TARRANT COUNTY HOSPITAL DISTRICT/JPS HEALTH NETWORK 2017 CHNA EXECUTIVE SUMMARY May 4, 2017
BACKGROUND JPS Health Netwrk is the cunty s public hspital system that prvides medical services t Tarrant Cunty residents, including underserved residents. The netwrk includes Jhn Peter Smith Hspital, the cunty s nly Level I Trauma Center and nly Psychiatric Emergency Center. JPS als perates ver 40 utpatient clinics and schl-based health centers acrss the cunty, prviding 1.7 millin patient encunters annually. In 2017, JPS Health Netwrk partnered with Health Resurces in Actin (HRiA), a nn-prfit public health rganizatin, t cnduct a cmmunity health needs assessment (CHNA) t gain a greater understanding f the health issues facing Tarrant Cunty residents, hw thse needs are currently being addressed, and where there are pprtunities t address these needs in the future. Previus CHNA In 2013, JPS Health Netwrk cnducted a CHNA t identify and priritize health issues. The 2013 CHNA infrmed the hspital s prgram planning and prvided a fundatin fr the develpment f an implementatin strategy. As a result f the key findings frm the 2013 CHNA, JPS Health Netwrk identified the fllwing three pririty areas, each f which aligned with identified cmmunity health needs: behaviral health and palliative care, cmmunity fcused and care crdinatin, and specialized services. Purpse and Gegraphic Scpe The 2017 CHNA builds upn the 2013 CHNA t further advance JPS Health Netwrk s cmmunity effrts and pririty tpic areas. This reprt describes the prcess and findings frm the 2017 CHNA, which aimed t: Examine the current health status f Tarrant Cunty and its sub-ppulatins, and cmpare these rates t state indicatrs Explre current health pririties as well as new and emerging health cncerns amng residents within the scial cntext f their cmmunities Identify cmmunity strengths, resurces, and gaps in services t guide planning and directin Fr this CHNA, the cmmunity served by JPS was defined as Tarrant Cunty, with a fcus n ppulatins residing in Arlingtn, Frt Wrth, and Haltm City; these three incrprated areas have the largest ppulatins in Tarrant Cunty and the highest percent f residents living belw pverty. PROCESS AND METHODS The CHNA emplyed a participatry apprach s that the prcess was infrmed by diverse perspectives and used a scial determinants f health framewrk, recgnizing that multiple factrs affect a cmmunity s health. As part f this effrt, JPS sught input frm a 30-member Advisry Cmmittee at several stages f the assessment. T develp a scial, ecnmic, and health prtrait f the cmmunity served by JPS Health Netwrk, existing quantitative data were drawn frm natinal, state, cunty, and lcal surces (e.g., U.S. Census, Texas Department f State Health Services, JPS Health Netwrk, etc.). Quantitative data was supplemented by three fcus grups and eleven interviews cnducted with 40 individuals frm Tarrant Cunty in February 2017 t understand participants perceptins f their cmmunities, health needs and assets, and suggestins fr future prgramming and services t address these issues. Additinally, a review f prgrams was dne t assess the existing health services landscape in Tarrant Cunty. Tarrant Cunty Hspital District/JPS Health Netwrk Page 1
In additin t the qualitative data cllected and analyzed by HRiA fr this CHNA, the reprt integrates relevant qualitative findings frm the Tarrant Cunty Lng-Range Planning Prcess. FINDINGS The fllwing prvides a brief verview f key findings that emerged frm this assessment: Demgraphics: Wh Lives in Tarrant Cunty? The health f a cmmunity is assciated with numerus factrs including the demgraphic distributin f age, race/ethnicity, educatinal attainment, incme, and emplyment status, amng thers. Wh lives in a cmmunity is significantly related t the rates f health behavirs and utcmes f the area. Ppulatin: Accrding t the U.S. Census, Tarrant Cunty had a ppulatin f nearly 2 millin between 2011 