Wyming Cunty Health Needs Assessment and Grant Guidance Prject Reprt #1 Needs Assessment Prepared fr the Cmmunity Fundatin fr Greater Buffal, Inc. - William F. Thiel Fund - Assessment Advisry Cmmittee September 2012 HMS Assciates Getzville, NY
Table f Cntents Intrductin 1 Assessment Prcess 2 Cmmunity Characteristics and Demgraphics 3 Health and Wellbeing 5 Health Service Use -- Access t Primary and Specialty Care 8 Current Health Related Cncerns f the Cmmunity Health and mental health care services Supprtive r enabling services Lcatins f services and use f services in Buffal r Rchester Health care services characteristics Need fr infrmatin abut health related issues Endntes 15 11 12 13 13 14 11 List f Exhibits Exhibit 1 Internet Survey Results High Need fr Primary Care Services 5 Exhibit 2 Cmparatively High Grss Death Rates Wyming Cunty 7 Exhibit 3 Utilizatin f General Hspital Inpatient Services by Wyming Cunty Residents by Physician Specialty - 2010 Exhibit 4 Internet Survey, Specialty Needs 10 Exhibit 5 Need fr Additinal Health Services Capacity 12 Exhibit 6 Need fr Additinal Supprtive Services Capacity 13 Exhibit 7 Health Care Service Characteristics 14 Exhibit 8 Health Related Infrmatin Tpics 15 9 List f Appendices Separate Dcument A 2010 US Census Characteristics Wyming Cunty B High Health Care Service Need Demgraphics, Wyming Cunty C Findings by Majr Cause and Specific Age Grup fr Eberts and WNY Cmparative Grups
D Additinal BRFSS data E Reprductive Health Statistics Wyming Cunty 2010 F Avidable Inpatient Use G Avidable Emregency Department Use PREPARED BY GREGORY BONK, PRESIDENT HMS ASSOCIATES 2280 MILLERSPORT HIGHWAY P O BOX 374 GETZVILLE, NY 14068 EMAIL: GREGORYBONK@ME.COM OR CONSULTHMS@AOL.COM WEB: WWW.ASKHMS.COM
Intrductin The William F. Thiel Fund was established in 1974 by William F. Thiel t benefit the health needs f the residents f Wyming Cunty. Under the stewardship f the Cmmunity Fundatin fr Greater Buffal, Inc. the fund has grwn and supprted a variety f prjects which have reached ne ut f fur cunty residents i. This assessment has been cnducted t update an assessment cmpleted several years ag and prvide insights n current and future needs and guidance n funding pririties thrugh 2017. This reprt summarizes findings t date n the health needs f Wyming Cunty residents. A subsequent reprt will address pririty needs and guidance n funding pririties. In general, Wyming Cunty residents are as healthy and in many instances healthier than residents f similar rural cunties in New Yrk State and Western New Yrk. Yet, cnsiderable unmet needs exist which can be addressed thrugh Cmmunity Fundatin administered Thiel funds. Key themes, findings and needs are: Current and future needs f the elderly and peple in lw incme grups Elderly ppulatin and peple with lw incmes are prjected t grw substantially thrugh 2017 Perceived need fr mre primary care services fr elderly ppulatin and lw incme grups Actins shuld take int accunt the develpment f new Federally Qualified Health Center capacity in the cunty Specialty care capacity within the cunty Out-migratin fr specialty care currently ccurring Lcal ptential shrtages fr sme specialties: Cardivascular Clrectal Surgens Dermatlgists Endcrinlgists Ear, Nse and Thrat Specialists Gyneclgists and Obstetricians Psychiatrists Perceived need fr mre specialists Cardilgy Onclgy Diabetes Cmprehensive prgrams fcusing n age grups t address high rates f Cancer Cardivascular Diseases Page 1 f 16
Diabetes Mellitus Suicide Obesity Childhd and adult Health persnnel shrtages Recruitment and retentin Educatin Training and re-training Primary care specialist Multi-disciplinary rientatin Health related cmmunity capacities Transprtatin Nutritin-related lcal farm prducts Scial supprt Federal Affrdable Care Act Lcal health care system Linkages Viability Finances Subsequent sectins f this reprt prvide detailed infrmatin n the make-up r demgraphics f the Wyming Cunty cmmunity which highly influence the need fr health care services, measures f the health f the cmmunity, measures f the health f the lcal system f health care services and cmmunity expressed pinins abut health needs, access t care, and the uncertainty surrunding evlving lcal, state and federal plicies. Assessment Prcess Multiple data surces were used t assess needs and the assessment prcess included bth statistical and qualitative appraches: Statistical: 2013 Lcal Services Plan, Wyming Cunty Dept. f Mental Health, Mental Hygiene Pririty Outcmes American Cmmunity Survey, 2008 thrugh 2010 Behaviral Risk Factr Surveys, New Yrk State Department f Health, 2008 thrugh 2009 Page 2 f 16
