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Jupiter Medical Center

Community Health Needs

Assessment

SEPTEMBER 5, 2013

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Steering Committee Members

Amy Abbott Director, Oncology Services Stacey Brandt Vice President, Marketing and Strategic Business Development Jessica Fuentes, RN, BSN Director, Case Management Betsy Heartfield, MSPT, NHA Vice President Long Term Care, Pavilion Administrator Dale Hocking, CPA Vice President Finance, Chief Financial Officer Karin Hudson, CCRN BSN NE-BC Director, Critical Care Services Margarite Mu, RN, BSN, CEN Clinical Manager, Emergency Room Amy L. Pepper, MBA Project Manager, Administration Corey T. Redlich Director, Patient Financial Services & Patient Access Steven Seeley, MSN RN CENP CEN CPHQ Vice President Chief Operating Officer, Chief Nursing Officer Terri Wentz Vice President Chief Ambulatory Care Officer Vivian Zadkovich, MSW, LCSW Oncology Support Services, Program Development Coordinator Paula M. Zalucki, FACHE Vice President, Physician Services, Committee Chair

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Acknowledgements

The community health needs assessment for Jupiter Medical Center supports the organization’s mission: To deliver excellent and compassionate health care advancing the well-being of the people we serve. The overall coordination of this project was provided by Dale Hocking, Amy Pepper, and Paula Zalucki. Their time and dedication, along with that of all the Steering Committee members, were instrumental to this project’s success. This health assessment was made possible because of the commitment toward addressing the health needs in Martin and Palm Beach Counties. Many individuals across the organization devoted time and resources to the completion of this assessment. Jupiter Medical Center would also like to thank community leaders who participated in the interviews for providing valuable information to be used in the assessment. Specially, the organization would like to thank Karen Golonka the Mayor of the Town of Jupiter; Debora Kerr the Chief Operating Officer of the Florida Public Health Institute; Dr. Alina Alonso, Director at the Florida Department of Health – Palm Beach County; and Jocelyn Skolnik, the Executive Director at El Sol. The feedback provided by these individuals through interviews and discussion has been valuable to the community health needs assessment process. In addition, the organization would like to thank Project SALUD. The Project SALUD assessment was produced and analyzed by the Rural Women's Health Project, Gainesville, FL. The Project SALUD Assessment was carried out by Project SALUD promotores de salud of El SOL between January and March of 2013. The assessment was funded by PIRSC (Program for Immigration Religion and Social Change) of the University of Florida's Center for Latin American Studies, with funding from the Ford Foundation. The Rural Women's Health Project collaborates with El SOL Jupiter's Neighborhood Center for the Project SALUD program. Betzey Rega serves as Promotor coordinator. The El SOL health program is funded by Allegany and Quantum Foundations. This community health needs assessment has been facilitated by Crowe Horwath LLP (“Crowe”). Crowe is one of the largest public accounting and consulting firms in the U.S. Crowe has significant healthcare experience including providing tax consulting and advice to hundreds of organizations across the country.

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Table of Contents Steering Committee Members ...................................................................................................................... 2Acknowledgements ...................................................................................................................................... 3I. Executive Summary .................................................................................................................................. 5

Introduction ............................................................................................................................................... 5Purpose .................................................................................................................................................... 5

II. Community Served by Jupiter Medical Center ......................................................................................... 6III. Health Profile of Community Served ....................................................................................................... 7

Population Characteristics ........................................................................................................................ 7Age Distribution ..................................................................................................................................... 8Income ................................................................................................................................................ 10Language ............................................................................................................................................ 12Race .................................................................................................................................................... 14Health Literacy .................................................................................................................................... 15Household Type .................................................................................................................................. 16Education ............................................................................................................................................ 18

Health Profile .......................................................................................................................................... 19Environment ........................................................................................................................................ 20Leading Causes of Death .................................................................................................................... 22Cancer ................................................................................................................................................. 23Heart Disease ..................................................................................................................................... 26Chronic Lower Respiratory Disease .................................................................................................... 28Unintentional Injury ............................................................................................................................. 29Stroke .................................................................................................................................................. 31Access to Health Care ........................................................................................................................ 33Insurance ............................................................................................................................................ 35Transportation ..................................................................................................................................... 39

IV. Input from Persons who Represent Broad Interests of Community ...................................................... 41Purpose .................................................................................................................................................. 41Community Leader Interviews ................................................................................................................ 41Health Survey Data from the Hispanic Community ................................................................................ 42

V. Prioritized Description of Significant Health Needs of the Community .................................................. 44Significant Health Needs Identified and Prioritized ................................................................................. 44Discussion of Significant Health Needs .................................................................................................. 44

VI. Measures and Resources Identified to Address the Significant Health Needs ..................................... 47Community Resources to Address Health Needs .................................................................................. 47 Access to Healthcare – Establishing Community Access Points .......................................................... 478

VII. Works Cited.......................................................................................................................................... 49