and 2015; by 2030, the cunty s ppulatin is prjected t increase by nearly 40%. Fcus grup and interview participants als shared persnal bservatins f ppulatin grwth. Age Distributin: Residents 45 years f age and lder cmprised abut ne-third f the cuntywide ppulatin. Cmparing 2006-2010 and 2011-2015 American Cmmunity Survey data indicates that the aging adult ppulatin (65 years and lder) has increased by 13.8%. Participants specifically mentined the regin has a grwing and vibrant ppulatin f aging adults; cncerns abut meeting the needs f this rapidly grwing ppulatin als emerged. I am nt sure ur system is ready fr the need [as the bmer ppulatin ages]. The sheer numbers are verwhelming the resurces aren t there. Interview participant Racial and Ethnic Diversity: Interview and fcus grup participants als stated that Tarrant Cunty has a diverse ppulatin, including Asians, African Americans, and Hispanics. Quantitative data shws apprximately half f Tarrant Cunty residents identified as White and slightly ver a quarter identified as Hispanic. Numerus participants nted the regin has a grwing number f refugees and large number f undcumented residents. Nativity data shws Tarrant Cunty had a similar prprtin f freign brn residents as the state (16.9% and 17.8%, respectively), while nearly a quarter f Haltm City residents were freign brn (25.4%). Prviders shared the diversity f immigrant and refugee grups in the cmmunity creates challenges in reaching everyne effectively. Educatinal Attainment: Educatinal attainment in Tarrant Cunty was higher than that f Texas; a majrity (61.4%) f cunty residents had at least sme cllege r an assciate s degree. A few interview participants nted mre needs t be dne t enhance pprtunities fr the regin s students. These participants cited lw reading levels, and heavy administrative staffing as barriers. Incme, Pverty, and Emplyment: Tarrant Cunty s median husehld incme was $58,711, which was abve that f Texas. Cunty residents were als less likely t live 100% belw the federal pverty level (12.5%) cmpared t residents statewide (14.5%), thugh nearly ne in five Frt Wrth residents were living belw the pverty level. Sme participants raised cncerns abut rising rates f pverty as evidenced by a high number f schl-aged children wh receive free r reduced lunch and a large hmeless ppulatin. While several participants pinted t ecnmic grwth in the regin, sme expressed cncern abut the distributin f ecnmic pprtunity. Tarrant Cunty Hspital District/JPS Health Netwrk Page 2
Scial and Physical Envirnment: What is it like t live in Tarrant Cunty? In additin t wh lives in a cmmunity, a cmmunity s health is assciated with what resurces and services are available (e.g., safe green space, access t healthy fds). The sectin belw prvides an verview f Tarrant Cunty s scial and physical envirnment t prvide greater cntext when discussing the cmmunity s health. Transprtatin: Cncerns abut transprtatin were discussed in nearly every fcus grup and interview. Transprtatin was als identified as a cmmunity cncern in interviews, fcus grups, and cmmunity listening sessins cnducted fr the Tarrant Cunty Lng Range Planning Prcess. The majrity f Tarrant Cunty residents used a car alne t cmmute t wrk (82.9%); the same is true fr residents f Arlingtn, Frt Wrth, and Haltm City. Less than 1% f cunty residents used public transprtatin. Husing: Lack f affrdable husing emerged as a prminent theme in interviews and fcus grups. Accrding t participants, husing csts cmprise a large part f spending fr lwer incme husehlds, leaving few resurces fr ther needs, such as health care, medicines, r nutritius fd. Quantitative data shw that apprximately ne in five hmewners in Tarrant Cunty spent 35% r mre f their incme n their mrtgage (19.4%); in cntrast, nearly twice as many renters spent 35% r mre f their incme n their rent (39.6%). Access t Healthy Fd: Fcus grup and interview participants expressed