Community Health Needs Assessment

Western Maryland Health SystemIn collaboration with

Allegany County Health Department2011

The Patient Protection & Affordable Care Act and the Health Care Education Reconciliation Act (known together as the Affordable Care Act) mandated…

• Development of a National Prevention & Health Promotion Strategy

• Community Health Needs Assessment by Non-Profit Hospitals in conjunction with public health entities (Section 9007)

Background

• Vision:Working together to improve the health and quality of life

for individuals, families and communities by moving the nation from a focus on sickness and disease to one based on prevention and wellness.

• Goal:Increase the number of Americans who are healthy at every stage of life.

• Strongest Predictors of health & well-being fall outside of the healthcare setting- social, economic and environmental factors all influence health.

• Encourages Partnerships among State & Local Government, Businesses, Community organizations and everyday Americans.

National Prevention Strategy

• Established to proactively plan for pending changes at federal level

• Directed State Health Department to develop State Health Improvement Plan in coordination with hospitals under Health Services Cost Review Commission

• Recommended development of interconnected state and local strategic plans to achieve improved health outcomes

• Maryland’s Health Improvement Plan 2011-2014 will provide a framework to support improvements in the health of Marylanders and their communities.

• Improving the health of all Marylanders through population planning requires commitment of local partnerships such as the hospital, local health department, private sector, etc.

Maryland Health Care Reform Coordinating Council

• Expands Community Benefit Report to Health Services Cost Review Commission (HSCRC)

• Required by Internal Revenue Service 990-Schedule H to justify non-profit status

• Guides decision making for community and allows us to engage effectively with State and Federal Initiatives

• Leads to development of Local Health Improvement Plan in partnership between the hospital and the local health department

Community Health Needs Assessment

National Priorities

Tobacco-Free Living Preventing Drug Abuse &

Excessive Alcohol Use Healthy Eating Active Living Injury & Violence Free Living Reproductive & Sexual Health Mental & Emotional Well-Being

Maryland Vision Areas

Reproductive Health Care & Birth Outcomes

Social Environments that are Safe & Support Health

Physical Environments that are Safe & Support Health

Prevent & Control Infectious Disease

Prevent & Control Chronic Disease

All Marylanders Receive Needed Health Care

National & State Plans Include:

• Engagement of Partners

• Alignment of Policies and Programs

• Utilization of Evidence Based Research & Best Practices

• Accountability

Tasks Jan-Mar‘11

Apr-Jun’11

July-Spt2011

Oct-Dec ‘11

Jan-Mar’12

Apr-Jun’12

July-Spt2012

Oct-Dec ‘12

Jan-Mar’13

Apr-Jun’13

July-Spt2013 and

beyond

Data Collection & Analysis

Presentations & Priorities

Service Line Coordination

Summary of Needs, Gaps & Resources5 Priorities, Best Practices & PartnersApprove Action Plan & Metrics

Community Benefit Report

Report to Public

Implement Plan & Report QuarterlyUpdate Timeline for Next 3 yr. cycle

WMHS Community Health Needs Assessment

Complete Remaining

FY11 FY12 FY13 FY14

WMHS Service Area

Patient Residence

July 2009-June 2010

Demographics of Community

• Poverty

• Less Educated (Fewer college graduate and illiteracy)

• Limited Diversity

• Elderly Population

• Single Parents and Responsible Grandparents

American Community Survey 2010

Community Needs Index5= Greater Community Need

Based on socio-economic barriers including income, culture, education, insurance & housing.

Comparison of CNI scores to hospital utilization shows a strong correlation between high need and high use.

