Hickman County, TN Community Health Needs Assessment 2016

Transcription

1 County, TN Community Health Needs Assessment 2016 County Health Council County Health Department Saint Thomas Hospital Saint Thomas Health STH Logo

2 Why are we here? Review findings of most recent County health assessment Primary Data (interviews & survey) Secondary Data Included: Input from community & pubic health Special attention to underserved, low-income & minority populations ACA related requirement Collectively identify needs of County: Exercise Collaborations 2013: with HCHD and Health Council 2016: VUMC shared regions and processes Hospital s next step: Develop Implementation Strategy

3 Welcome Health is: A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity Source: World Health Organization

4 Social Determinants of Health Introduction and Methods

5 Findings from Secondary Data Review County, TN 2016 Community Health Assessment

6 Indicator Topics Demographics and Socioeconomic Status Social & Natural Environment Access to Health Care Health Status Morbidity/Mortality Birth Outcomes Preventive Care/Risk Factor Behaviors Infectious Diseases Mental & Emotional Health Other Community Assessments

7 Demographics: Demographic / Socioeconomic 2014 Population estimate: 24,384 Population, % change from TN USA -1.3% 3.2% 3.3% Persons under 18 years 21.8% 23.0% 23.3% Persons 65 years and over 15.5% 14.7% 14.1% Female persons, percent 47.4% 51.2% 50.8% Language other than English spoken at home 2.1% 6.6% 20.7% Persons below poverty level 17.4% 17.6% 15.4% Persons per square mile Source: US Census Bureau (2015). State and County QuickFacts: Co., TN. Retrieved on 6/30/15, from:

8 Unemployment Demographic / Socioeconomic Co. 5.7% Tennessee 5.7% United States 5.3% Source: TN Dept. of Labor & Workforce Dev, Div Emp Sec, R&S (2015) Distribution by county of unemployment rate (%) in Tennessee for May Retrieved on 7/29/15, from:

9 Population Below the Poverty Level ACS Demographic / Socioeconomic Co. 17.4% Tennessee 17.7% United States 15.4% Source: : Map of Population Below Poverty Level, Co. TN. Community Commons (2015). Retrieved: July 15, 2015, from Data Source: US Census Bureau, American Community Survey Source geography: Tract

10 Children in Poverty Trends, County, State and National Demographic / Socioeconomic Source: : University of Wisconsin Population Health Institute. County Health Rankings Data Source: US Census Bureau, Small Area Income and Poverty Estimates, American Community Survey. Retrieved on August 16, 2015 from:

11 Population with No High School Diploma (25yrs and older) Demographic / Socioeconomic Status Co. 24.5% Tennessee 15.6% United States 14.0% Source: Map of Population with No High School Diploma, County, TN. Community Commons (2015). Retrieved: July 15, 2015, from Data Source: US Census Bureau, American Community Survey Source geography: Tract

12 Graduation Rates 2014 Demographic / Socioeconomic 81% (2013) USA 93% (2014) 87% (2014) TN County ranks in the middle of TN Counties Source: County and State : The Annie E. Casey Foundation KIDS COUNT Data Books, Retrieved from : US rate source: National Center for Education Statistics -

13 Summary Demographic / Socioeconomic Little racial and ethnic diversity 75% with high school education 17.4% live in poverty; 33% of children live in poverty (66% below 200%) Poverty and Education vary by geography

14 Social & Natural Environment Housing Neighborhood Safety Transportation Access to Healthy Food Air

15 Affordable Housing 2013 Social & Natural Environment Tennessee US Homeownership rate 77.9% 67.8% 64.9% Median household income $39,581 $44,298 $53,046 Median value of owneroccupied housing $100,400 $139,200 $176,700 House value / Income 2.5 / / / 1 Cost Burdened Households 29% 31.0% 35.5% Cost Burdened Renters 43% 45.9% 48.3% Poverty 17.4% 17.6% 15.4% Source: US Census Bureau (2015). State and County QuickFacts: Co., TN. Retrieved on 6/30/15, from:

16 Violent Crime Rate Per 100,000 population Social & Natural Environment 199 USA 621 TN 210 Source: 2015 County Health Rankings

17 Domestic Violence Number of Victims Social & Natural Environment 2014 Rate per 1, Tennessee 11.6 Source: Tennessee Bureau of Investigation. Tennessee Crime On-Line. Retrieved on 8/12/15, From:

18 Transportation Households with No Vehicle Social & Natural Environment Co. 3.5% Tennessee 6.3% United States 9.1% Percent without Vehicle >8% 6.1-8% 4.1-6% <4.1% Source: : Map of Households with No Vehicle, Co., TN. Community Commons (2015). Retrieved: July 14, 2015, from Data Source: US Census Bureau, American Community Survey Source geography: Tract