Birth and Death Certificate Data, New Yrk State Department f Health, 2003 thrugh 2010. Cmmunity Health Indicatr Need Data, New Yrk State Department f Health, varius years General Hspital Inpatient and Emergency Department Use Data, New Yrk State, Statewide Perfrmance and Research Cperative System (SPARCS), varius years 2003 thrugh 2010 P2 Western New Yrk Cmmunity Health Planning Institute, Wyming Cunty, Analytical Synthesis Reprt, July 2012 Ppulatin Frecasts, Nielsen/Claritas, 2017 U S Census 2010 Wyming Cunty Health Department, 2010-2013 Cmmunity Health Assessment Qualitative: Cmmunity Interviews (24), Warsaw Walk, July 2012 Internet Surveys (150+), August 2012 Leadership Interviews (10), via telephne, June 2012 The verall apprach resembles a cmprehensive physical exam which reviews lab tests (statistical data), the pinin f the patient (the cmmunity) and the input f ther dctrs r specialists (health care prvider leadership). High pririties in mst cases were thse areas which were supprted r crss-validated by ptential pririties based n different types f infrmatin. Statistical data which was in the wrst 20 t 25% f cmmunities studied and pinins with a high degree f cncurrence were in mst cases viewed as ptential pririties. Cmmunity Characteristics and Demgraphics Several characteristics f cmmunities, like individuals, are indicatrs f the need fr health r health related services. Peple in different age grups use health care services at different rates. High use age grups include children under 5 years f age and senir citizens r thse appraching senir citizen status such as adults 55 t 64 years f age. Once peple reach 55, their use f health services begins t increase markedly. Hence the actual number f peple in thse age grups influences the need fr care and health care practitiners. Frm a cmmunity r cunty cmparative basis, the percent f peple in thse age grups als shws which cunties need higher amunts f health care resurces. Wmen f childbearing age als require mre health care than the ppulatin in general. Additinally lw-incme grups such as peple with incme levels belw pverty standards exhibit higher rates f health prblems and cnsequently a Page 3 f 16
higher level f need fr services. This ppulatin als ften requires additinal supprtive services nt generally available as standard health care services in rder t assist them in accessing services and addressing ther needs ften crrelated with general health and well-being. The furth key variable is level f educatinal attainment. Like individuals with lw incmes, peple withut high schl diplmas ften need assistance in accessing health care and fllwing medical care plans. Levels f these grups in a cmmunity influence current need and trends in the grwth r reductin f these ppulatin grups als influence future demand. Accrding t the 2010 US Census, in 2010 the cunty had 42,155 peple. There are fur majr ppulatin centers including Attica (7,702), Arcade (4,205), Perry (4,616), and Warsaw (5,064) in which slightly mre than half f the ppulatin reside. There are mre males (22,953 r 54.4%) than females (19,202 r 45.5%). These figures include the state crrectinal facility ppulatin in the cunty which has a high percentage f males in the 18 t 44 years f age grup which in turn skews several ther prprtinal characteristics f the cunty. 3,804 males r 9% f the ttal ppulatin reside in institutinal grup quarters whereas 57 females reside in thse institutinal grup quarters. Over 92% f the ppulatin are Caucasian, 6% African American and 3% Hispanic r Latin. Apprximately ne ut f every fur husehlds has a senir citizen. Appendix A 2010 US Census Characteristics Wyming Cunty cntains a listing f this and ther data. The current characteristics f the cunty d nt indicate high need fr health care services fr specific ppulatin grups in cmparisn t ther rural-urban designated cunties in New Yrk State r the Western New Yrk cmmunity ii. Lw r average levels f children under 5 years f age, wmen f child bearing age, adults 55 t 64, 65 t 75 and 75+ years f age, lw incme individuals and peple with at least a high schl educatin were present in the cunty in 2010. Additinally data n bth lack f health care insurance cverage 15.1% age adjusted rate fr Wyming Cunty and n access t a regular health care prvider 86.7% age adjusted, were similar t the statewide experience (Adults, BRFSS Survey 2009). Trends in the ppulatin frecasted t ccur by 2017 hwever shwed a highly significant increase in peple 65 t 74 years f age and ver 75 years f age. These age grups are frecasted t grw by 1,300 peple during that time perid. An additinal high need fr services characteristic pverty althugh average in 2010, is expected t increase at a cmparatively high rate 2.2% between 2012 and 2017. These frecasts fr grwth were higher than bth cmparable and WNY cunties. Hence verall demand fr health care services in the cunty will increase ver time fr peple ver 65 years f age and peple with lw incmes. The cunty s verall ppulatin is frecasted t grw by apprximately 100 peple, a Page 4 f 16