cncern abut limited healthy fd ptins in lwer incme cmmunities f Tarrant Cunty, reprting a lack f grcery stres and prevalence f cnvenience stres and fast fd in these cmmunities. Quantitative data supprt these bservatins; frm 2012 t 2014 the rate f cnvenience stres and fast fd restaurants increased and were higher than the statewide rates. Additinally, in 2015, mre than ne in fur lw-incme residents f Tarrant Cunty reprted lw fd access (25.7%). Crime and Safety: Few participants spke abut crime in the cmmunity. Tarrant Cunty s vilent crime rate (391.9 vilent crimes per 100,000 ppulatin) is belw that f Texas (410.5 vilent crimes per 100,000 ppulatin). Hwever, Frt Wrth and Arlingtn experienced vilent and prperty crime rates abve thse f the cunty and state. While a cuple shared that the crime rate seems t be lw and the cmmunity feels safe, a few Peple are spending s much n husing the primary driving surce f incme spending. Interview Participant The scial agencies [in Tarrant and Frt Wrth] wrk well tgether and gvernment fficials als wrk well. Interview Participant participants shared that sexual and interpersnal vilence, including child abuse and neglect was reprted t be high in the regin. The sexual assault incidence rate in Tarrant Cunty was abve that f Texas and increased frm 77 incidents per 100,000 ppulatin in 2013 t 83 incidents per 100,000 ppulatin in 2015. Cmmunity Strengths and Resurces When asked abut cmmunity strengths, participants identified several assets including health care resurces, generus residents, cllabrative rganizatins, supprtive lcal fficials, and a resilient ppulatin. Envirnmental Scan f External Prgrams: A review f existing prgrams and services reveals numerus rganizatins already wrking n key health issues in Tarrant Cunty. The tpic areas f Tarrant Cunty Hspital District/JPS Health Netwrk Page 3
aging, health care resurces, and hmelessness are well represented in the service landscape f Tarrant Cunty. Areas where there appears t be limited prgramming include besity, substance abuse, and cmmunicable disease. Health Cnditins This sectin f the reprt prvides an verview f leading health cnditins in Tarrant Cunty examining incidence and mrtality data as well as discussing the pressing cncerns that cmmunity stakehlders identified during in-depth cnversatins. Mrtality: Frm 2013 thrugh 2015, the tw leading causes f death in Tarrant Cunty were heart disease and cancer (all-sites). At a rate f 46.2 deaths per 100,000 ppulatin, cerebrvascular disease became the third leading cause f death in 2015. In 2014, Alzheimer s became the fifth leading cause f death in Tarrant Cunty. Accrding t 2017 Cunty Health Rankings, Tarrant Cunty ranks 33 rd in length f life amng 243 cunties statewide. Chrnic Diseases and Related Risk Factrs: Similar t the 2013 CHNA results, chrnic diseases and their risk factrs specifically besity, diabetes, cardivascular disease, and cancer were mentined in the majrity f fcus grups and interviews. Obesity: Obesity was identified by several participants as a cncern fr the regin, particularly childhd besity. Quantitative data shws that in 2015, 61.4% f Tarrant Cunty Adults were reprted t be verweight r bese and nearly ne in five (18.9%) Frt Wrth Independent Schl District high schl students were reprted t be verweight; Black and Hispanic students were mre likely t be verweight than White students. Diabetes: Diabetes in the regin was als mentined as a particular cncern amng participants because f its high prevalence, its impact n cmrbidities, and the csts assciated with the disease. In 2015, 9.6% f Tarrant Cunty adults reprted t be diagnsed with diabetes cmpared t 11.4% statewide. Healthy Eating and Physical Activity: Fcus grup and interview participants reprted that exercise and healthy eating were ways t prevent chrnic diseases such as besity and cancer. Hwever, residents described cmpeting pririties, such as wrk, child care, and cultural nrms as barriers t maintain a healthy lifestyle. In 2013, 13.5% f Tarrant Cunty adults reprted cnsuming fruits and vegetables five r mre times a day cmpared t 19.2% in 2015, surpassing the statewide prprtin that year. Between 2013 and 2015, the prprtin f Tarrant Cunty adults reprted t have met aerbic recmmendatins als increased, frm 36.0% t 46.7%, again surpassing the statewide average. Tarrant Cunty Hspital District/JPS Health Netwrk Page 4