19 Population with Limited Food Access Social & Natural Environment Co. 9.2% Tennessee 27.4% United States 23.6% >50% % % <5.1% No Low Food Access Source: Map of Population with Limited Food Access, Nashville TN. Community Commons (2015). Retrieved: July 14, 2015, from Data Source: US Department of Agriculture, Economic Research Service, USDA - Food Access Research Atlas Source geography: Tract

20 2-1-1 Calls, Top 10 Categories FY2014 Social & Natural Environment Source: Family & Children s Services. Data Source: United Way of Metropolitan Nashville., 2-1-1

21 Air Pollution and Lung Disease Social & Natural Environment Particulate Air Pollution (Daily PM2.5) TN USA Source: 2015 County Health Rankings

22 Summary Social & Natural Environment Access to basic needs is limited for some Many are impacted by domestic violence Particulate air pollution presents a regional challenge

23 Access to Health Care Provider availability Health staffing shortages by HPSAs Insurance coverage

24 Provider Rates Access to Health Care County Heath Rankings Best 10% of US Counties Primary Care 4834:1 1045:1 Dental 8089:1 1377:1 Mental Health 2427:1 386:1 Source: 2015 County Health Rankings

25 Access to Providers Behavioral Risk Factor Surveillance Survey Access to Health Care Source: Tennessee Department of Health (2013/2012) Behavioral Risk Factor Surveillance System: Tennessee State and Regional Data, retrieved from: on July 17, 2015 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online] [accessed Aug 05, 2015].

26 Preventable Hospital Stays # of Hospital Stays for ambulatory-care sensitive conditions / 1,000 Medicare Enrollees Access to Health Care 65 USA 73 TN 69 Source: University of Wisconsin Population Health Institute. County Health Rankings, Preventable Hospital Stays, Data CDC, National Center for Health Statistics and Division of Behavioral Surveillance Dartmouth Institute for Health Policy & Clinical Practice. Retrieved on 7/17/15, From:

27 Chronic Disease Hospitalization Rate (age-adjusted per 100,000) Access to Health Care Source: TN DOH, Chronic Disease Health Profile, December 2011, Retrieved 8/15/15, from:

28 Health Insurance Tennessee Coverage of Total Population 2013 Access to Health Care Source: : Kaiser Family Foundation State Health Facts. Health Insurance Coverage of the Total Population. Retrieved: August 28, 2015, from Data Source: US Census Bureau, American Community Survey Source geography: Tract

29 Health Insurance Uninsured Population Access to Health Care Co. 16.9% Tennessee 14.1% United States 14.9% Percent Uninsured 20% % % <10.1% No Data Source: : Map of Insurance-Uninsured Population, Co., TN. Community Commons (2015). Retrieved: July 14, 2015, from Data Source: US Census Bureau, American Community Survey Source geography: Tract

30 Summary Access to Health Care Fewer providers relative to nation and state 21% did not see MD due to cost (more than 1 out of every 5) 47% did not visit a dental professional in the past year HPSA within county Remain less than 100% coverage, 100% access

31 Health Status Morbidity/Mortality Causes of Death Premature Death (Years of Potential Life Lost) Birth Outcomes Preventive Care/Risk Factor Behaviors Infectious Disease Mental & Emotional Health

32 Percentage of Deaths County ( ) Morbidity / Mortality Cancer 24 Heart Disease 16 Accidents 7 Lung Disease 6 Stroke 5 Diabetes 3 Influenza / pneumonia 3 Alzheimer's 2 Suicide 2 Liver Disease 1 Other [31] Source: CDC Wonder

33 Percentage of YPLL <age 75 years Leading Causes of Years of Potential Life Lost (2009) vs. Tennessee (2013) vs. United States (2013) Morbidity / Mortality County TN USA Cancer Heart Disease Unintentional Injury Chronic Lung Disease Source: State and National data - National Vital Statistics System-Mortality (NVSS-M) (2013), County Data - Tennessee Department of Health, Office of Policy, Planning and Assessment, Division of Health Statistics (2009)

34 Summary Morbidity / Mortality Cancer and heart disease are leading causes of death Causes of death vary by race and gender Combined accidents, assaults and suicide represent 7% of deaths and 16% of years of potential life lost