small number and lw rate (0.3%) which is negligible yet high fr WNY cunties. The results f the internet survey and individual interviews crrbrated the need fr the develpment f health care services, especially primary care services and supprtive services, fr peple with lw incmes, migrant wrkers and n r inadequate health care insurance and senirs. The results are listed in Exhibit 1 High Need fr Primary Care Services. Appendix B High Health Care Service Need Demgraphics, Wyming Cunty cntains a listing f this and ther data. Exhibit 1: Internet Survey Results High Need fr Primary Care Services Health and Wellbeing A cmmunity s health is ften defined by the absence f illness r lw death rates, lw levels f negative birth related statistics, and lw levels f negative persnal habits r behavirs such as smking r lack f exercise. Overall the cunty cmpares favrably with similar NYS cunties and WNY cunties n grss death rates fr tw verlapping three year perids, 2005 t 2007 and 2007 t 2009. Age specific rates shwed a marked imprvement in the death rate fr peple under 24 years f age between 2005 t 2007 and 2007 t 2009. The death rate fr peple ver 75 years f age was significantly high fr bth time perids studied but average fr peple 25 t 54 and 55 t 74 years f age. Average r lw rates fr the Page 5 f 16
yunger ppulatin grups suggests that access t care may be imprving and health risk behavirs may be declining amng Wyming cunty residents. Changes ccurred in the severity f majr causes f death f cunty residents fr the tw perids studied. In the initial perid, 2005 t 2007, the cunty had high grss rates fr 9 causes and in 2007 t 2009 that drpped t high rates fr 6 causes. Majr imprvements r declines were seen in deaths due t cerebrvascular disease and cancer f the breast. The cmparative standing fr lymphatic cancer and cnditins f the perinatal perid hwever declined t the wrst 20% f 12 Eberts Cunties studied. Deaths due t cnditins f the perinatal perid are generally rare and highly subject t change but als clsely mnitred as ptential indicatrs f pr access t care befre and immediately fllwing birth. Data fr 2010 indicates this rate is declining thugh, yet surveys and interviews suggested an unmet need fr bstetric and gyneclgical services in the Cunty. The principal finding related t majr causes f death fr all age grups pertain t high rates fr: Cancer: Lymphatic & Hematpietic Tissue Hypertensin Other Cardivascular Diseases Diabetes Mellitus Suicide Perinatal cnditins warrants further review High rates fr the 25 t 54 age grup fr the 2007 t 2009 perid were nted fr Suicide with 12 deaths and the secnd prest rate f Eberts Cunties. High rates fr the 55 t 74 age grup fr the 2007 t 2009 perid were nted fr: Cancer: Genital Organs Cancer: Urinary Organs Cancer: Other & Unspecified Sites Cancer: Lymphatic & Hematpietic Tissue Other Diseases f the Circulatry System Cirrhsis f the Liver High rates fr the 75+ age grup fr the 2007 t 2009 perid were nted fr: Heart Disease Acute Mycardial Infarctin Diabetes Mellitus Nephritis et al Septicemia Page 6 f 16
Exhibit 2 displays Wyming Cunty grss death rates fr causes f death which were significantly high r pr fr either f the tw perids studied. Appendix C cntains several charts which depict findings by majr cause and specific age grup fr bth Eberts and WNY cmparative grups. Exhibit 2: Cmparatively High Grss Death Rates Wyming Cunty The internet survey indirectly indicated that, based upn the perceived high need fr increased capacity, cancer, heart disease and diabetes are majr prblems in the cunty. The 2007-2009 Behaviral Risk Factr Surveillance System (BRFSS) Assessment randm telephne survey cnducted by the NYS Health Department shwed that Wyming Cunty residents have rates f pr health regarding: Heart Disease: High levels f peple diagnsed with high bld pressure Alchl Abuse: High levels f adult men averaging mre than 2 alchlic drinks per day and adult wmen averaging mre than 1 alchlic drink per day within the past mnth Obesity: High numbers f peple having a bdy mass index (BMI) f 30.0 r greater: BMI is calculated as weight in kilgrams divided by the square f height in meters. Appendix D cntains additinal BRFSS data. Page 7 f 16