Heart Disease: Heart disease is the leading cause f death in the U.S. The heart disease mrtality rate amng the Tarrant Cunty ppulatin was 157.6 deaths per 100,000 ppulatin in 2015, belw the statewide and natinwide rate. Hwever, Black residents in Tarrant Cunty are disprprtinately affected by heart disease (198.9 deaths per 100,000 ppulatin). Hypertensin: In 2015, 27.2% f Tarrant Cunty adults were reprted t have had high bld pressure. When this data is stratified by 2013 2014 2015 race/ethnicity, disparities emerge. In 2015 the prprtin f Black adults reprted t have had high bld pressure (34.4%) was greater than the 2013 cuntywide average (32.4%). Behaviral Health: Cnsistent with 2013 CHNA findings, assessment participants discussed mental health, especially depressin, stress, and substance abuse, as a significant cncern facing the cmmunity. Behaviral health cncerns fr aging adults were identified as a critical and grwing health need in Tarrant Cunty; participants mentined rising rates f dementia and Alzheimer s as the cunty s ppulatin ages. Mental Health: Quantitative data shw that nearly ne in five Tarrant Cunty adults reprted a depressive disrder diagnsis (18%), which was slightly higher than adults statewide. Accrding t Frt Wrth Independent Schl District data, mre than a quarter f high schl students reprted persistent sadness (29%) in 2015. Heart Disease Mrtality Rate per 100,000 Ppulatin, by U.S., Texas, and Tarrant Cunty, 2013-2015 170.7 U.S. Texas Tarrant Cunty 169.8 168.5 DATA SOURCE: Centers fr Disease Cntrl and Preventin, Natinal Center fr Health Statistics, Underlying Cause f Death 1999-2015 n CDC As mentined previusly, in 2014, Alzheimer s disease became the fifth leading cause f mrtality in Tarrant Cunty; the cunty and state Alzheimer s mrtality rate steadily increased between 2013 and 2015, with a slightly higher mrtality rate in Tarrant Cunty in 2015 (41.2 deaths per 100,000 ppulatin). There was als a gradual upward trend in the suicide mrtality rate in Tarrant Cunty, frm 11.1 suicide deaths per 100,000 ppulatin in 2013 t 11.8 suicide deaths per 100,000 ppulatin in 2015; hwever, the cuntywide suicide mrtality rate remained belw that f the state (12.1 suicide deaths per 100,000 ppulatin). Amng Frt Wrth ISD high schl yuth, Black students reprted the highest prevalence f attempted suicide in 2015 (11.2%). Substance Abuse: Stakehlders raised substance abuse as being an imprtant health issue in the cmmunity, especially in the cntext f mental health. Participants shared cncerns abut depressin, suicide, and increased use f substances amng elders in the cmmunity. Specifically, participants stated Tarrant Cunty experiences high rates f alchl, piids, 171.6 162.3 157.6 We still aren t where we shuld be in recgnizing the impact f mental illness in Tarrant. Fcus grup participant Tarrant Cunty Hspital District/JPS Health Netwrk Page 5
