Caro Community Hospital 2016 Community Health NeedsThe leaders of Caro Community Hospital understand that operating a COMMUNITY hospital means striving to understand and respond to

CaroCommunityHospital2016CommunityHealth

NeedsAssessment

AReporttotheCommunity

Caro Community Hospital Community Health Needs Assessment

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TableofContents

ContentsExecutiveSummary................................................................................................................................................................................................2

ProcessOverview....................................................................................................................................................................................................6

RepresentingtheCommunityandVulnerablePopulations..................................................................................................................7

2013CHNAPlanProgress...................................................................................................................................................................................9

CHNAMethodology..............................................................................................................................................................................................11

Findings.....................................................................................................................................................................................................................14

PrioritizationProcess..........................................................................................................................................................................................29

AssessExistingResourcesThatareAddressingPriorities..................................................................................................................32

WrittenCHNAReportandImplementationPlan.....................................................................................................................................33

AdditionalDocuments(AvailableUponRequest).....................................................................................................................................2


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ExecutiveSummary…

ExecutiveSummaryThisreportisaprimarydatasourcethatcomplementsotherprimaryandsecondarydatasourcescollectedbyCaroCommunityHospitalforits2016CommunityHealthNeedsAssessment.TheprimarydatacontainsinformationfromtheThumbCHNACollaborationCommunityHealthSurveydevelopedanddistributedbyhospitalsandpublichealthdepartmentsinHuron,Sanilac,andTuscolaCounties.CaroCommunityHospitaldistributedsurveysineightZIPcodesinitsservicearea.Theyalsoheldafocusgroupof8womenand5menwithagerangesfrommid/late30sto60s.Theattendeesrepresentedhospitalemployees,otherhealthprofessionals,schools,ISD,CountyCommission,lawenforcement,andcommunitymembers.Keystakeholderinterviewswereheldwithfiveindividualsfromfiveorganizations.Thesurveyfindingsarebasedontheresponsesof207individuals,three‐quarters(78.3%)ofwhomwerefemale.Respondentswerewelleducatedwiththree‐fifths(61.2%)earningsomecollegedegree,andalittleoverone‐quarter(27.7%)reportinghouseholdincomesof$75,000ormore.Thesurveycoveredfiveareasofconcerns:community’shealth,qualityoflife,availabilityofhealthservices,safetyandenvironment,deliveryofhealthservices,andvulnerablepopulations(seniors,females,loweducation,andlowincome).Italsoaskedaboutpreventingaccesstocare.Manyconcernswereaboutaccesstoandavailabilityofhealthcareprovidersandthecostsofhealthcare.Surveyrespondentswereconcernedaboutjobswithlivablewages,supplyofdoctorsandnurses,andalackofsubstanceabuse,mentalhealthanddentalservices.Theynotedthecostsofhealthinsurance,healthcareservicesandprescriptiondrugs.Focusgroupmembersidentifiedpovertyasamajorissuewhichincludednotenoughjobswithlivablewages.Theywerealsoconcernedaboutthecostsofhealthinsurance,healthcareservicesandprescriptiondrugs.Theyperceivedalackofmentalhealthservicesandthoughtthecommunityhaddifficultyretainingdoctorsandnurses.FocusgroupmembersthoughtmostpeopleuseCaroCommunityHospitalbecauseofitsstaff,location/convenience,qualityandbeingsafe,butusedotherprovidersbecausetheypreferredthestaffordoctorsatotherhospitalsandalackofprivacyatCCH.Theysuggestedthatthehealthofthecommunitywouldbeimprovedbyhavingbetterleadership,integratingthestaffintothecommunity,anewclinic,andafocusonrespondingtotrauma.Thestakeholderintervieweesindicatedthatalackoftransportation,especiallyforhealthandmedicalneedsasamajorchallenge.Theywereconcernedabouttheavailabilityofmentalhealthservices,youthobesityandyouthsubstanceuseandabuse,andtheavailabilityofresourcesforcaringfortheelderly.ThestakeholdersperceivedalackoftrustinthelocalTuscolacountyhospitalsbutheldthecountyhealthdepartmentinhighesteem.Theywantedtheproviderstobecomemoreinvolvedwiththecommunityandcollaboratetogetinformationoutaboutservices.


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BackgroundandOverview

BackgroundCaroCommunityHospitalisaCriticalAccessHospital.TheMedicareRuralHospitalFlexibilityProgram(FlexProgram),createdbyCongressin1997,allowssmallhospitalstobelicensedasCriticalAccessHospitalandoffersgrantstoStatestohelpimplementinitiativestostrengthentheruralhealthcareinfrastructure.CriticalAccessHospital(CAH)DesignationAMedicareparticipatinghospitalmustmeetthefollowingcriteriatobedesignatedasaCAH:•BelocatedinaStatethathasestablishedaStateruralhealthplanfortheStateFlexProgram;•BelocatedinaruralareaorbetreatedasruralunderaspecialprovisionthatallowsqualifiedhospitalprovidersinurbanareastobetreatedasruralforpurposesofbecomingaCAH;•DemonstratecompliancewiththeConditionsofParticipation(CoP)relevantto42CFRPart485Sub‐partFatthetimeofapplicationforCAHstatus;•Furnish24‐houremergencycareservices7daysaweek,usingeitheron‐siteoron‐callstaff;•Providenomorethan25inpatientbedsthatcanbeusedforeitherinpatientorswingbedservices;however,itmayalsooperateadistinctpartrehabilitationorpsychiatricunit,eachwithupto10beds;•Haveanaverageannuallengthofstayof96hoursorlessperpatientforacutecare(excludingswingbedservicesandbedsthatarewithindistinctpartunits);and•Belocatedeithermorethana35‐miledrivefromthenearesthospitalorCAHora15‐miledriveinareaswithmountainousterrainoronlysecondaryroadsORcertifiedasaCAHpriortoJanuary1,2006,basedonStatedesignationasa“necessaryprovider”ofhealthcareservicestoresidentsinthearea.CaroCommunityHospital:MissionCaroCommunityHospital,acommunity‐mindedhealthcaresystem,isdedicatedtoprovidingcompassionatecareandservicestoenhancethehealthofallpeopleweserve.Services:GeneralandAcuteServices

24/7EmergencyDepartment OB/GYN(evaluation&surgicalservices)

CardiologyOphthalmology(evaluationandsurgicalservices)

Dermatology Oral/MaxillofacialSurgeryEndocrinology Orthopedics(evaluation&surgicalservices)ENT&FacialPlasticSurgery PathologyFamilyPracticeClinics PharmacyHematology/Oncology Podiatry(evaluation&surgicalservices)Hospital(acutecare,includinghospitalist) PulmonologyNephrology RheumatologyNeurology StrokeRobotNeurosurgery SurgicalServicesNutritionCounseling Urology


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Screening/TherapyServices

ChronicDiseaseManagement PediatricservicesDOTPhysicals PhysicaltherapyHolterMonitoring RespiratorycareLaboratoryServices SleepStudiesLowerextremitycirculatoryassessment SocialServicesOccupationalphysicals Totalbodyfatanalysis

RadiologyServices

CTScan MRI(ThumbMRI)DigitalMammography Teleradiology(Afterhours)Generalx‐ray UltrasoundNuclearmedicine BoneDensityTestingTheleadersofCaroCommunityHospitalunderstandthatoperatingaCOMMUNITYhospitalmeansstrivingtounderstandandrespondtotheneedsofthecommunity‐you,yourfamilies,andyourfriends.Itwaswiththiscommunitymindset,in2016,thatCaroCommunityHospitallaunchedaCommunityHealthNeedsAssessment(CHNA).

WhatisaCommunityHealthNeedsAssessment?Thefirststepinmeetingcommunityneedsisidentifyingtheneeds.Usinganobjectiveapproachhelpsensurethatprioritiesarebasedonevidenceandaccurateinformation.TheassessmentprocessusedbyCaroCommunityHospitalincludedatrifectaapproachofreviewingthreesourcesofprimarydata.Inthetrifectaapproach,whentherearethreesourcesofdatathatillustrateaneed,thereisagreaterlikelihoodthataddressingthatneedwillproduceapowerfulimpact.Threemethodswereusedtocollectprimarydata:

Surveys:SurveysweredistributedineightZIPcodesinthehospital’sservicearea.Thesurveywasalsopostedonlineusingwww.surveymonkey.com.