Greatest Need Lowest Need21502- Cumberland - 3.8

26726 - Keyser - 3.8

26757- Romney– 3.8

21562 – Westernport – 3.6

21539 – Lonaconing- 3.6

21531 – Friendsville- 3.6

21536 – Grantsville – 3.6

21532 – Frostburg -3.6

21557 –Rawlings – 2.2

26753 – Ridgeley – 1.8

26710 – Burlington – 2.2

15539 – Fishertown – 1.2

15559 – Schellsburg – 2

15535 – Clearville - 2

Catholic Healthcare West and Thomson Reuters

Lifestyle & Environment

• Unhealthy Behaviors

• Tobacco Use

• Substance Abuse

• Limited Fruits and Vegetables

• No Physical Activity

• Poor Access to Healthy Food

• Lack of Emotional and Social Support

Tobacco & Alcohol Use

Garrett MD Mineral WV Hampshire WV Bedford PA Somerset, PA

% Adults Smoking 20 20 23 28 22

% Adults Excessive Drinking 14 11 12 9 23

County Health Ranking 2011 (U of Wisconsin)

Food Choices and Access

Garrett MD Mineral WV Hampshire WV Bedford PA Somerset PA

% Adults eating <5 fruits & vegetables a day

78.3 82.3 71.4 77.1 79.5

% Adults with access to healthy food 33 38 13 38 46

County Health Ranking 2011 (U of Wisconsin) and Health Indicator Warehouse

Physical Activity & Social Support

Garrett MD Mineral WV Hampshire WV Bedford PA Somerset PA

% Adults no leisure time physical activity

30 30 31 24 25

% Adults without emotional & social support

19 15 15 17 24

County Health Ranking 2011 (U of Wisconsin)

Well Being Index

MD 6 WV 1 WV 2 PA 9

Overall Rank 99 364 390 218

Life Evaluation 132 402 396 313

Emotional Health 264 401 399 276

Physical Health 206 403 426 320

Healthy Behavior 200 307 384 249

Work Environment 42 85 132 78

Basic Access 93 318 336 166

Ranking of 436 Congressional Districts 2010

www.well-beingindex.com

Health Needs & Disease Status

• Birth Measures

• Health Status

• Death Rates

• Incidence

• Usage

Birth Factors

Garrett MD Mineral WV Hampshire WV Bedford PA Somerset PA

Teen Birth Rate per 1000 39.4 40.2 46.9 (9.4%) (7.2%)

% No Care in First Trimester 19.6 25.3 12.6 16.7 17.9

Kids Count 2005-2011 & Vital Statistics

Tobacco & Drug Use During Pregnancy

Garrett MD Mineral WV Hampshire WV Bedford PA Somerset PA

%Tobacco use during pregnancy 17.0 22.6 23.4 22.9 20.4

MD Prenatal Risk Assessment FY10 & WV/PA Vital Statistics

Birth Weight & Infant Mortality

Garrett MD Mineral WV Hampshire WV Bedford PA Somerset PA

% Low Birth Wt. <2500 g 8.5 9.8 6.2 6.3 7.6

% Very Low Birth Wt. <1500 g 1.8 2.1 1.3 1.5 1.2

Infant Mortality (deaths per 1000 live births) 10.8 8.4 8.2 No data No data

Kids Count 2005-2011 & Vital Statistics

Health Factors

Garrett MD Mineral WV Hampshire WV Bedford PA Somerset PA

% Adults with Body Mass Index >30 29 34 33 27 32

% Adults with high blood pressure 25.9 32.5 31.2 NA 24.8

% Adults diagnosed with diabetes 10.3 10.4 10.2 7.6 8.3

County Health Ranking, 2008 CDC Trends, & Community Health Status Indicators

Self-Reported Health Status

Garrett MD Mineral WV Hampshire WV Bedford PA Somerset PA

% Adults reporting poor or fair health 17 18 18 19 14

Avg. # poor physical days in past 30 3.4 4.9 3.7 3.6 3.5

Avg. # poor mental days in past 30 3.3 3.7 3.4 3.4 3.3

County Health Ranking 2011 (U of Wisconsin)

Mental Health Prevalence

• In Allegany County, there is a 6% prevalence of mental disorders in adults and 13% prevalence among children ages 13-18

• During the first three quarters of fiscal year 2011, mental disorders have grown to be the fourth largest category of admissions at 8.01%.

• Severe depression was the 6th most prevalent reason for hospital admission in past year.