marijuana, and prescriptin drug use. In rural areas, use f methamphetamines was reprted t be prevalent. Accrding t the Texas Behaviral Risk Factr Surveillance Survey and Yuth Behaviral Risk Factr Surveillance Survey, there has been an verall upward trend in alchl cnsumptin at the cunty level frm 2013 t 2015 (44.9% t 59.3%, respectively). Additinally, Texas has seen a gradual decrease in self-reprted binge drinking since 2013, while Tarrant Cunty has seen an increase; in 2015, apprximately 20% f Tarrant Cunty residents reprted cnsuming five r mre drinks n any ne ccasin in the past mnth up frm 16% in 2013. Less than 2% f Frt Wrth ISD high schl students reprted t have ever used herin in 2015. Thugh quantitative data shw that prescriptin drug use is mre cmmn in Tarrant Cunty, with apprximately 14% f high schl students reprting t have ever taken prescriptin drugs withut a dctr s prescriptin. Cancer: In additin t identifying brad health issues facing residents, the 2017 CHNA examined health behavirs and utcmes acrss the cancer cntinuum f care, including preventin, screening, treatment/health care utilizatin, and survivrship. While cancer did nt emerge as a cmmunity cncern unprmpted, when participants were asked abut cancer, several reprted that they viewed cancer as a cncern Percent Adults Reprted Binge Drinking in Past Mnth, by Texas and Tarrant Cunty, 2013-2015 16.7% 16.3% 16.0% Texas 11.9% Tarrant Cunty 19.7% 2013 2014 2015 DATA SOURCE: Texas Behaviral Risk Factr Surveillance Survey, 2013-2015 It s abstract until yu have it [cancer]. Until yu have smene in yur life wh has it. Then yu re entering the freeway in a fast lane, because it s cming fast and furius. Fcus Grup Participant fr residents f Tarrant Cunty. Cancer Preventin and Screening: Fcus grup participants nted that while Tarrant Cunty has gd resurces fr cancer screening, lwer incme residents are less likely t be screened because they lack insurance r face ther barriers. Quantitative data shw that ver 70% f wmen acrss the state ages 40 and lder reprted having had a mammgram within the past tw years. These screening rates have imprved acrss the state f Texas, frm 68.4% in 2012 t 71% in 2014. In cntrast, breast cancer screening rates have declined in Tarrant Cunty, frm 76.4% in 2012 t 70.9% in 2014. This data represents the mst current mammgraphy rates available fr the cunty. 15.9% Tarrant Cunty Hspital District/JPS Health Netwrk Page 6
Cervical cancer screening rates were generally high acrss Texas and Tarrant Cunty. Amng wmen 21-65 years ld, 80% f Texas wmen reprted receiving a pap test t screen fr cervical cancer in the past three years. Percentages were even higher in Tarrant Cunty where apprximately 89% f wmen were screened in 2015 a steady increase since 2012. The prprtin f adult Percent Female Adults (Ages 21-65) Reprted t Have Had Pap Test Within Past Three Years, by Texas and Tarrant Cunty, 2012, 2014 and 2015 80.6% 79.8% Texas Tarrant Cunty 88.0% 89.1% 77.7% 80.4% 2012 2014 2015 DATA SOURCE: Texas Behaviral Risk Factr Surveillance Survey, 2012, 2014, and 2015 men 40 and lder in Tarrant Cunty wh have had a Prstate Specific Antigen (PSA) test within the past tw years (47%) is higher than the prprtin f men in Texas verall (44%). Adults age 50 and lder wh reprted t have ever had a clnscpy r sigmidscpy in Tarrant Cunty increased frm 65% in 2012 t 79% in 2014. Screening rates acrss the state during these years remained relatively stable at apprximately 63%. Cancer Incidence and Mrtality: Cancer is amng the tp tw leading causes f death in Tarrant Cunty similar t statewide and natinal trends. Since 2010 there has been an verall dwnward trend in cancer incidence and mrtality acrss the state f Texas and Tarrant Cunty. Tarrant Cunty experienced a decrease in verall cancer mrtality frm 171.4 deaths per 100,000 ppulatin in 2012, t 156.3 deaths per 100,000 in 2013. Lung, female breast, prstate, and cln cancers were the leading types f cancer deaths in Tarrant Cunty frm 2010-2013. The rate f lung cancer incidence in Tarrant Cunty has declined frm 62.4 cases per 100,000 residents in 2012 t 56.2 cases per 100,000 ppulatin in 2013. This dwnward trend is als bserved fr lung cancer mrtality; in 2013, the state f Texas and Tarrant Cunty experienced 39.6 and 38.6 lung cancer deaths per 100,000 ppulatin, respectively a steady decline frm 2010. Breast cancer incidence and mrtality rates remained relatively stable frm 2010 t 2013; Latinas experienced the lwest rate f breast cancer deaths in Tarrant Cunty with 15.9 deaths per 100,000 ppulatin in 2013. Cnversely, White and Black residents experienced the highest breast cancer mrtality rates (21.6 deaths per 100,000 ppulatin and 21.1 per 100,000 ppulatin, respectively). Cervical cancer incidence rates have steadily declined in Tarrant Cunty frm 10.6 cases per 100,000 ppulatin in 2010 t 7.0 cases per 100,000 in 2013. Mrtality rates have remained Tarrant Cunty Hspital District/JPS Health Netwrk Page 7