FocusGroups:TheHospitalheldonefocusgroup.Participantsincludedafocusgroupof8womenand5men.TheyrepresentedCaroCommunityHospitalemployees,otherhealthprofessionals,schools,ISD,CountyCommission,lawenforcement,andcommunitymembers,Agesrangedfrommid/late30s‐to‐60s

KeyStakeholderInterviews:Acountylevelcommitteeselectedkeyorganizationsandindividualsforstakeholderinterviews.Theseinterviewswereheldwithfiveindividualsfromfivedifferentorganizations.

Inadditiontotheprimarydata,secondarydatawasreviewedforcomparisontostateratesandacrosscountieslocatedintheThumb.ThisdatawasorganizedintoaThumbreportcard.The


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CHNAprocesswasfollowedbyaprioritizationprocessandimplementationmeeting.Onceprioritieswereselected,therewasanassessmentofexistingservicesandprograms.Thisassessmentwasusedtoidentifygapsinservicesanddevelopstrategiestoaddressthepriorityneeds.Thesestrategiesarethenorganizedintoanimplementationplanandprogresswillbemonitored.ThisisthesecondcycleofCommunityHealthAssessmentandPlanning.Thefirstcyclewascompletedin2012‐2013.TheprocessisintendedtobecompletedonathreeyearcyclethatalignswithAffordableCareActrequirements.The2016CHNAreportincludesareviewofthe2013implementationplanandprogresstowardtargets.

WhyisaCommunityHealthNeedsAssessmentvaluable?Mostexpertsagreethattherearemanychallengesfacinghealthcaretoday.Rapidlychangingtechnology,increasedtrainingneeds,recruitingmedicalprofessionals,andrespondingtohealthneedsofagrowingseniorcitizenpopulationarejustafewofthemostpressingchallenges.Thesechallengesoccuratatimewhenresourcesforfamiliesandhealthcareprovidersarestretched.TheseconditionsmaketheCommunityHealthNeedsAssessment(CHNA)processevenmorecritical.ACHNAhelpstodirectresourcestoissuesthathavethegreatestpotentialforincreasinglifeexpectancy,improvingqualityoflife,andproducingsavingstothehealthcaresystem.

BackgroundandAcknowledgmentsInAugust2015,theMichiganCenterforRural,HospitalCouncilofEastCentralMichigan,andThumbRuralHealthNetworkconvenedadiscussiongrouparoundtheCHNAprocessinHuron,Sanilac,andTuscolaCounties.Thisregion,oftenreferredtoastheThumbofMichigan,includeseighthospitalsandthreepublichealthdepartments.HospitalsandhealthdepartmentsinvitedrepresentativesfromtheCenterforRuralHealth(CRH),UniversityofNorthDakota,andSchoolofMedicine&HealthSciencestopresenttheirmethodforconductingCHNAsinruralareas.AttheendofthistrainingallthehospitalsandhealthdepartmentsdecidedtocollaborateusingacommonprocessforCommunityHealthNeedsAssessment.Theyagreedtodevelopandadministerasurveyofcommunitymembersandusethesamesetofquestionsandprocessesforfocusgroupsandkeystakeholderinterviews.EachhospitalreceivedresultsforitsserviceareabasedontheZIPcodeofsurveyrespondents.Individualhospitalsutilizedfindingsfromthesurvey,focusgroupsandkeystakeholderinterviewsfortheirlocalCHNA.Theuseofacommonsurveyinstrument,focusgroupandinterviewscheduleswillpermitaggregatingthehospitaldatabycountyandbythethreecountyThumbregion.Thiswillenablecooperativeinitiativeswithincountiesandtheregion.


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NeedsAssessm

entProcess

ProcessOverview

StepsinProcessInDecember2015,themembersoftheThumbCHNACollaborationreceivedtrainingfromtheUniversityofNorthDakotaonbestpracticesinthefieldofCommunityHealthNeedsAssessment.Basedonthistraining,aprocesswasdevelopedfortheThumbAreathatwouldallowforconsistentdatacollection.Thisconsistentdatacollectionwouldallowforcountyandregionalaggregationofdata.Inadditiontothelocalhospitalplansandactivities,thisprocesswouldallowforgreaterimpactofcountywideandregionalprojectsandinitiatives.TheprocesswasdevelopedbasedreviewoftheUniversityofNorthDakotaModel1:

Step1:Establishalocalandregionaltimeline Step2:Convenecountyteamstomanagerlogisticsofassessmentactivities Step3:DevelopandAdministerSurveyInstrument* Step4:DesignandimplementCommunityFocusGroupsinlocalhospitalcommunities* Step5:DesignandimplementKeyStakeholderInterviewsorcountyagencies* Step6:Producelocalizedhospitalreportsbasedonsurveyzipcodedata,localfocus

groups,andcountyinterviewdata Step7:HavelocalhospitalsholdImplementationPlanningMeetings Step8:HavelocalhospitalsprepareawrittenCHNAReportandImplementationPlan Step9:Producecountyandregionalreports Step10:Convenecountyandregionalmeetingstoreviewreports Step11:MonitorProgress

Timeline

*Inordertoutilizethetrifectamodel,thesethreedatacollectionmethodswereconsistentinscopeandquestiontopics.

Develop Standardized Methodology and Tools (September 2015)

Implement Surverys (January‐March 2016)

Stakeholder Interviews (February‐March 2016)

Conduct Focus Groups (March and November 2016)

Develop Reports (May‐November 2016)


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RepresentingtheCommunityandVulnerablePopulations

DefinetheCommunityServedTuscolaCountyisaruralcountylocatedintheThumbofMichigan.Apopulationof55,729residesinthecounty.Thefollowingchartsshowcasecharacteristicsofthepopulation.

Indicator Michigan Huron Sanilac TuscolaPopulation 9,909,877 32,065 41,587 54,000%below18yearsofage 22.40% 19.60% 22.20% 21.40%%65andolder 15.40% 23.40% 19.50% 18.30%Non‐HispanicAfricanAmerican 13.90% 0.50% 0.50% 1.20%%AmericanIndianandAlaskanNative 0.70% 0.40% 0.60% 0.60%%Asian 2.90% 0.50% 0.40% 0.40%%NativeHawaiian/OtherPacificIslander

0.00% 0.00% 0.00% 0.00%

%Hispanic 4.80% 2.10% 3.70% 3.30%Non‐HispanicWhite(belowHispanic) 75.80% 95.70% 94.10% 93.70%%NotProficientInEnglish(2014) 1% 0% 0% 0%%Females 50.90% 50.50% 50.40% 49.90%%Rural 25.40% 89.50% 90.20% 84.20%

EducationLevels

Indicator Michigan Huron Sanilac TuscolaHighschoolgraduation** 78% 90% 87% 80%Somecollege 66% 54% 52% 57%

HouseholdIncome

Indicator Michigan Huron Sanilac TuscolaMedianHouseholdIncome $49,800 $41,700 $42,100 $43,200

PovertyRates

Indicator Michigan Huron Sanilac TuscolaChildreninPoverty:underage18livinginpoverty

23% 21% 23% 24%

ALICElevel:householdabovepovertylevel,butlessthanthebasiccostoflivingforcounty

NA 27% 27% 22%

PovertyRate–USCensus 16.9% 15.5% 15.6% 15.3%


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Unemployment

Indicator Michigan Huron Sanilac TuscolaChildreninPoverty:underage18livinginpoverty 23% 21% 23% 24%

ALICElevel:householdabovepovertylevel,butlessthanthebasiccostoflivingforcounty

NA 27% 27% 22%

PovertyRate–USCensus 16.9% 15.5% 15.6% 15.3%CommonOccupationsandIndustries Healthcareandsocialassistance Manufacturing Retailtrade Educationservices Construction

Uninsuredrates

Indicator Michigan Huron Sanilac TuscolaUninsured 13% 15% 15% 14%Uninsuredadults 16% 18% 19% 18%Uninsuredchildren 4% 6% 6% 4%

SurveysandFocusGroupsDistributionofsurveyswasintentionallyplannedtoincludeindividualsfromvulnerablepopulationgroupssuchasseniorcitizens,under‐resourcedfamilies,veterans,andwomen.Dataanalysisincludedcrosstabulationofresultsforvulnerablepopulations.Hospitalsinvitedavarietyofindividualsthatrepresentedmultiplesectorsofindustry,age,andhealthconditions.Seniors58orolderaccountedforonequarter(26.7%)ofrespondents;thosewithahighschooleducationorlessaccountfor19.9%oftherespondents,andaboutone‐third(30.7%)reportedhouseholdincomes$24,999orless.