Health and wellbeing are highly influenced by the characteristics f wmen wh bear children and the care they receive during and immediately after pregnancy. Wyming Cunty cmpares very favrably with similar New Yrk State and WNY Cunties. Of the 79 variables studied fr 2010, nly tw were ntewrthy: A very high rate f live births t wmen between the ages f 24 and 29 the highest fr WNY and cmparable cunties. A very high rate f late r n prenatal care fr wmen ver 35 years f age Appendix E Reprductive Health Statistics Wyming Cunty - 2010 cntains a listing f this and ther data. The Wyming Cunty Health Department s Cmmunity Health Assessment fr 2013 highlighted unmet needs fr peple with chrnic diseases and the need fr preventin f chrnic disease and the 2013 Lcal Services Plan - Wyming Cunty Department f Mental Health - Mental Hygiene Pririty Outcmes referenced the high rate f suicide fr the Cunty and ptential service related actins and imprvements. Health Service Use Access t Primary and Specialty Care Wyming Cunty residents use f general hspital services is f key imprtance in this assessment. Nt nly des such data reflect the ptential need fr a variety f ther types f health care services, but mst imprtantly, the data applies t all residents f Wyming Cunty regardless f age, sex, medical prblem and the type f health care service cverage they have. This all-payer database cnsequently cnveys a very cmprehensive view f the use f and need fr different types f health care prgrams. The verall use f hspital inpatient services is cnsidered by sme experts t be a reflectin in part f the ppulatin s ability t access and use ther types f less intensive and cstly healthcare services and especially utpatient services. In 2010, 4,698 Wyming Cunty residents were discharged frm general hspitals lcated thrughut New Yrk State. This equaled an verall discharge rate (nn ageadjusted) f 111.5 per 1,000 peple. This rate was very similar t the rate fr the 12 similar cunties in New Yrk State (113.0 per 1,000 peple) but amng the lwest f the eight cunties in Western New Yrk (121.9 per 1,000 peple). Findings fr each f the three age grups studied peple under 18 years f age, peple 18-64 years f age, and peple 65 years f age and ver differed t sme extent. Ntably, Wyming Cunty senir citizens hspital inpatient rates ranked cmparatively higher r prer than ther age grups in the cunty. Apprximately 12.8% f all inpatient admissins were cvered by Medicaid and 39.5% by Medicare. These percents are lw in Page 8 f 16
cmparisn t ther cunties. Cnversely, percents fr peple with HMO, wrkers cmpensatin r crrectins cverage were cmparatively high. The wrkers cmpensatin and crrectins categries were very lw (apprximately 2%) cmpared t ther payer grups. Use f inpatient services can als reflect the ppulatin s access t physician specialties. Residents f Wyming Cunty access a variety f specialists, as cmpnents f their inpatient care, at very lw rates in cmparisn t the Western New Yrk cmmunity. Thse specialty categries include: Cardivascular Clrectal Surgens Dermatlgists Endcrinlgists Ear, Nse and Thrat Specialists Gyneclgists and Obstetricians Psychiatrists An examinatin f use f general hspital inpatient services by clinical specialties by Wyming Cunty residents is depicted in Exhibit 3. Exhibit 3: Utilizatin f General Hspital Inpatient Services by Wyming Cunty Residents by Physician Specialty - 2010 survey results stp Page 9 f 16
The internet survey als inquired abut specialty care needs in the cunty. Specialists fr heart disease, cancer, diabetes and primary care geriatricians tpped the list. This data is presented in Exhibit 4 Internet Survey, Specialty Needs. Exhibit 4: Internet Survey, Specialty Needs The need fr primary care and preventive health care services is ften measured by the extent t which hspital emergency rm visits are used as a surce f primary care by the general ppulatin. A secnd variable is the extent t which peple use inpatient services fr cnditins which culd be treated n an utpatient basis. An analysis f 2010 data shwed that neither f these measures revealed a high need fr additinal r imprved primary care and preventive health services thrughut Wyming Cunty. The hspital emergency department and inpatient discharge rates fr avidable cnditins fr peple under 17 years f age and 65 years f age and ver were generally similar t r slightly abve average in cmparisn t WNY and similar NYS cunties. Data n the 18 t 64 years f age grup were remarkable in that use f hspital emergency departments fr avidable cnditins was the lwest f any cunty in Western New Yrk r cmparable NYS cunty. Anther key measure assciated with emergency department data is the extent t which the uninsured use it as a majr surce f care. ED use by the uninsured f Wyming Cunty is lw in cmparisn t similar cunties and WNY cunties. In 2010, 939 Wyming Cunty residents wh were self-pay (uninsured) patients used hspital EDs. This equaled 8.3% f all peple using the ED frm Wyming Cunty and was lw in cmparisn t ED use rates fr self-pay patients fr Page 10 f 16