stable ver time thrughut Texas and Tarrant Cunty, thugh data shuld be interpreted with cautin given the small number f cases that cmprise these rates. While Tarrant Cunty experienced a decrease in its prstate incidence rate, the incidence f prstate cancer was abve that f the state (117.0 cases per 100,000 ppulatin in 2010 and 104.2 cases per 100,000 ppulatin in 2013). A dwnward trend was als bserved fr prstate cancer mrtality rates at bth the state and cunty level thugh there cntinues t be great disparity in prstate cancer mrtality fr Black men cmpared t all ther racial and ethnic grups. In 2010, Tarrant Cunty had a rate f 41.4 cases f clrectal cancer per 100,000 ppulatin, slightly higher than the 2013 incidence rate f 33.8 cases per 100,000 ppulatin. Similar t prstate cancer, Black residents are disparately affected by clrectal cancer. In 2013, Black residents experienced 20.9 clrectal cancer deaths per 100,000 ppulatin, nearly three times the rate f Hispanic/Latin residents. Age-adjusted Cancer Mrtality Rate per 100,000 Ppulatin in Tarrant Cunty, by Cancer Type, 2010-2013 Breast (Female) Cervical Prstate Clrectal Lung 46.5 45.6 42.1 39.6 21.6 20.6 20.5 20.7 19.2 19.5 18.0 16.9 15.8 13.7 14.7 2.9 2.9 3.0 3.0 2010 2011 2012 2013 Cancer Survivrship: Survivr care healthy living during and after cancer care was als mentined as an area needing attentin. Accrding t prviders, few prgrams exist t help thse living with cancer t learn abut and be supprted t engage in healthy behavirs such as healthy eating and physical activity. Accrding t quantitative data, prstate cancer had a 96% five-year survival rate, while nly 15.9% f thse diagnsed with lung cancer survived after five years. When stratified by race, Black residents had lwer survival rates acrss all leading cancers cmpared t all ther racial and ethnic categries. Tarrant Cunty Hspital District/JPS Health Netwrk Page 8
Maternal and Child Health: Several participants reprted that infant mrtality in the regin is high, especially amng lwer incme and African American wmen. Prviders saw a need fr mre educatin arund STI preventin as well as infant care fr yung mthers (including preventin f sudden infant death syndrme and smking in the hme). Infant Mrtality Rate per 1,000 Live Births, by U.S., Texas, and Tarrant Cunty, 2010-2014 6.1 6.1 U.S. Texas Tarrant Cunty 7.5 7.2 2010 2011 2012 2013 2014 DATA SOURCE: Texas Department f State Health Services, Center fr Health Statistics, Texas Health Data, Vital Statistics Annual Reprt, 2010, 2011, 2012, 2013, and 2014 and fr U.S. data, Centers fr Disease Cntrl and Preventin, Natinal Center fr Health Statistics, as cited by Annie E. Casey Fundatin, Kids Cunt Data Center, 2010-2014 5.8 5.8 Infant Mrtality: Tarrant Cunty had a higher infant mrtality rate than Texas and the U.S. (7.2 and 5.8 deaths per 1,000 live births, respectively). Additinally, Black wmen experienced the highest rates f infant mrtality cmpared t all ther race/ethnicities in 2014 (13.6 deaths per 1,000 live births); while the infant mrtality rate amng Black wmen has decreased since 2010, it was nearly duble the cuntywide rate in 2014 (7.2 deaths per 1,000 live births). Prenatal Care. Accrding t the Texas Department f State Health Services, 57.7% f live births in Tarrant Cunty in 2014 ccurred t mthers wh received prenatal care in their first trimester cmpared t 61.6% f all live births statewide. Smking During Pregnancy. The percent f mthers