Healthcare/SocialServiceOrganizationsProvidingInputParticipantsinstakeholderinterviewswerechosenbasedontheirexpertiseinservingvulnerablepopulationsandtheirexperiencewithcommunityissues.Organizationswerechosenbyeachcountylevelcommitteeandvariedslightlybycounty.

StakeholdersInterviewedName Title Affiliation ChristineTrish CountyCommissioner TuscolaCountyGovernmentSharonBeals ChiefExecutiveOfficer TuscolaBehavioralHealthSystemsSusanWalker Coordinator HumanServicesCommunityCollaborativeKarenSouthgate ProgramManager Tuscola/HuronCountyDHHSJulieBooms FamilyIndependenceManager HuronDHHS


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ConsultantsDuringtheprocess,variousconsultantswereutilizedtomanagetheworkflowandensureconsistency,including: BalcerConsulting&PreventionServices,KayBalcer:Overallprojectcoordinationandfacilitation,

stakeholderinterviews,templatedevelopment. MichiganCenterforRuralHealth,CrystalBarterandSaraWright:Notetaking,andcodingoffocusgroup

andinterviewresponses. InstituteforPublicPolicyandSocialResearch,MichiganStateUniversity:Papersurveyprocessing,coding

ofsurveydata,andproductionofstatisticaldataforanalysis. IndependentConsultants,HarryPerlstadt,PhD,MPHandTravisFojtasek,PHD:Dataanalysisandreports.

SomehospitalsalsochosetocontractwithBalcerConsultingorMichiganCenterforRuralHealthforfocusgroupfacilitation,facilitationofimplementationmeetings,andpreparationoftheCHNAreportandimplementationplan.QuestionsabouttheCHNAprojectandrequestsfordocumentscanbemadebycontactingKayBalcerat(989)553‐[email protected].

2013CHNAPlanProgressIn2013,theCommunityHealthNeedsassessmentprioritiesidentifiedbyCaroCommunityHospital(CCH)included:

1.AfterHoursClinic2.TransportationNeeds3.Cooperationbetweenneighboringhospitals4.Communitysupportofavailableservices5.Publicize211

Thefollowingtableincludesanupdateontheprogresstowardactivitiesinthe2013ImplementationPlan:

Priority Progress/UpdateAfterHoursClinic CCHhasworkeddiligentlytofindanappropriatelocationforan

afterhoursclinic.TheyhaverecentlysecuredabuildingindowntownCaroforanurgentcare/afterhoursclinicthatisscheduledtoopen7daysaweekinSpring2017.

TransportationNeeds CCHhasworkedwiththeTuscolaCountyTransitAuthorityaswellasTRHNtohelpmarkettheservicestothepublic.TheyhavealsodiscussedroutesandavailabilityoftransportationtoThumbMRI.

CooperationBetweenNeighboringHospitals TheyhaveworkedextensivelywithTRHNtoprovidehealthandwellnessservicestotheentirethumbandcollaboratedonpotentialgrants.CCHhasalsoworkedwithotherhospitals(ThumbaswellasSaginaw)oncommunityeducation–specificallyPATHforDiabetes.

CommunitySupportforAvailableServices CCHcontinuestoprovideextensivecoverageinmultiplemediaareasincludingsocialmedia,billboards,directmailings,newspaperads(TuscolaCountyAdvertiser,ReeseReporter,FrankenmuthNews,CassCityChronicle,VassarPioneerTimes,HuronDailyTribune,ThumbAreaSeniorNewsandVarsity


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Monthly).Inthelast2years,theyhavecompletelyupdatedallmarketingmaterialstobetterpromotehospitalandclinicservices.CCHhasprovidedpubliceducationatlocalExchangeClubandRotarymeetingsaswellastheCaroSeniorCommons.TheyalsohostannualcommunityhealthfairsaswellasaMammPartytoeducatethepublicaboutearlydetectionandbreasthealth.

Publicize211 CCHinvites211totheirannualhealthfair,thereisalinkonthehospitalwebsite,theyPRtheserviceregularlyonsocialmedia,thereisinformationthroughoutthehospitalandclinicsandtheyhaveinvited211tospeakatCaroRotary.


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CHNAMethodologySurveys:Sample/TargetPopulation:TheThumbCHNACollaborationmembersdecidedtousenonprobabilitysampling,combiningconveniencesamplingwithpurposive(judgmental)sampling.Inaconveniencesample,respondentscanbeanyonewhocomesincontactwiththeresearcherorhasaccesstothesurvey‐frompeopleonastreetcornerorinamalltothosewhocomeacrossthesurveyonline.Inapurposivesample,respondentsarerecruitedbasedonsomecharacteristicwhichwillbeusefulforthestudy.Forexample,apurposiveCHNAsurveywouldtargetmembersofclubsandreligiouscongregationsinlowincomeneighborhoodsorseniorsresidinginindependentlivingandassistedlivingfacilities.Inaddition,amixedsamplingdesignintendedtogatherasufficientnumberoflowincome,loweducationandseniorcitizenstopermitananalysisoftheirhealthconcernsandviewsonhealthcareservices.Finally,sinceeachhospitalusedthesamesurveymethodology,theresultscanbeanalyzedandcompared.Althoughthefindingscannotbegeneralized,theycanpointoutcommonneedsandsolutions.

Table1:DemographichighlightsAge Respondentswereaskedtheiryearofbirthwhichwasthenrecodedintoquartiles.Ofthe

validcases,23.0%were35oryounger,26.2%between36and48,24.1%between49and57,and26.7%were58orolder.

Gender Three‐quarters(78.3%)oftherespondentswerefemaleand21.7%male.MaritalStatus

Alittleoverhalf(56.7%)weremarriedorremarried.

Children Alittleovertwo‐fifths(43.8%)ofhouseholdshadchildrenunder18.Education Aboutone‐fifth(19.9%)hadahighschooldiplomaorless,18.9%somecollege,18.9%a

technical/Jrcollegedegree,one‐fifth(20.9%)abachelor’sdegreeand21.4%agraduateorprofessionaldegree.

EmploymentStatus

Alittleoverhalf(56.4%)workedfulltime,10.9%workedparttimeand2.5%heldmultiplejobs.Retireesaccountedfor10.3%.

HealthSector Alittlelessthanone‐third(31.2%)workedforahospital,clinicorpublichealthdept.Race 90.3%self‐identifiedasWhite/Caucasian.Householdincome

Aboutone‐third(30.7%)reportedhouseholdincomes$24,999orless;one‐fifth(20.0%)between$25,000and$49,999,15.1%betweenonebetween$50,000and$74,999(26.1%)andalittleoverone‐quarter(27.7%)$75,000ormore.

HealthInsurance

Almostthree‐fifths(57.4%)hadhealthinsurancethroughanemployerorunion,16.8%wereonMedicare,one‐fifth(20.3%)onMedicaidand9.4%individuallypurchasedaplan.Only1.0%reportednothavinganyhealthinsurance.

Hospitalsusedinpast2years

CaroCommunityHospitalwasthemostfrequentlyusedhospitalwithhalf(52.2%)oftherespondentsreportingtheyuseditinthepasttwoyears.ThiswasfollowedbyHills&DalesinCassCitywithone‐third(34.1%),andCovenantHospitalinSaginaw(28.3%).

ZIPCodes Ofthe8Zipcodes,half(49.8%)livedin48723(Caro).SurveyInstrumentandProcedures:Thesurveyinstrumentcontained34questionscoveringCommunityAssets,CommunityConcerns,DeliveryofHealthCareandDemographicInformation(AppendixA).Thesurveywasprintedandpostedonline.Eachcountydevelopedadistributionlistidentifyingpubliclocationsforenvelopesandsurveys.Surveyswerealsodistributedatmeetings.Printedsurveyscouldbeleftindropboxesor


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mailedintotheInstituteforPublicPolicyandSocialResearch(IPPSR)atMichiganStateUniversity.Theon‐lineversionofthesurveywaspostedatwww.surveymonkey.com.Surveylinkswereincludedinpressreleasesandregionalpromotionefforts.Linksweredistributedbydirectemailandforwardedtohospitalsandserviceproviderswhocouldforwardittotheirstaffandtheiremailpatientbase.SurveyswereenteredanddatasetspreparedbyIPPSR.DatawasanalyzedusingtheStatisticalPackagefortheSocialSciences(SPSS)Version20multipleresponsesetsfrequenciesandcross‐tabulations.FocusGroups:Afocusgroupof5menand8womenwasheldonSeptember27,2016from6:00‐7:30pmatCaroCommunityHospital.Thegrouprepresentedhospitalemployees,otherhealthprofessionals,schools,ISD,CountyCommission,lawenforcement,andcommunitymembers.Agesrangedfrommid/late30s‐to60s.ThegroupwasfacilitatedbySaraWright,notesbyVictoriaLantzy,bothfromtheMichiganCenterforRuralHealth.