35 Birth Outcomes Infant Mortality Low Birth Weight Prenatal Care Teen Pregnancy

36 US Rank Infant Mortality #1-60, worldwide Birth Outcomes VIRGIN ISLANDS GIBRALTAR UNITED STATES CROATIA GUAM SLOVAKIA GREECE NEW ZEALAND TAIWAN AUSTRALIA LUXEMBOURG AUSTRIA ISRAEL IRELAND NETHERLANDS GUERNSEY FINLAND ITALY HONG KONG SINGAPORE JAPAN US Ranks 55 th Source: World Factbook, 2014 est -

37 Infant Mortality Birth Outcomes Botswana (9.4) Sri Lanka (9.0) Kuwait (7.5) Tennessee Ireland (3.7) Japan (2.1) Low Birth Weights (Avg ) 8.9% Tennessee 9.2% 1 0 Infant Death Rate / 1000 births Source: TN Dept of Health, Division of Policy, Planning and Assessment, Office of Health Stats, KIDScount

38 Teen Pregnancy Rates; Ages 15-17, Trend: Birth Outcomes Teen Pregnancies are In Decline Across the County and State Tennessee (-52%) (-37%) Source: KIDScount, Tennessee Department of Health, Office of Policy Planning and Assessment, Division of Health Statistics.

39 Summary Birth Outcomes Infant mortality and low birth weight rates are high Mothers receiving early prenatal care is steady, but remains below HP2020 goal Teen pregnancy and birth rates continue to decline

40 Preventive Care / Risk Factor Behaviors Well-being Tobacco & Substance Use Obesity & Nutrition Physical Activity Youth Risk Behavior Survey Vaccinations

41 Adults Reporting Poor or Fair Health Preventive Risk Factors 17% USA 23% TN 24% Source: 2015 County Health Rankings, BFRSS,

42 Adult Smokers 2013 Preventive Risk Factors 21% USA 23% TN Tobacco use is the most preventable cause of premature mortality and morbidity - TN Dept. of Health Healthy People 2020 Target 38% 12% Source: 2015 County Health Rankings, : Tennessee Department of Health, Division of Policy, Planning and Assessment, Behavioral Risk Factor Surveillance System., HealthyPeople2020.gov

43 Percent Substance Abuse Abuse within the past year, Mental Health Region 5 ( ) Preventive Risk Factors Adults: Adults: Alcohol Pain Relievers Other Illicit Drugs Cocaine Source: TN Department of Mental Health & Substance Abuse Services, Tennessee County and Regional Behavioral Health Prevalence Estimates: to , National Survey on Drug Use and Health (NSDUH) and data from 2010 Census.

44 Adults Obese and Overweight 2013 Preventive Risk Factors 31% Obese USA 34% Obese TN 64% Overweight and Obese 68% Overweight and Obese South Central Region 35% Obese 68% Overweight and Obese Source Mid-Cumberland and State Source: Tennessee Department of Health, 2013 BRFSS. US Source: Kaiser Family Foundation

45 Adults Participating in Physical Activity (Past Month) 2013 Preventive Risk Factors 75% USA 63% TN South Central Region 62% Source: Tennessee Department of Health, 2013, Behavioral Risk Factor Surveillance Survey

46 Influenza & Pneumococcal Vaccination Adults and Seniors 2013 Preventive Risk Factors Source: BRFSS: TN DoH (2013). Behavioral Risk Factor Surveillance System: Tennessee State and Regional Data. Retrieved 8/14/15 from:

47 24-Month Vaccinations 2014 Preventive Risk Factors South-Central Region 68% 73% 24 Month Olds, Fully Vaccinated (4:3:1:3*:3:1:4 Series) The South-Central Region Exceeds Healthy People 2020 Targets in 5 of 7 Leading Recommended Vaccinations at 24 months of age HP 2020 Target (90%) DTaP Poliomyelitis MMR Hepatitis B Hib Varicella Pneumococcus 88.1 Source: TN DoH (2014). Behavioral Rtor Surveillance System: Tennessee State and Regional Data.. *Data is for Mid-Cumberland Region

48 Youth Risk Behavioral Survey 2013 Tennessee High School Youths (US) Preventive Risk Factors Tobacco Use 15.4% smoked cigarettes within 30 days (US: 15.7%) 12% smoked a whole cigarette before age 13 (US: 9.3%) Nutrition & Obesity 16.9% are obese (US: 13.7%) 15.4% are overweight (US: 16.6%) Physical Activity 19.6% were not physically active at least 60 min on at least 1 day during the past week (US: 15.2%)

49 Summary Preventative Risk Factors Smoking rate remains high Many are overweight and obese High School Youths 15.4% smoked cigarettes within 30 days 16.9% are obese 25% seniors (age 65 years and older) are not vaccinated for influenza and pneumococcal