smking during pregnancy slightly decreased between 2012 and 2014 fr Tarrant Cunty, which was similar fr Texas statewide. Birth Outcmes. In 2014, apprximately ne in ten babies brn in Tarrant Cunty were premature, meaning brn befre 37 weeks gestatin slightly lwer than the state average f 12.3%. Apprximately 8% f babies brn each year in Texas and Tarrant Cunty are brn lw birthweight, althugh this varied greatly by race/ethnicity; babies wh are Black were mre than twice as likely t be brn lw birthweight cmpared t ther races and ethnicities (14%). Teen Births. In Tarrant Cunty, Hispanic/Latina girls were mre likely t be teen mthers (3.9%), cmpared t Black (2.4%) and White mthers (1%). Cmmunicable Diseases: Cmmunicable diseases are nt as prevalent as chrnic diseases in the regin, but they d disprprtinately affect vulnerable ppulatin grups. Fcus grup and interview participants had few cncerns r cmments abut cmmunicable disease apart frm the perceived increase in sexually transmitted infectins, including HIV. Tarrant Cunty Hspital District/JPS Health Netwrk Page 9
Sexually Transmitted Infectins. Rates f chlamydia and syphilis have remained relatively stable cuntywide, while gradually increasing statewide. In 2015, there were 444.9 cases f chlamydia per 100,000 ppulatin in Tarrant Cunty, cmpared t 487.3 cases per 100,000 in the state f Texas. A similar difference is bserved with syphilis rates, with 23.6 STIs are a grwing prblem in Tarrant Cunty and surrunding areas. Interview Participant cases per 100,000 ppulatin in Tarrant Cunty cmpared t 30.6 per 100,000 ppulatin acrss the state. There is a grwing number f residents living with HIV in Tarrant Cunty; the rate increased frm 236.4 cases per 100,000 ppulatin in 2013 t 254.1 cases per 100,000 ppulatin in 2015. Hwever, the HIV mrtality rate in Tarrant Cunty decreased frm 2.2 HIV deaths per 100,000 ppulatin in 2012 t 1.3 HIV deaths per 100,000 ppulatin 2015 Vaccine-Preventable Diseases: Tarrant Cunty Public Health reprts that in 2015, there were 308 cases f pertussis (15.7 cases per 100,000 ppulatin), 122 cases f streptcccus pneumniae, invasive (6.2 cases per 100,000 ppulatin), and 118 cases f varicella (6.0 cases per 100,000 ppulatin). The prprtin f children ages 19-35 mnths nt receiving the recmmended set f immunizatins was similar between the state and cunty at 38% in 2014. Fr influenza, there has been a dwnward trend in the prprtin f adults aged 65 years r lder wh did nt receive a flu sht in the past year. The mrtality rate fr influenza and pneumnia hvered at apprximately 12 deaths per 100,000 ppulatin in Tarrant Cunty. Oral Health: Participants shared cncerns abut dental care, especially access fr lwer incme residents. The percent f adults that reprted a dental visit in the past year has remained clse t 60% at bth the state and cunty levels since 2012. White adults were mre likely t reprt a dental visit in the past year (70.9%) than Tarrant Cunty adults verall (60.8%), while Black and Hispanic adults were less likely t visit a dentist (45.8% and 48.6%, respectively). Vilence, Injury, and Trauma: Quantitative data shw that hmicide mrtality is relatively lw acrss the Texas and Tarrant Cunty, with arund 5 deaths per 100,000 ppulatin in 2015. Deaths frm unintentinal injuries are mre cmmn than hmicide; frm 2013-2015, there were 37.2 unintentinal deaths per 100,000 ppulatin statewide, slightly higher than the 29.7 deaths per 100,000 ppulatin fr Tarrant Cunty. Accrding t JPS Health Netwrk s 2016 Annual Trauma Reprt, the tp five mechanisms f injury were by mtr vehicle/mtrcycle crashes, falls, assault, gunsht wunds, and aut-pedestrian crashes. Tarrant Cunty Hspital District/JPS Health Netwrk Page 10