Participantsweretold(verbally)thattheirresponseswillbetreatedinawaythatwillnotrevealtheirnameandthattheirresponseswillbecombinedwithothersinanyreports.Theyweretoldthatduetotheclosenessofthecommunity,completeconfidentialityinreportingtheirresponsescannotbeensured.

Thefacilitatorfollowedascript(seeAppendixE)andengagedthegroupinseveralproceduresincludingaskingparticipantstoreviewandcommentonalistofpotentialhealthconcernsthatmayaffectthecommunityasawhole;usingpostitnotesonaneaselpad;andgroupdiscussion/brainstorming.APowerPointpresentationviaaprojectorwasusedtoshowthequestioninthefrontoftheroomaswellasverbally.Aprioritizationprocesswasnotconductedsincethatwillhappeninthefollowupfocusgroupafterthesurveyandinitialreportissharedandreviewed.

StakeholderInterviews:TheTuscolacountycommitteeselectedthreeorganizationsforinputandsuggestedanindividualattheseorganizations.Theindividualsinterviewedagreedandprovidedconsenttoparticipateandhavetheirnameincludedinalistofinterviewparticipants.Individualsparticipatingininterviewsbutwereassuredthattheirresponseswouldnotbeconnectedtotheirname.KayBalcer,ofBalcerConsultingandPreventionServicesconductedtheinterviewsinperson,andSaraWrightofMichiganCenterforRuralHealthtooknotesviaphone.Theinterviewfollowedasimilarscriptaswasusedforthefocusgroups.


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SecondaryDataTable1:MajorDataSourcesforCHNA

PublicHealthStatistics

Source/Participants

URLorCitation DatesofData

AdditionalDescriptors

UnitedStatesCensusBureau

http://quickfacts.census.gov

2010 IncludesdatafromtheAmericanCommunitySurvey(5‐yearaverages),CensusDemographicprofilesfromthe2010Census,andsubtopicdatasets.

MichiganLaborMarket

http://www.milmi.org 2016 UnemploymentData

MichiganDepartmentofCommunityHealth

http://milmi.org/cgi/dataanalysis/?PAGEID=94

2000to2014

Daterangesvariedbyhealthstatistic.Somestatisticsrepresentoneyearofdataasothersarelookingat3or5yearaverages.

MichiganBehavioralRiskFactorSurvey

http://www.michigan.gov/mdch/0,1607,7‐132‐2945_5104_5279_39424‐‐‐,00.htmlandwww.trhn.org

2003‐2015

Localdataavailablefor2003and2008only.CountydatathatismorerecentwaspulledfromCountyHealthRankings.

HealthResources&ServicesAdministration(HRSA)

http://bhpr.hrsa.gov/shortage/ 2016 ShortagedesignationsaredeterminedbyHRSA.

MichiganProfileforHealthyYouth(MIPHY)

http://michigan.gov/mde/0,1607,7‐140‐28753_38684_29233_44681‐‐‐,00.html

2014 Localdatafromsurveysof7th,9th,and11thgradestudentsiscomparedtocountydata.StateandnationaldatausingtheMIPHYwasnotavailable.9th‐12thgradeYouthBehaviorRiskFactorsurveydatawasusedforstateandnationalstatistics.

CountyHealthRankings

www.countyhealthrankings.org 2005to2013

Includesawidevarietyofstatistics.Manystatisticsrepresentacombinedscoreandreflectmultipleyearsofdata.

KidsCount http://www.mlpp.org/kids‐count/michigan‐2/mi‐data‐book‐2016

2016 IncludesavarietyofdatafromMichiganDepartmentofCommunityHealth,DepartmentofHumanServices,andDepartmentofEducation.

HealthcareUtilizationData

CommunitySurvey

CommunitySurvey 207communitymembersparticipatedinsurvey.

2016 Questionsincludedratingdraftpriorities,openendedquestions,andinputonthecurrenthealthcareservicesprovidedinthecommunity.

FocusGroup/StakeholderInterviews

FocusGroup 13communitymembersparticipatedinfocusgroup

2016 Meetingincludeddiscussionofquestionsthatwerealsoutilizedinindividualinterviews.

IndividualInterviewsandFocusGroups

2016FocusGroupParticipantsandKeystakeholders

2016 Resultsfrominterviews&meetingswereincludedinsurveyreport.

LimitationsThesurveyemployedanon‐probabilitysampling,combiningconveniencesamplingwithpurposive(judgmental)sampling.Surveyswereavailableon‐lineandpapersurveysweredistributedatavarietyoflocations.Thisresultedinsomeskeweddemographics.Respondentsweredisproportionatelyfemale(78.3%),hadsomecollege


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degree(61.2%),and27.7%hadhouseholdincomesof$75,000ormore.Alittlelessthanone‐third(31.2%)workedforahospital,clinic,orpublichealthdepartment.Censusinformationongender,educationandincomearegroupedbycensustractswhicharenotalwayscongruentwithZIPcodes.Itisnotpracticabletoadjustthesurveyresponsesforgender,educationandincomeforthenineZIPcodes.However,thiscouldbedoneatthecountylevel.Surveyswereavailableonlineandpapersurveysweredistributedatavarietyoflocations.Thisresultedinsomeskeweddemographics.Respondentsweredisproportionatelyfemale(78.3%),hadsomecollegedegree(61.2%),andone27.7%hadhouseholdincomesof$75,000ormore.Alittlelessthanone‐third(31.2%)workedforahospital,clinic,orpublichealthdepartment.

FindingsCompaniondocumentsareavailablefortheinformationincludedinthisreport.Thefollowingpagessummarizethekeyinformationutilizedbythecommittee.Informationhasbeenorganizedintothreecategories;howevermostofthedataisinter‐related.AccesstoCare

Table2containsresponsestoQ17.Pleaseratehowmuchthefollowingissuespreventyouorothercommunityresidentsfromreceivinghealthcare.Responseswereonafourpointscalefrom1=notaproblemto4=majorproblem.Meansandstandarddeviationswerecalculatedforeach.

Table2:Q17Issuesthatpreventreceivinghealthcare

Inthistable,ahighermeanscoreindicatesahigherperceivedproblem.

N Mean

μ

Std.Deviation

Q17.Notenoughspecialists 193 2.55 1.35

Q17.Notenougheveningorweekendhours 197 2.51 1.28

Q17.Notenoughdoctors 191 2.42 1.31

Q17.Notabletogetappointment/limitedhours 198 2.29 1.14

Q17.Don’tknowaboutlocalservices 193 2.27 1.20

Q17.Can’tgettransportationservices 198 2.26 1.25

Q17.Distancefromhealthfacility 195 2.21 1.15

Q17.Notacceptingnewpatients 195 2.08 1.20

Q17.Notabletoseesameproviderovertime 194 1.99 1.20


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Q17.Poorqualityofcare 192 1.85 1.13

Q17.Barrierstoaccessingveteransservices 196 1.76 1.39

Q17.Lackofdisabilityaccess 194 1.55 1.07

Q17.Iamafraidortoouncomfortabletogo 189 1.52 1.11

Q17.Limitedaccesstotelehealthtechnology 196 1.48 1.33

Q17.Concernsaboutconfidentiality 197 1.48 0.96

Q17.Ihaveother,moreimportantthingstodo 193 1.33 1.08

Q17.Don’tspeaklanguageorunderstandculture 194 1.18 0.76

Thetablerevealsthatthetopthreeissuesthatpreventreceivinghealthcarewerenotenoughspecialists(meanofμ=2.55),notenougheveningorweekendhours(μ=2.51),andnotenoughdoctors(μ=2.42).Thesewereconsideredtobebetweenaminorandmajorproblem.Minorproblemswerenotabletogetappointment/limitedhours(μ=2.29),don’tknowaboutlocalservices(μ=2.27),can’tgettransportationservices(μ=2.26),anddistancefromhealthfacility(μ=2.21).

Thetopthreerefertothesupplyofphysicianswhichishighlydependentontheratioofphysicianper100,000population.This,combinedwithissuesoftransportationanddistancefromhealthfacility,reflectstheruralnatureofTuscolaCounty,whichhadapopulationof55,729in2010.2

Table3containsresponsestoQ16:“Whatcostconsiderationspreventyouorothercommunityresidentsfromreceivinghealthservices?”RespondentswereencouragedtochooseALLthatapply.