ther cunties (WNY cunties:12.5% and similar NYS cunties: 11.1%). An additinal ntewrthy finding was that the 4pm t midnight perid was the 8 hur perid during which the emergency department was mst needed, that is, visits were mre prne t be emergencies than substitutes fr primary care. Appendix F and G cntain extensive sets f charts n avidable use. Current Health Related Cncerns f the Cmmunity The internet survey prvided a cnsiderable amunt f input n health care needs. 157 peple respnded t the survey and f thse wh cmpleted the respective questins, tw-thirds were between the ages f 45 and 65, 80% were female, 90% nt retired r semiretired, 85% were residents f the cunty, apprximately tw thirds were emplyed in health care r human services and the remaining ne third was equally split between educatin, banking and law enfrcement. Key findings related t the need fr health and mental health care services, supprtive r enabling services, service characteristics, lcatins f services and use f services in Buffal r Rchester, infrmatinal needs and methds fr making the public aware f health related issues in Wyming Cunty. Health and mental health care services As nted earlier, the internet survey indicated that additinal specialty services fr the treatment f cancer, heart disease, breathing prblems, and diabetes were perceived t be mst critically needed in the cunty. A secndary key cncern was the need fr primary medical care fcusing n the geriatric r elderly ppulatin. The need fr dental care emerged within the secnd tier f care needs as well as preventive health screenings, wmen s health, and pregnancy care. These results are depicted in Exhibit 5 n the fllwing page. Page 11 f 16
Exhibit 5: Need fr Additinal Health Services Capacity Supprtive r enabling services As usual, transprtatin received the highest rating f need fr supprtive services f thse referenced. Other high need categries included supprt grups, utreach prgrams, translatin services, health educatin and help understanding medical care. Secnd tier needs related t case management, discharge planning, cunseling assessment, and facilitated enrllment. Several interviewees expressed significant cncern ver the general lack f transprtatin capacity. Several prgrams in additin t the public bus system exist but there appears t be a need t examine the ptential fr crdinating r supprting varius prgram resurces. Exhibit 6 depicts the survey results regarding supprtive service needs. Page 12 f 16
Exhibit 6: Need fr Additinal Supprtive Services Capacity Lcatins f services and use f services in Buffal r Rchester When asked where service expansin was mst needed, a majrity f respndents chse either the central (apprximately 27%) r sutheast (apprximately 25%) areas fr additinal capacity. The suthwest area received a scre f 20%. Given the gegraphic split in Wyming Cunty, individuals in the eastern and western prtins f the cunty generally g in thse directins fr additinal healthcare services, therefre it is nt surprising t find that thse wh travel fr care t Buffal r Rchester mre than three times a year d s in rughly equal prprtins, apprximately 40% f thse wh respnded t the questin. A slight preference fr Rchester existed in the verall finding. Health care services characteristics The imprtance f characteristics assciated with needed prgrams was als assessed. The fur areas which ranked mst highly included ease f access t care, speed f access t care, credentials f staff and the range f services available at health care prgram sites. Fee structures, linkages with Buffal r Rchester based Page 13 f 16
prgrams and fllw up health care services at hme received lwer ratings. These results are presented in Exhibit 7. Exhibit 7: Health Care Service Characteristics Need fr infrmatin abut health related issues This questin explred the need fr particular types f infrmatin related t educatinal pprtunities and training fr heath related prfessinal staff develpment, services thrughut the cunty and abut the Federal Affrdable Care Act. A majrity f respndents were mst cncerned abut understanding the impacts f the Federal Affrdable Care Act. The results are summarized in Exhibit 8 n the fllwing page. This area left blank intentinally. Page 14 f 16
Exhibit 8: Health Related Infrmatin Tpics i These prjects als received financial supprt frm ther rganizatins. ii Eberts Cunty Designatins: Rural-urban Allegany Cunty Clumbia Cunty Greene Cunty Herkimer Cunty Livingstn Cunty Schharie Cunty Schuyler Cunty Seneca Cunty Washingtn Cunty Wayne Cunty Wyming Cunty Yates Cunty Page 15 f 16
Western New Yrk Cunties Allegany Cunty Cattaraugus Cunty Genesee Cunty Orleans Cunty Wyming Cunty Chautauqua Cunty Erie Cunty Niagara Cunty Page 16 f 16