Death Rates

MD Vital Statistics & BRFSS 2009

Death Rates

Vital Statistics 2007-2009

Cancer Death Rates & Incidence

Death Rate/Trend Comparison by State/County, Death Years through 2007Allegany County, Maryland versus Maryland

All Races, Both Sexes

Above State Rate Similar to State Rate Below State Rate

RisingTrend

Priority 1: rising and above

[none]

Priority 2: rising and similar

Lung & Bronchus (Females)Non-Hodgkin Lymphoma (Males)

Priority 3: rising and below

[none]

StableTrend

Priority 4: stable and above

Lung & Bronchus (Males)

Priority 6: stable and similar

Non-Hodgkin Lymphoma (Females)Prostate (Males)

Priority 7: stable and below

[none]

FallingTrend

Priority 5: falling and above

[none]

Priority 8: falling and similar

Breast (Females)Colon & Rectum (Females)Colon & Rectum (Males)

Priority 9: falling and below

[none]

Created by statecancerprofiles.cancer.gov on 06/14/2011 12:46 pm.

Injuries

DHMH Injuries 2005-2008

Top 10 Diagnoses 2010 WMHS Emergency Department

1. Chest Pain

2. Abdominal Pain

3. Urinary Tract Infections

4. Acute Bronchitis

5. Sprain of Ankle

6. Noninfectious Gastroenteritis

7. Head Injury

8. Otitis Media (Ear Infection)

9. Sprain of Neck

10. Headache

Most Prevalent Diagnoses for WMHS Admissions

1. Natural Birth2. Coronary Atherosclerosis3. Pneumonia4. Rehabilitation Process5. Obstructive Chronic Bronchitis6. Recurring Depressive Disorder7. Osteoarthritis8. Cesarean Birth9. Chest Pain10. Atrial Fibrillation11. Acute Chronic Systolic Heart Failure12. Septicemia

July 2010-April 2011

Access to Care

• Payor Mix

• Providers

• Barriers

Payor Mix

Garrett MD Mineral WV Hampshire WV Bedford PA Somerset PA

% Uninsured under age 65 22 21 25 16 16

% receiving Medical Assistance 23.9 16.5 17.1 17.5 16.8

% Medicare Beneficiaries 19.1 20.7 18.8 21.5 21.2

% Other-Commercial Insurance, Private Pay, etc.

35 41.8 39.1 45 46

2011 County Health Ranking & Community Health Status Indicators

Payor Mix

Payor Mix

ACHD Mental Health Clinic Report 2010 PharmaCare Network 2010

Providers Needed

Top Needs:

• Primary Care

• Psychiatry

Other needs:• Medical Oncology

• Gastroenterology

• Vascular Surgery

• Urology

Dentists to provide care for adults with no insurance or Medical Assistance.

WMHS Foundation 2011

Continuum of Care & Utilization

Garrett MD Mineral WV Hampshire WV Bedford PA Somerset PA

Preventable Stays-hospitalization rate for ambulatory care sensitive conditions per 1000 Medicare enrollees

86 111 91 79 76

% 65 and over getting flu vaccine within year

61.4 68 65.5 NA 63.9

County Health Ranking 2011

Barriers

• Transportation• 11% of Allegany households are without vehicles• Allegany County Transit does not run on weekends or

major holidays.• Health Literacy• US Department of Education claims only 12% of English

speaking adults in the US have proficient health literacy skills

• Health literacy disproportionately impacts lower socioeconomic groups

• Other?

American Community Survey 2010

Overall Needs to Consider

• Economy

• Education Level

• Elderly Population

• Lifestyle Choices

• Emotional & Mental Health

• Lack of Insurance

• Transportation

• Provider Shortages

• Chronic Diseases & Risk Factors

• Healthy Pregnancy & Birth

Current Strategies

Top Community Health Priorities to Address• Tobacco Cessation (especially during pregnancy)

• Emotional & Mental Health (suicide rate and self diagnosed depression)

• Prenatal Care – Healthy Start

• Access to Care & Providers

• Health Literacy

• Screening & Prevention-Diabetes, Hypertension, Cancer

• Substance Abuse (alcohol & drugs)

• Obesity

• Immunization (flu)

• Heart disease & Stroke

• Cancer (narrow types?)

• Chronic Respiratory Disease

• Dental

Thank you!

For more information:Nancy Forlifer

WMHS Community Health & Wellness 240-964-8422

Dr. Sue RaverAllegany County Health Department

301-759-5000