Table3showsthatthenumberonecostconsiderationpreventingreceivinghealthserviceswashighdeductibleorco‐paywithone‐third(33.9%)oftheresponsesandchosenbythree‐quarters(74.2%)oftherespondents.Thesecondlargestwasnothavinginsurancewith18.9%oftheresponsesandchosenbytwo‐fifth(41.4%)oftherespondents.

TABLE3Q16.Costconsiderationspreventreceivinghealthservices

Timeschosen

Percenttimeschosen

PercentofRespondentschoosing

Q16aQ16.Highdeductibleorco‐pays 138 33.9% 74.2%

Q16.Noinsurance 77 18.9% 41.4%

2 Popula on of Michigan Coun es 2000 and 2010. Available at h p://www.michigan.gov/cgi/0,1607,7‐158‐54534‐252541‐‐,00.html


16

Q16.Insurancedeniesservices 67 16.5% 36.0%

Q16.NotaffordableServices 64 15.7% 34.4%

Q16.Providersdonottakemyinsurance 61 15.0% 32.8%

Total 407 100.0% 218.8%

a.Dichotomygrouptabulatedatvalue1.

Itisnotsurprisingthatasolidmajority(74.2%)ofrespondentspickedhighdeductiblesandcopays.Intheory,bothdeductiblesandcopaysarecostsharingdevicesdesignedtopreventpolicyholdersfrommakingsmallnuisanceclaimsorseekinghealthcareunnecessarily.Thechargeshavetobejustlargeenoughtoinfluencepeople'sdecisions,andnotsobigastokeeppeoplefromgettingthecaretheyneed.Consumersareaskedtodecideaheadoftimebetweenplansthathavelowerpremiumsbuthigherdeductible(whichtheywouldpreferiftheyarelesslikelytoneedhealthcare)vshigherpremiumsbutlowerdeductibles(whichtheywouldpreferiftheyaremorelikelytoneedhealthcare).Theoretically,thisbalancesriskwithcost.3Unfortunately,thecostsofpremiums,deductiblesandcopayshavesteadilyincreased,makingcostadeterminingfactorinobtaininghealthinsurance.

IntermsofCHNAimplementation,althoughhospitalsandhealthdepartmentsmayadjusttheirowncopays,theyhavealmostnoabilitytochangeinsurancedeductibles.

Althoughonly1.0%ofrespondentsansweredthattheyhadnohealthinsurance,41.4%thoughtthatnothavinginsurancepreventsthemselvesorcommunityresidentsfromreceivinghealthservices.ThisismorethandoubletheCensusBureau’s2014estimate4of15.1%to20.0%uninsuredinTuscolaCounty.Thequestionmayreflectaconcernwiththecostsofpurchasinghealthinsurancethroughhealthcare.govratherthanindirectlymeasuringthepopulationnothavinganyhealthinsurance.

CommunityConcerns

Thesurveyaskedquestionsaboutfiveareasofconcerns.ThetopconcernsaresummarizedfromthelistedtablesinAppendixC.

3 Kunreuther, H. and Pauly, M. (2005). Insurance Decision‐Making and Market Behavior. Founda ons and Trends® in Microeconomics. 1:2 p 63‐127. 4 US Census Bureau 2014 Small Area Health Insurance Es mates (SAHIE) Insurance Coverage Es mates: Percent Uninsured: 2014 h p://www.census.gov/did/www/sahie/data/files/F4_Map.jpg


17

Theconcernsaboutthecommunity’shealthincluded: Table5.Q7

Accesstohealthyfood Assistanceforlow‐incomefamilies Awarenessoflocalhealthresourcesandservices Accesstoexerciseandfitnessactivities Understanding/NavigatingHealthcareReform

Concernsaboutthequalityoflifeinthecommunity: Table6.Q8

Jobswithlivablewages Attractingandretainingyoungfamilies Affordablehousing Adequateschoolresources

Concernsaboutavailabilityofhealthservices: Table7.Q9

Availabilityofdoctorsandnurses Abilitytogetappointments Availabilityofsubstanceabuse/treatmentservices Availabilityofdentalcare Availabilityofmentalhealthservices

Concernsaboutthecommunity’ssafetyandenvironment: Table8.Q10

Publictransportation(optionsandcost) Waterquality(i.e.wellwater,lakes,rivers) Crimeandsafety Emergencyservicesavailable24/7

Concernsaboutthedeliveryofhealthservices: Table9.Q11

Costofhealthinsurance Costofhealthcareservices Abilitytoretaindoctors,nurses,andotherhealthcareprofessionals Costofprescriptiondrugs

ConcernsrelatedtoVulnerablePopulations

OnepurposeoftheCHNAistoaddressperceptionsandconcernsofandaboutvulnerablepopulations.Vulnerablepopulationsincludeyouth,seniors,females,loweducation,lowincomeandrace/ethnicity.


18

Thesurveyinstrumentaskedallrespondentsfortheirconcernsaboutyouthandseniors(seeAppendixC).

Table4belowshowsthatthelargestconcernaboutyouthphysicalhealthwasyouthobesity,whichaccountedforone‐quarter(26.1%)oftheresponses.Itwasselectedbyalittleoverone‐third(35.7%)oftherespondents.Thesecondlargestconcernwasyouthhungerandpoornutrition,chosen22.4%ofthetimeandselectedby30.6%oftherespondents.

Table4.Q12bTop3concernsphysicalhealthinyourcommunity(youthfrequencies)

Timeschosen

Percenttimeschosen


Q12ba

Q12b.Youthobesity 35 26.1% 35.7%

Q12b.Youthhungerandpoornutrition 30 22.4% 30.6%

Q12b.Wellnessanddiseaseprevention,includingvaccine‐preventable 25 18.7% 25.5%

Q12b.Teenpregnancy 23 17.2% 23.5%

Q12b.Youthsexualhealth(includingsexuallytransmitteddiseases) 21 15.7% 21.4%

Total 134 100.1% 136.7%

a.Dichotomygrouptabulatedatvalue1.

Table5showsthatthelargestconcernwithyouthmentalhealthandsubstanceabusewith26.1%oftheresponseswasyouthdruguseandabuse(includingprescriptiondrugabuse).Itwaschosenbyalmosthalf(47.3%)oftherespondents.Thesecondlargestconcern(25.6%oftheresponses)wasyouthbullyingcheckedby46.6%oftherespondents.

Table5.Q13bTop3concernsmentalhealthsubstanceabuseinyourcommunity(youthfrequencies)


19

Timeschosen

Percenttimeschosen


Q13ba

Q13b.Youthdruguseandabuse(includingprescriptiondrugabuse) 62 26.1% 47.3%

Q13b.Youthbullying 61 25.6% 46.6%

Q13b.Youthalcoholuseandabuse(includingbingedrinking) 36 15.1% 27.5%

Q13b.Youthmentalhealth 35 14.7% 26.7%

Q13b.Youthsuicide 22 9.2% 16.8%

Q13b.Youthtobaccouse(includingexposuretosecond‐handsmoke) 22 9.2% 16.8%

Total 238 99.9% 181.7%

a.Dichotomygrouptabulatedatvalue1

AsshowninTable6,below,thetopconcernwiththeseniorpopulationintheircommunitywasthecostofmedicationswith17.5%oftheresponse).Itwaschosenbyhalf(52.7%)oftherespondents.Thesecondlargestat15.7%oftheresponsesandselectedby47.3%oftherespondentswastheavailabilityofresourcestohelptheelderlystayintheirhomes.Thethirdlargestconcernwastransportation(12.1%)chosenbyalittlemorethanone‐third(36.5%)oftherespondents.Table6.Q14Top3concernsaboutseniorpopulationinyourcommunity

Timeschosen Percenttimeschosen


Q14a

Q14.Costofmedications 107 17.5% 52.7%Q14.Availabilityofresourcestohelptheelderlystayintheirhomes 96 15.7% 47.3%Q14.Transportation 74 12.1% 36.5%Q14.Availabilityofresourcesforfamilyandfriendscaringfor 61 10.0% 30.0%Q14.Assistedlivingoptions 55 9.0% 27.1%Q14.Dementia/Alzheimer’sdisease 55 9.0% 27.1%Q14.Availabilityofactivitiesforseniors 50 8.2% 24.6%Q14.Hungerandpoornutrition 39 6.4% 19.2%


20

Q14.Long‐term/nursinghomecareoptions 38 6.2% 18.7%Q14.Elderabuse 21 3.4% 10.3%Q14.Costofactivitiesforseniors 15 2.5% 7.4%Total 611 100.0% 300.9%

a.Dichotomygrouptabulatedatvalue1

Anadditionalanalysisexaminedthetopconcernsofrespondentswhoself‐identifiedasmembersofvulnerablepopulations:lowincome,loweducation,seniorsandfemales(seeAppendixD).