50 Infectious Disease STD incidence rates chlamydia gonorrhea syphilis HIV incidence rate

51 Chlamydia Trends Infectious Disease State 2012 White Black 1,629.9 Source: Community Commons (2015). Data Source: US Department of Health Human Services, Health Indicators Warehouse. Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Source geography: County. Retrieved on 7/14/15, From: Source: Centers for Disease Control and Prevention. NCHHSTP Atlas. Chlamydia by County. Retrieved on 8/12/15, From:

52 Summary Infectious Disease Chlamydia rates are rising Gonorrhea incident rate is low HIV prevalence rates low

53 Mental & Emotional Health ACE Well-being Mental Illness Serious mental illness

54 Adverse Childhood Experiences (ACEs) Mental and Emotional Health # ACEs % (TN) 0 48% 1 20% 2 11% 3 7% 4(or more) 14% Source: Adverse Childhood Experiences in Tennessee, Tennessee Department of Health

55 Poor Mental Health Days last 30 days 2013 Mental and Emotional Health 3.5 USA 3.4 TN 5.0 Source: Source: 2015 County Health Rankings

56 Mental Illness in the past Year (18+) 2013 Mental and Emotional Health 18.6% USA 20.6% TN 19.9% Source: 2015 County Health Rankings.

57 Serious Mental Illness (SMI) in the past Year (18+), 2013 Mental and Emotional Health Serious Mental Illness (SMI) Schizophrenia ~730 in Co. Experience Serious Mental Illness Bipolar Disorder Schizoaffective Disorder Major Depressive Disorder Source: Substance Abuse and Mental Health Services Administration. Behavioral Health Barometer: Tennessee, HHS Publication No. SMA TN. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.

58 Mental Illness Mental and Emotional Health Evidence has shown that mental disorders are strongly related to the occurrence of many chronic diseases, including diabetes, cancer, cardiovascular disease, asthma, and obesity and many risk behaviors for chronic disease; such as, physical inactivity, smoking, excessive drinking, and insufficient sleep. - Centers for Disease Control

59 Other Community Assessments TN Dept. of Health Drive Your County to the Top Ten County Health Status Indicators

60 Summary Community Needs Assessments 17% live in poverty 66% of children below 200% poverty level Health outcomes could be improved Place matters Many resources in our community

61 Findings From Interviews with Community Leaders and Intercept Survey Results

62 Methods: Interviews Interviewed community representatives and leaders with: Focus on the broad interests of the community Serving low-income, minority or underserved populations Sectors represented include: public health, government/public sector, health care, education, faith community, private foundations, academia Interviews conducted by STH (n=27) Closed and open-ended questions

63 Methods: Interviews Semi-structured interview protocol focused on health concerns, determinants of health, health systems issues, health assets Quantitative data (6 questions) : Entered in REDCap and analyzed using excel Other responses coded or analyzed separately Qualitative data (3 questions): Thematic analysis conducted using team of 3 reviewers for each question

64 Methods: Intercept Survey Intercept survey held in County, May 7, 2015 (87) Save-A-Lot Dollar General (2) Saint Thomas Medical Clinic County Health Department (13) Completed survey forms Survey form was used, discussion topics Community Strengths Top Community Issues Greatest Health and/or Health care Concerns Barriers in Addressing Issues ER use for non-emergencies Magic Wand Priority Actions

65 Methods: Intercept Survey Qualitative data: conducted, reviewed and summarized by consultant Primary Focus Demographics of 100 Participants 77 Female/ 23 Male Education 56 HS/GED; 16 some HS; 28 with training beyond HS Insurance 34 Private Insur.; 31 Medicare; 16 No insurance; 9 TennCare; 6 Medicare/private; 4 Not sure

66 What Community Health Assets work well to support health and well-being? (n=27) What Community Health Assets/Resources work well to support health and wellbeing? (n=100) Leaders/Representatives Community Health Assets () Hospital & Healthcare system Saint Thomas Hospital Primary care and urgent care providers Community cohesiveness People s willingness to help each other Working together Local health department and health council Outdoor recreation opportunities Walking trails, outdoor living Intercept Survey Community Health Assets () Mentions 1. Small, quiet rural town Friendly people People help each other Healthcare 7 4. School system 7 6. Low crime, public servants 6

