMC-Iuka s service area. Residents aged 65 and older in NMMC-Iuka s service area are more likely to die from a heart disease or a stroke compared to all adults aged 65 and older in Mississippi and Alabama. Adults in NMMC-Iuka s service area are more likely to report being diagnosed with diabetes compared to all adults in Mississippi and Alabama. Community leaders mentioned obesity and heart disease as top health concerns in the community. Education opportunities for obesity and healthy lifestyles were mentioned by community leaders as needed resources in the community. 40

41 Social Determinants of Health Median household income in NMMC-Iuka s service area is lower than in Mississippi and Alabama. Residents aged 25 years and older are less likely to be college educated compared to all Mississippi and Alabama residents aged 25 years and older. The high school graduation rate in NMMC-Iuka s service area is lower compared to Mississippi and Alabama. Cost, transportation, and insurance issues were mentioned as barriers to obtaining health services by community leaders. Low-income residents and the elderly were mentioned as medically underserved populations by community leaders. ` 41

42 Health Resources Cancer NMMC-Iuka conducts community outreach activities and health seminars that provide cancer education to residents in the community. The Cancer Center at Magnolia, located in Corinth, is approximately 20 miles from Iuka. This 17,000 square-foot comprehensive care facility offers radiation therapy, medical oncology and chemotherapy services, and supportive care services and resources for patients and their families. Valley Cancer Center, located approximately 30 miles from Iuka in Sheffield, Alabama, offers treatment numerous forms of cancer. Valley Cancer Center s primary form of treatment is radiation therapy. 42

43 Health Resources (continued) Chronic Health Conditions Located at 619 Battleground Drive, NMMC-Iuka offers a Wellness Center to the members of the community. This 6,500 square foot fitness facility is the most comprehensive health and wellness facility in the area. Memberships are available to all residents in the community for various fees. The Wellness Center has instructors on staff who are specially trained to provide advice and guidance for members looking to improve their fitness in order to lower their risk of heart disease and other chronic conditions. The counties that comprise the service area for NMMC-Iuka make up Public Health District 2. The county health departments located in this district offer blood pressure screening services and a Diabetes Prevention and Control Program. The Mississippi State Department of Health (MSDH) also offers online resources for exercise education and obesity prevention. Nutritional information is also available. The MSDH created an Obesity Action Plan in 2015 that outlines strategies for coordinating wellness programs and initiatives, promoting healthy foods and beverages, increasing physical activity among young children, and many more. 43

44 Health Resources (continued) Social Determinants of Health The county health departments in district 2 provide an array of services for community residents. Each health department offers the following services: family planning, WIC, child health, free and low cost immunizations, and breast and cervical cancer screening. The Family Health Care Clinic, located approximately 33 miles from Iuka in Muscle Shoals, Alabama, provides pediatric, family medicine, OB/GYN, and dental services on a sliding fee scale. The regular charges are discounted based on a patient s qualifications from 20% to 80%. The FHCC also offers nutrition counseling, diet planning, and WIC certification and counseling. 44

45 References INTELLIMED International. (2016). Esri United States Census Bureau. (2016). Poverty thresholds by size of family and number of children. Retrieved from United States Department of Labor, Bureau of Labor Statistics. (2016). Labor force data by county, 2014 annual average. Retrieved from U.S. Census Bureau, American Fact Finder. (n.d.) American community survey 3-year estimates. Retrieved from Institute for Health Metrics and Evaluation. (2016). US County Profiles. Retrieved from Alabama Department of Public Health. (2016). County Health Profiles. Retrieved from: Mississippi State Department of Health. (2016). County Health Profiles Retrieved from: Centers for Disease Control and Prevention. (2016). Mortality in the United States, Retrieved from Centers for Disease Control and Prevention. (n.d.). Interactive Atlas of Heart Disease and Stroke. Retrieved from National Cancer Institute. (2016). State Cancer Profiles. Retrieved from 45

46 References (continued) Mississippi State Department of Health. (2016). Vital Statistics Reports Retrieved from: Centers for Disease Control and Prevention. (2016). National Vital Statistics Reports. Retrieved from: County Health Rankings and Roadmaps. (2016). Health Rankings. Retrieved from Centers for Disease Control and Prevention. (2016). Diabetes Data and Statistics. Retrieved from: Centers for Disease Control and Prevention. (2016). SMART BRFSS. Retrieved from: 46

47 Appendix A: Carnahan Group Qualifications Carnahan Group is a strategic healthcare consulting firm focused on the convergence of regulations, transactions, and strategies. For over 15 years, we have been trusted by healthcare organizations and other entities throughout the nation as an industry leader in providing Fair Market Valuations, Community Needs Assessments, Community Health Needs Assessments, Medical Staff Demand Analyses, and other integrated strategies. We serve a variety of healthcare organizations, including but not limited to, hospitals and health systems, large and small medical practices, and public health agencies. Our highly educated and experienced staff provides only exceptional customer service, quality work, and unsurpassed insight into their specific needs. Carnahan Group strives to become each of our clients trusted partner by providing customized solutions, rapid turnaround time, and competitive pricing. Our staff members offer varied backgrounds and diverse capabilities, allowing us to understand that our clients need more than just a document; they need a sound plan to guide them through time-sensitive transactions in the face of the healthcare industry s most challenging scrutiny and in litigation. 47

48 Appendix B: Community Leader Organizations Organization Iuka Elementary School NMMC Iuka Registered Nurse Tishomingo County Development Foundation Area Represented Education Hospital Leader Medical Professional Public Service Organization 48

49 Company Overview Headquarter Address: Carnahan Group Inc West Laurel Street Suite 204 Tampa, FL Branch Offices: Nashville, TN Thank you for the opportunity to serve North Mississippi Medical Center! We are committed to being your innovative strategic partner. 49

50 50