Income

Respondentswithhouseholdincomeslessthan$25,000weremorelikelythanthosewithhigherincomestobeconcernedabout:

Assistanceforlowincomefamilies Affordablehousing Availabilityofdentalcare Crimeandsafety Availabilityofaffordabledentalcare Wellnessanddiseaseprevention

Respondentswithhouseholdincomeslessthan$25,000werelesslikelythanthosewithhigherincomestobeconcernedabout:

UnderstandingandnavigatingHealthcareReform Availabilityofsubstanceabuseandtreatmentservices Publictransportationandwaterquality Retainingdoctorsandhealthcareprofessionals Youthdruguseandabuse

Education

Respondentswithahighschooleducationorlessaremorelikelythanthosewithmoreeducationtobeconcernedabout:

Affordablehousing Costofhealthcareservices Youthhungerandpoornutritionandwithwellnessanddiseaseprevention

Respondentswithhighschooleducationorlesswerelesslikelythanthosewithmoreeducationsbeconcernedabout:

Adultdruguseandabuse


21

Seniors

Respondents58yearsofageorolderaremorelikelythanyoungerrespondentstoconcernedabout:

Changeinpopulationsize Wellnessanddiseaseprevention,includingvaccinepreventableconditions Youthmentalhealth

Respondents58yearsofageorolderwerelesslikelythanyoungerrespondentstobeconcernedabout:

Youthsexualhealth Youthalcoholuseandabuse

Gender

Femalesweremorelikelythanmalestobeconcernedabout:

Youthsexualhealth Adultdruguseandabuse

Femalesareslightlymorelikelythanmalestobeconcernedabout:

Accesstoexerciseandfitnessactivities

Malesweremorelikelythanfemalestobeconcernedabout:

Prejudiceanddiscrimination Diabetes Wellnessanddiseaseprevention Youthdruguseandabuse Dementia/Alzheimer’sdisease


22

SecondaryDataThefollowingThumbReportCardillustrateshoweachcountycomparestodatafromthestate.

Source Indicator Year Michigan Huron Sanilac Tuscola

CHR

HealthOutcomes(countyrank) 41 33 28

CHR LengthofLife(countyrank) 41 51 36CHR YearsofPotentialLifeLostper100,000 2011‐2013 7,200 7,100 7,300 6,900CHR AgeAdjustedMortalityper100,000 2011‐2013 360 350 360 350MDCH HeartDiseaseDeaths 2012‐2014 199.3 203.3 233.2 196.9MDCH CancerRelatedDeaths 2012‐2014 173 176.9 164.5 176.4MDCH DiabetesRelatedDeaths 2012‐2014 73.7 86.1 84.4 65.9MDCH DeathsduetoSuicide 2010‐2014 13.2 14.6 18.5 13.1CHR ChildMortality(under18)per100,000 2010‐2013 50 50 40 50CHR InfantMortality(underage1)per1000 2006‐2012 7 NA NA NA

CHR QualityofLife(countyrank) 40 19 23

CHR PoororFairHealth 2014 16% 14% 13% 13%

CHRAverage#ofPoorphysicalhealthdays(Inpast30days)

2014 3.9 3.5 3.4 3.5

CHRFrequentphysicaldistress(>14days‐past30whenphysicalhealthwasnotgood)

2014 12% 11% 10% 11%

CHRAverage#ofPoormentalhealthdays(Inpast30days) 2014 4.2 3.6 3.6 3.7

CHR

FrequentMentalHealthdistress(>14days‐past30whenmentalhealthwasnotgood)

2014 13% 11% 11% 11%

PHY

7thgradestudentswhofeltsosadorhopelessalmosteverydayfortwoweeksormoreinarowthattheystoppeddoingsomeusualactivities‐past12months

2014H‐T2010SC

NA 20.6% NA 35.7%

PHY


2014H‐T2010SC

NA 23.9% 45.0% 34.3%

PHY


2014H‐T2010SC

NA 19.3% 34.0% 30.3%

CHR LowBirthweight(<2500grams;5lbs,8oz) 2007‐2013 8% 8% 7% 7%

MDCH CancerIncidence(AgeAdjustedRate) 2010‐2012 471.8 441.0 356.5 436.9

MDCHCardiovascularDischargesIncidence(AgeAdjusted‐AcuteMyocardialInfarction) 2011‐2013 200.3 225.2 275.8 251.6

MDCHCardiovascularDischargesIncidence(AgeAdjustedRate‐CongestiveHeartFailure)

2011‐2013 284.8 245.2 260.2 288.1

MDCH CardiovascularDischarges(Stroke) 2011‐2013 226.4 218.7 207.0 225.2

MDCH DiabetesDischargesIncidence 2011‐2013 183.0 122.7 176.2 138.8

CHRDiabetesPrevalence**(age20+diagnosedwithdiabetes,2012) 2012 10% 11% 11% 10%


23

CHR HIVPrevalence2012)per100,000 2012 178 18 42 26


CHR HealthFactors(countyrank) 17 49 43CHR HealthBehaviors(countyrank) 16 53 41CHR AdultObesity**(BMI>30) 2012 31% 31% 34% 31%

PHY7thGradeObesity(>95thand85thpercentile)

2014H‐T2010SC

NA 12.9%/13.4% 16.3%/14.3% 13%/16.8%


2014H‐T2010SC NA 13.6%/18.4% 18%/16.9% 20.3%/18.7%


2014H‐T2010SC

NA 15.3%/24.1% 17.1%/19% 19.3%/15.8%

0‐8 Obesityamonglowincomechildren 2014 13% 12% 11% 11%

CHR

LimitedAccessToHealthyFoods:%oflowincomewhodon'tliveclosetogrocerystore

2010 6% 11% 2% 3%

CHR

Indexoffactorsthatcontributetoahealthyfoodenvironment,0(worst)to10(best).

2013 7.1 6.9 7.7 7.6

CHRFoodInsecurity(didnothaveaccesstoreliablesourceoffoodinthepastyear)

2013 16% 14% 15% 15%

CHRPhysicalInactivity:noleisure‐timephysicalactivity.

2012 23% 28% 22% 30%

PHY7thGrade‐60minutesofphysicalactivityforatleast5of7pastdays.

2014H‐T2010SC NA 24.6% 58.0% 59.5%


2014H‐T2010SC

NA 38.4% 62.7% 66.5%


2014H‐T2010SC

NA 26.7% 36.4% 47.6%

CHR

%ofindividualsinacountywholivereasonablyclosetoalocationforphysicalactivitysuchasparks.

2010&2014

84% 53% 13% 43%

CHR AdultSmoking(everydayormostdays) 2014 21% 16% 18% 17%

PHY7thGradeyouthwhosmokedcigarettesduringthepast30days

2014H‐T2010SC

NA 0.9% 5.1% 2.4%


2014H‐T2010SC NA 8.1% 15.7% 11.0%


2014H‐T2010SC

NA 21.5% 19.6% 18.7%

0‐8LiveBirthstoWomenWhoSmokedDuringPregnancy

2011‐2013 21.6% 24.7% 26.3% 32.9%

CHRExcessiveDrinking(Binge‐5+drinksordailydrinking) 2014 20% 19% 20% 21%

CHRAlcoholImpairedDrivingDeaths(%ofalldrivingdeaths)

2010‐2014 30% 27% 36% 39%

PHY7thgradestudentswhohadatleastonedrinkofalcoholduringthepast30days

2014H‐T2010SC

NA 4.8% 6.1% 9.3%


2014H‐T2010SC NA 24.4% 32.2% 21.2%


24


2014H‐T2010SC NA 48.2% 46.2% 38.6%


PHY7thgradestudentswhousedmarijuanaduringthepast30days

2014H‐T2010SC NA 1.4% 1.0% 3.5%


2014H‐T2010SC

NA 6.2% 5.1% 11.3%


2014H‐T2010SC

NA 17.8% 13.9% 21.0%

CHRDrugOverdoseDeaths:drugpoisoningdeathsper100,000 2012‐2014 16 NA 14 12

CHR

DrugOverdoseDeathsModeled:estimateofthenumberofdeathsduetodrugpoisoningper100,000

2014 18 6.1‐8.0 12.0‐14.0 12.0‐14.0

CHRMotorVehicleCrashDeaths:trafficaccidentsinvolvingavehicleper100,000 2007‐2013 10 11 16 17