67 What are the Greatest Health and/or Health Care Concerns in your Community? (n=27) What are the Greatest Health and/or Health Care Concerns in your Community? (n=100) Leaders/Representatives Leading Health Concerns () 1. Mental/Emotional Obesity Alcohol/Drug abuse Diabetes Poverty Tobacco use/smoking Health Education Domestic Violence Access to care 22 % Intercept Survey Leading Health Concerns () Mentions 1. More Physicians Cancer Illegal drugs Obesity 9 5. Diabetes 8 6. No Health Insurance 7 7. Mental Health 6 8. Allergies 5 8. Dental 5 8. Physically clean up the area 5

68 What Socioeconomic and Demographic Factors have the Biggest Impact on Community Health? (n=27) What are the Top Issues of County? (n=100) Leaders/Representatives Socioeconomic / Demographic () 1. Poverty/Working poor Education attainment Health Insurance Coverage Unemployment 26 % Intercept Survey Top Issues () Mentions 1. More Jobs Illegal drugs More growth Activities for young people Better roads 7 6. Physically clean up the area 7. More physicians 5 6

69 What Environmental Factors Have the Biggest Impact on Community Health? (n=27) Respondents Could Select Up to Three Response Options Leaders/Representatives Conditions/Diseases () 1. Healthy Food Access Transportation Second-Hand Smoke Rural Setting Affordable Housing/Homelessness Limited sidewalks/safe rec. space 30 %

70 What Conditions and Diseases are Causing Illness and Death in your Community? (n=27) Leaders/Representatives Conditions/Diseases () 1. Alcohol & Drug abuse/addiction Diabetes Cancer Obesity Cardiovascular/Hypertension Emotional/Mental 22 % Multiple Answers Were Permitted

71 What Are the Greatest Barriers within the Health System? (n=27) Leaders/Representatives Health System () 1. Access to care: Mental Health Access to care: Oral/Dental ER use for non-emergencies Affordability/Cost of Care Transportation Access to care: Overall 22 % Multiple Answers Were Permitted

72 What Behaviors Have the most Negative Impact on Health in your Community? (n=27) Leaders/Representatives Behaviors () 1. Alcohol & Drug abuse/addiction Tobacco Use/Smoking Nutrition/Healthy Eating Physical Activity Preventative care Domestic Violence 22 % Multiple Answers Were Permitted

73 What are the Barriers to addressing these Issues and Concerns? Intercept Survey Barriers to addressing top concerns () Mentions Local politics / government 30 Money / resources 29 Old way of thinking 16 More jobs 6 Illegal drugs 6 Need more physicians 5

74 What Reasons/Barriers exist that cause the Use of ER for non-emergencies? (n=27) What Reasons/Barriers exist that cause the Use of ER for non-emergencies? (n=100) Leaders/Representatives ER Use for Non-Emergencies () Convenience, hours of operation and transportation It is hard to find a doctor at the hours I can get there You don t have to wait to be seen Health Navigation/Literacy Lack of understanding of what is an emergency Not knowing where or when to go for care No Health Insurance cost of care You can t be turned away, for failure to pay Lack of consistent source of medical care Waiting too late for care Lack of preventive care Intercept Survey ER Use for Non-Emergencies () Mentions 1. Lack of Insurance Convenience Doctor s Office Closed Drug seeking Can t get in to see the doctor Perceived severity 9 7. No Physician Relationship 6

75 What Priority Actions should County focus on? (n=27) What would you like to see County Focus on in the next three years? (n=100) Leaders/Representatives Community Health Assets () Mental and emotional health Lifestyle support & health education Nutrition Physical activity Healthy food access Substance abuse Dental health Intercept Survey Community Health Assets () Mentions 1. More jobs More growth Activities for young people Illegal drugs 9 5. Promote healthy options 7 6. Physically clean up area 6 7. Better roads 5

76 Limitations: Primary and Secondary Data Interviews: Response categories on interview guide for some questions not mutually exclusive Variability in number of responses that respondents chose Intercept Survey: Representativeness of listening session participants Secondary data: Source variability Benchmarking not always available

77 Acknowledgements Interviewees and Survey Participants Primary Focus Survey Sites Save-A-Lot; Dollar General (2); Health Department; ST Medical Clinic County Health Department County Health Council Vanderbilt University Medical Center Student team members: Christopher Artis, Meharry Medical College Althea Robinson, Vanderbilt University

78 Questions/Discussion

79 Exercise Identification of Health Needs Identification of Current Activities Using worksheet provided Please write down 3 Health Needs 1 per section Note current activities addressing the Need

80 County Identified Community Health Needs Wellness and Disease Prevention (21) Tobacco Use/Smoking (6); Physical Activity (6); Obesity (4); Other (5) Mental and Emotional Health/Substance Abuse (18) Access to Care/Care Coordination (8) Social Determinants (7)

81 Thank you to all!!