Infrmatin and Crdinatin Health Care Access: Fcus grup and interview participants reprted that althugh Tarrant Cunty has substantial health resurces, these services are mre difficult fr lwer incme individuals t access. A variety f reasns were cited, including health insurance, cst, transprtatin, and language barriers. Aggregated U.S. Census data fr 2011-2015, shws 19.3% f the Tarrant Cunty ppulatin had n health insurance, cmpared t 20.6% statewide. Obtaining health insurance was identified as a challenge fr sme individuals due t lack f awareness and the burden f cmpleting paperwrk. The cst f healthcare including c-pays Percent Ppulatin with N Health Insurance, by Age, by Texas and Tarrant Cunty, 2011-2015 11.7% 11.2% Under 18 years 34.2% 31.9% Texas Tarrant Cunty 63.3% 59.4% 40.7% 35.4% DATA SOURCE: U.S. Census Bureau, American Cmmunity Survey 5-Year Estimates, 2011-2015 and deductibles fr thse with insurance, and the high cst f medicatins was als reprted by participants t be a challenge fr sme residents. 2.0% 1. 18-24 years 25-44 years 45-64 years 65 years ve Navigating the Health System: Numerus participants stated that navigating health insurance and the health system can be challenging fr individuals. Aging adults again were singled ut by participants as facing substantial challenges in navigating enrllment deadlines, understanding all the cmpnents f Medicare, and negtiating paperwrk t get equipment like a walker r apply fr hme health care. Language and Transprtatin: Transprtatin and language barriers were als cited as challenges t accessing health care in Tarrant Cunty. Participants described hw the lack f public transprtatin ptins ften means lng trips t make health appintments. Cmmunicatin challenges identified included the lack f bilingual prviders and translated dcuments as well as a need fr enhanced cultural cmpetency amng prviders. Healthcare Utilizatin. While in 2013 ne in fur Tarrant Cunty adults reprted having n persnal health care prvider, reprts f limited prvider access increased in 2014 and 2015. Hispanic/Latin adults were mre likely t reprt nt having a prvider than adults cuntywide. The majrity f behaviral health, dental, and specialty prviders are lcated in r near Frt Wrth, which reflects ppulatin density; thse prviders lcated utside f Frt Wrth are nt accessible via the public transprtatin system, which supprts qualitative findings. Tarrant Cunty Hspital District/JPS Health Netwrk Page 11
Cmmunity Suggestins fr Services and Prgrams When asked abut suggested services and prgrams in the cmmunity, several themes emerged amng fcus grup and interview participants. These included: address the scial determinants f health, expand behaviral health services, emphasize wellness t address chrnic disease, enhance access t services, imprve crdinatin acrss agencies, and increase attentin t aging adults and diverse ppulatins in the cunty. Health Needs f the Cmmunity Thrugh a review f secndary data and discussins with cmmunity stakehlders, this assessment reprt prvides an verview f the scial and ecnmic envirnment f the cmmunity served by JPS Health Netwrk, health cnditins and behavirs that mst affect the ppulatin, and perceived strengths and gaps in the current envirnment. The fllwing table presents the identified health needs f the cmmunity that emerged frm this synthesis f quantitative and qualitative data. Area f Need Identified Needs Health Cnditins/Service Lines Diabetes & Obesity: Preventin and Management Heart Disease & Strke: Preventin and Management Cancer: Educatin & Screening Behaviral Health Maternal & Child Health Aging Adults Infrmatin and Crdinatin Access t Health Care Navigatin f Health Care System Lack f Awareness f Services Care Crdinatin Scial Determinants f Health Pverty Access t Healthy Fd Husing Transprtatin Tarrant Cunty Hspital District/JPS Health Netwrk Page 12
Please address written cmments n the Implementatin Plan and requests fr a cpy f the plan t: Merianne Rth VP, Chief Strategy Officer JPS Health Netwrk 1500 S. Main Street, Frt Wrth, Texas 76104 MRth@jpshealth.rg www.jpshealthnet.rg Tarrant Cunty Hspital District/JPS Health Netwrk Page 13