CHRSexuallytransmittedinfections:diagnosedchlamydiacasesper100,000 2013 453.6 141.7 158.5 217.7

PHY7thgradestudentswhoeverhadsexualintercourse

2014H‐T2010SC

NA 4.5% 4.0% 9.7%


2014H‐T2010SC

NA 14.4% 29.0% 17.5%


2014H‐T2010SC NA 41.3% 51.1% 43.9%

CHRTeenBirths(#ofbirthsper1,000femalepopulation,ages15‐19)

2007‐2013 29 21 25 26

MDCHPercentofTotalBirthstoMothersAge<20

2011‐2013 7.8 6.3 7.3 7.5

CHRInsufficientSleep:adultswhoreportfewerthan7hoursofsleeponaverage 2014 38% 32% 30% 32%

CHR ClinicalCare(countyrank) 48 75 71

CHRUninsured:<65thathasnohealthinsurancecoverage 2013 13% 15% 15% 14%

CHR

UninsuredAdults:18to65thathasnohealthinsurancecoverageinagivencounty

2013 16% 18% 19% 18%

CHRUninsuredChildren:<19thathasnohealthinsurancecoverage 2013 4% 6% 6% 4%

CHR

Healthcarecosts:price‐adjustedMedicarereimbursements(PartsAandB)perenrollee

2013 $10,153 $10,391 $10,117 $10,808

CHR

PrimaryCare:ratioofthepopulationtototalprimarycarephysicians.Higher=lessaccess

2013 1,240:1 1,530:1 3,490:1 3,190:1

CHR

RatioofotherPrimaryCareProviders:nursepractitioners(NPs),physicianassistants(PAs),andclinicalnursespecialists

2015 1,342:1 1,458:1 2,079:1 2,348:1


25

CHRDentists:ratioofthepopulationtototaldentists.Higher=lessaccess 2014 1,450:1 2,290:1 3,470:1 2,840:1


26


CHR

MentalHealth:ratioofthepopulationtototalmentalhealthproviders.Higher=lessaccess

2015 450:01:00 1,280:1 670:01:00 430:01:00

HPSA

ProviderShortageDesignations Varies NAPrimaryCare

DentalMentalHealth

PrimaryCareDentalMentalHealth

PrimaryCareDental

MentalHealth

0‐8LiveBirthstoWomenWithLessThanAdequatePrenatalCare

2011‐2013 29.9% 16.0% 29.7% 24.3%

0‐8ToddlersAges19‐35MonthsWhoAreImmunized4:4:1:3:3:1:4

2014 73.8% 73.3% 75.0% 73.9%

CHR

PreventableHospitalStays:dischargerateforambulatorycare‐sensitiveconditionsper1,000Medicareenrollees

2013 59 52 72 72

CHR

DiabeticMonitoring:Medicareenrolleesages65‐75thatreceiveHbA1cmonitoring

2013 86% 85% 87% 83%

CHR

MammographyScreening:femaleMedicareenrolleesages67‐69thatreceivemammographyscreening

2013 65% 66% 64% 64%

CHRSocial&EconomicFactors(countyrank) 12 35 32

CHRHighSchoolGraduation:%ofstudentswhograduatehighschoolinfouryears. 2012‐2013 78% 90% 87% 80%

CHR

SomeCollege:adultsages25‐44withsomepost‐secondaryeducation;nodegree

2010‐2014 66% 54% 52% 57%

0‐8BirthstoMothersWithoutaHighSchoolDiploma/GED 2011‐2013 13.8% 10.3% 17.0% 10.9%

KC Childrenage3‐4enrolledinpreschool. 2009‐2013 47.5% 57.9% 48.0% 45.5%

0‐8Changeinlicensedchildcareproviders

From2011‐2015 NA ‐2 ‐3 ‐13

CHRUnemployment:ages16+butseekingwork

2014 7.30% 6.80% 8.40% 8.50%

CHR

MedianHouseholdIncome:halfthehouseholdsearnmoreandhalfthehouseholdsearnlessthanthisincome.

2014 $49,800 $41,700 $42,100 $43,200

CHR

Incomeinequality:Higherinequalityratioindicatesgreaterdivisionbetweenthetopandbottomendsoftheincomespectrum

2010‐2014 4.7 4.1 3.9 3.7

CHR ChildrenInSingleParentHouseholds 2010‐2014 34% 33% 26% 27%

CHR

ChildrenEligibleForFreeLunch:%enrolledinpublicschoolseligibleforfreelunch

2012‐2013 42% 39% 44% 49%

CHRChildreninPoverty:underage18livinginpoverty

2014 23% 21% 23% 24%


27

Alice

ALICElevel:householdsabovepovertylevel,butlessthanthebasiccostoflivingforcounty.

2014 NA 27% 27% 22%

census Povertyrate‐USCensus 2014 16.9% 15.5% 15.6% 15.3%


0‐8

Rateper1,000ChildrenAges0‐8WhoAreSubstantiatedVictimsofAbuseorNeglect

2014 20.6 13.0 24.1 25.2

0‐8

Changeinrateper1,000ChildrenAges0‐8SubstantiatedVictimsofAbuseorNeglect

From2010to2014

2.6 ‐6.6 4.6 6.9

0‐8Rateper1,000ofChildrenAges0‐8inFosterCare

2014 5.9 5.7 10.3 5.8

PHY

7thgradestudentswhohaveseenstudentsgetpushed,hit,orpunchedoneormoretimesduringthepast12months

2014H‐T2010SC NA 62.1% 89.2% 71.6%

PHY


2014H‐T2010SC NA 57.7% 82.0% 60.9%

PHY


2014H‐T2010SC

NA 51.9% 75.7% 52.0%

CHRViolentCrime:offensesthatinvolveface‐to‐faceconfrontationper100,000.

2010‐2012 464 123 196 177

CHR Homicides:deathsper100,000 2007‐2013 7 NA NA NA

CHRInjuryDeaths:intentionalandunintentionalinjuriesper100,000

2009‐2013 61 60 70 56

CHR InadequateSocialSupport‐adults 2005‐2010 20% 14% 20% 16%

CHRSocialassociations:numberofassociationsper10,000population

2013 10.2 23.3 13.2 14.6

CHR

ResidentialSegregationBlackWhite:degreetowhichliveseparatelyinageographicarea(0integrationto100segregation)

2010‐2014 74 NA 57 62

CHR

ResidentialSegregationnonwhite‐white:degreetowhichliveseparately(0integrationto100segregation)

2010‐2014 61 32 24 21

CHRPhysicalEnvironment(countyrank)

24 29 47

CHRAirPollutionParticulateMatter:averagedailydensity

2011 11.5 12 12.3 12

CHR Drinkingwaterviolations:Yes=presence FY2013‐14 No No No

CHR

SevereHousingProblems:atleast1of4problems‐overcrowding,highhousingcosts,orlackofkitchenorplumbing

2008‐2012 17% 13% 14% 14%

CHR

DrivingAloneToWork:percentageoftheworkforcethatusuallydrivesalonetowork.

2010‐2014 83% 81% 77% 83%

CHRLongCommuteDrivingAlone:Greaterthan30minutes 2010‐2014 32% 22% 37% 42%


28

NOTE:TheThumbRuralHealthNetworkReportmaybebeneficialinRegionalconversationsaboutneedandalsocanshedsomelightasaregionastotrends.ThisreportdidnotincludecountyorMichigancomparisonsandthereforedidnotlendwelltoinclusioninthereportcardtable.

SourceKey CHR‐CountyHealthRanking 0‐8‐Birthto8Indicators PHY‐MichiganProfileforHealthyYouth HPSA‐HealthProviderShortageArea MDCH‐MichiganDepartmentofCommunityHealth AR‐AliceReport ALICE‐AssetLimitedIncomeConstrainedEmployed KC‐KidsCount


29

IdentifiedNeeds&Priorities

PrioritizationProcessACHNAhelpstodirectresourcestotheissuesthathavethegreatestpotentialforimprovingthehealthofthecommunity.Successfullyaddressingpriorityissuesincreaseslifeexpectancy,improvesqualityoflife,andresultsinasavingstothehealthcaresystem.

ImplementationMeetingCaroCommunityHospitalbegantheprioritizationprocessbyreviewingthedatadescribedinthefindingssectionofthisreport.TheImplementationmeetingincluded8menand6women;frombothCaroCommunityHospital’sBoardofDirectorsandinternalhospitalleadership.Themeetingparticipantsalsoreviewedthefollowlistofconcernsrevealedinfocusgroups:

Table7TopconcernsoffocusgroupbytopicCaroCommunityHospital:

o Community/EnvironmentalConcerns Poverty (9)(*6) Notenoughjobswithlivablewages,notenoughtoliveon (7)(*5) Attractingandretainingyoungfamilies (6)(*4) Notenoughpublictransportation,costofpublictransportation(5)(*3) Childabuse (5) Physicalviolence,domesticviolence,sexualabuse (4)

o Physical,mentalhealth,andsubstanceabuseconcerns(adults)

Druguseandabuse(includingprescriptiondrugabuse) (9)(*5) Obesity/overweight (9)(*4) Poornutrition,pooreatinghabits (8)(*1) Alcoholuseandabuse (7)(*1) Cancer (6)(*2) Diabetes(3)(*2) Stress (3)(*2) Suicide(3) Smokingandtobaccouse/exposuretosecond‐handsmoke (3)

o Concernsabouthealthservices

Costofhealthinsurance (10)(*3) Costofprescriptiondrugs (7)(*1) Abilitytoretaindoctorsandnursesinthecommunity(5)(*2) Availabilityofmentalhealthservices (5)(*2) Costofhealthcareservices (5)(*1) Adequacyofhealthinsurance(concernsaboutout‐of‐pocketcosts) (5)(*1) Availabilityofspecialists (5) Extrahoursforappointments,suchaseveningsandweekends (4)(*2) Qualityofcare (3)


30

o Concernsaboutyouthandchildren Youthobesity (5)(*1) Youthmentalhealth (5)(*1) Youthdruguseandabuse(includingprescriptiondrugabuse)(3)(*1) Notenoughactivitiesforchildren/youth (3) Youthhungerandpoornutrition (2)(*2)

o Concernsabouttheagingpopulation

Availabilityofresourcestohelptheelderlystayintheirhomes (5) Beingabletomeetneedsofolderpopulation (4) Assistedlivingoptions(4)

Keyinformationinterviewresultswereutilizedtoconfirmconcernsidentifiedinotherdataandtoidentifyotherpotentialareasofconcern.Themeetingparticipantsusedaprioritizationprocessthatincludedanalysisofissueslocatedinmultipledatasources.

POTENTIALNEEDSInAlphabeticalorder

(Combinedindicatorsfromsurveys,focusgroups,andsecondarydata)

=Notmeeting

stateaverage

=CountyNeedbasedondata

=CountyNeedbasedoninterview

Focusgroup

=Survey

VOTEforyourtop5(1topchoice,5lowest)

1. AbuseandViolenceincludingBullying

o

2. AccesstoDentalHealthcareandProviders

o

4

3. AccesstoEmergencyCare o 4. Accesstoinhomehealthcare

andsupports o

5. Accesstolongtermhealthcareservices

o

6. AccesstoPrenatalCare o 7. AccesstoPrimaryHealthcare

andProviders o

10

8. AccesstoPublicHealthServicesandProviders

o

9. Accesstospecializedhealthcareservices

o

10. AccesstoVisionHealthcareandProviders

o

11. AlcoholUse/Abuse o 4

12. Cancer o

13. Diabetes o

14. Education o

15. EnvironmentalHealth o

16. FamiliesServicesandSupports o 17. HealthEducationand

Awareness o


31

18. HealthInsuranceandHealthcareCosts

o

4

19. HealthcareWorkforce o 4

20. HeartDisease

21. LocalEconomicConditions o

22. LungDiseaseandAsthma o

23. MentalHealth o 8

24. Nutrition o

25. Obesity o 26. PersonalAttitudestoHealth

andHealthcare o

27. PhysicalActivity o

28. QualityofHealthcare o

29. ReproductiveHealth o

30. SafetyandViolence o

31. SeniorSupportServices o

32. SocialConditions o

33. SocialEmotionalSupport o

34. SubstanceAbuse o

35. TeenBirths o

36. TobaccoUse (prenatal) (prenatal) o

37. TrafficSafety o

38. Transportation o


32

Assessexistingresourcesthatareaddressingpriorities

IdentifiedNeeds&AvailableResourcesThenextstepintheresourceassessmentwastogroupneedsintocategories.ThecategoriesarelistedonTable4alongwiththeresourcesthatareprovidedbythehospitalandthecommunity.

Table4:CommunityHealthNeeds&Resources

Category Need5 and Related Data Current Caro Community

Hospital Efforts Current Community Efforts

Access to Care

Need

Access to primary healthcare and providers

Access to dental health

Related Data

Not meeting state average

County need based on data

County need based on stakeholder interviews

Hospital need based on focus group

Hospital need based on survey

1. Specialty clinic offering various specialty medical providers: a. Dermatology b. Nephrology c. Cardiology d. Pulmonology e. Orthopedics f. Neurology g. Gynecology h. Endocrinology i. Oncology j. Neurosurgery k. And more

2. Primary care clinic in Caro. 3. After Hours Clinic with

evening and weekend hours opening soon

4. Students from CMU College of Medicine

5. Use of mid‐level practitioners 6. Ongoing advertising of

physicians to increase consumer awareness

County Programs 1. Adult day services and Foster Care Homes 2. Human Development Commission 3. Subsidized Housing Assistance, Independent

and Assisted Living, long term care homes 4. Region VII Area Agency on Aging and Huron

County Council on Aging 5. Legal services for seniors‐ Port Huron Office 6. A&D Home Care and BWCIL provides Nursing

Home Transition services 7. BWCIL is the Housing Assistance Resource

Agency (HARA) for the Thumb Area Continuum of Care. Provides homeless prevention and rapid re‐housing

8. Homeless Coalition‐ Emergency Shelter, security deposits rental arrearages

9. Lakeshore Legal Aid Local Programs 1. HDC‐Home delivered meals

Specialty Services

Need

Mental Health

Alcohol use/abuse Related Data





1. Referrals to local Mental Health providers through hospital and primary care

2. Invite mental health providers to Health Fairs

3. Invite Mental Health providers to host community training onsite

4. Referrals for patients to substance abuse treatment and community support groups such as AA

1. Thumb Area Unity Council: conglomeration of local Alcoholics Anonymous groups.

2. List Psychological, Thumb Area Psychological Services and Thumb Behavioral Health offer substance abuse counseling.

3. Thumb Area Psychological Services based in Cass City.

4. Thumb Behavioral Health, List Psychological and other mental health providers.

5 *indicates issue related to top community health priori es ** indicates issue related to top health system priori es


33

Hospital need based on survey

5. Substance Abuse screening and treatment referral in primary care clinics

Health Insurance & Healthcare

Costs .

Need

Health insurance and healthcare costs

Related Data





1. Financial Assistance Program 2. Working with new insurance

companies to be in their network

3. Financial Counselor 4. Payment Plans 5. Online Bill Pay 6. Annual Community Health

Fair 7. Low‐cost sports physicals for

local students 8. Program for uninsured or

those with high deductibles to get cost‐effective lab work

County Programs 10. Adult day services and Foster Care Homes 11. Human Development Commission 12. Subsidized Housing Assistance, Independent

and Assisted Living, long term care homes 13. Region VII Area Agency on Aging and Huron

County Council on Aging 14. Legal services for seniors‐ Port Huron Office 15. A&D Home Care and BWCIL provides Nursing

Home Transition services 16. BWCIL is the Housing Assistance Resource

Agency (HARA) for the Thumb Area Continuum of Care. Provides homeless prevention and rapid re‐housing

17. Homeless Coalition‐ Emergency Shelter, security deposits rental arrearages

18. Lakeshore Legal Aid Local Programs HDC‐Home delivered meals

Recruitment and

Retention

Need

Healthcare Workforce

Related Data





1. Ongoing, active recruiting efforts of medical staff

2. Competitive wage/benefit packages

3. Continually updating employee benefits package

4. Internationals 5. Medical Opportunities of MI

(MCRH)

WrittenCHNAReportandImplementationPlan TheCHNAreportwascompletedindraftforminNovember,2016.Thefinalreportwasreviewedand

postedtothehospitalwebsiteatwww.cch‐mi.orginDecember,2016. TheImplementationPlaniscurrentlyindevelopmentandwillalsobepostedtothehospitalwebsitewith

finalapprovalbytheHospitalBoardofDirectorsinDecember,2016.


2

AdditionalDocuments(AvailableUponRequest) SurveyInstrument ImplementationPlan FocusGroupDesign InterviewOutline

Survey,Stakeholder,FocusGroupReport ThumbAreaHealthStatusDataReports