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I. Executive Summary Introduction Jupiter Medical Center (“JMC”) is a not-for-profit community medical center that operates a 163-bed hospital. Affiliates of JMC include Jupiter Medical Center Pavilion, a skilled nursing facility with 120 beds; Jupiter Medical Center Physicians Group, a multi-specialty physician group; and Jupiter Medical Center Foundation. JMC is comprised of an ambulatory care division, an acute care division, and a post-acute care division. JMC provides a broad range of services with specialty concentrations in oncology, imaging, orthopedics & spine, digestive health, emergency services, lung & thoracic, women’s health, weight management and men’s health. JMC has approximately 1,600 employees, 574 physicians and 600 volunteers in 2013. JMC’s mission is to deliver excellent and compassionate health care advancing the well-being of the people it serves. JMC fulfills its mission by focusing on the following core values in order to be recognized as the leading health care organization in the region: Respect, Integrity, Excellence, Stewardship, Teamwork and Lifelong Learning.

Purpose JMC conducted a Community Health Needs Assessment (“CHNA”) as required by section 501(r) of the Internal Revenue Code of 1986, as amended, which was enacted as part of the Patient Protection and Affordable Care Act of 2010. The objective of the CHNA is to identify the health needs in the community served by the hospital, and to identify ways in which JMC can help address those needs, in a manner consistent with its mission, capabilities and resources. The assessment contains a description of the community served by JMC, an analysis of data collected from primary and secondary sources, a summary of identified health needs of the community, as well as a review of current services available in the community to address the health needs. The health needs were analyzed and prioritized to determine which health needs will be addressed and incorporated into JMC’s strategic planning process. The goal is to ensure that new programs and services developed closely match the needs of the community.

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II. Community Served by Jupiter Medical Center JMC is located in Jupiter, Florida. A majority of the patients served by the hospital reside in northern Palm Beach County and southeast Martin County. Palm Beach County makes up 1,970 square miles and Martin County makes up 543 square miles (“State and County QuickFacts”). Palm Beach County is the state’s third largest county by population. Martin County is the 31st largest county out of 67 counties (“Resident Population Estimates”). The community served by JMC is defined primarily by four zip codes and secondarily by five zip codes, within Palm Beach and Martin Counties; therefore demographic and health indicators are presented for these two counties. Within the data presented in the CHNA, zip code level data is used where available, and county level data is presented where zip code level data is unavailable.

Zip Code Community Primary Service Area 33458 Jupiter 33477 Jupiter 33478 Jupiter 33469 Tequesta Secondary Service Area 33455 Hobe Sound 33410 Palm Beach Gardens 33418 Palm Beach Gardens 33408 North Palm Beach 33403 West Palm Beach

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III. Health Profile of Community Served Population Characteristics The population of the community served by JMC is shown in Table 1 below. The population of the primary service area has increased 26.53% from 2000 to 2010, and the population for the secondary service area has increased 17.21%. The population of the primary and secondary service areas is growing faster than Palm Beach and Martin Counties overall.

"Profile of General Population and Housing Characteristics: 2010 Demographic Profile

Data, Florida." American FactFinder. 2010. United States Census Bureau. Web. 11 July 2013.

Zip Code CommunityPopulation

2000Population

2010Total 2000

Total 2010

Percent Change

33458 Jupiter 33,214 49,396 33477 Jupiter 11,903 13,074 33478 Jupiter 11,315 12,704 33469 Tequesta 14,400 14,449 70,832 89,623 26.53%33455 Hobe Sound 16,513 19,980 33410 Palm Beach Gardens 27,174 32,570 33418 Palm Beach Gardens 27,391 36,017 33408 North Palm Beach 17,086 16,921 33403 West Palm Beach 12,112 12,042 100,276 117,530 17.21%Various Palm Beach County 1,131,184 1,320,134 16.70%Various Martin County 126,731 146,318 15.46%

Table 1: Population Change by Zip Code

Secondary Service AreaSource: U.S. Census Bureau, 2000 and 2010 Census

Primary Service Area

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Age Distribution

In 2010, a majority of the primary service area’s population was between the ages of 45 and 64. The elderly population (those 65 and older) makes up 20.55% of the primary service area as well as 25.43% of the secondary service area, compared to 21.79% of the population in Palm Beach County and 27.32% in Martin County. Figures 1a and 1b below show the population by age groups for both service areas compared to Palm Beach County as well as Martin County. Figure 2 shows the population by zip code by gender.

"Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2011.

Florida." American FactFinder. 2010. United States Census Bureau. Web. 11 July 2013.

-5,000

10,00015,00020,00025,00030,00035,00040,000

Popu

latio

n

AgeGroups

Figure1a:ServiceAreaAgeGroups

PrimaryServiceArea

SecondaryServiceArea

-50,000

100,000150,000200,000250,000300,000350,000400,000

Popu

latio

n

AgeGroups

Figure1b:CountyAgeGroups

PalmBeachCounty

MartinCounty

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"Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2011.

Florida." American FactFinder. 2010. United States Census Bureau. Web. 12 July2013.”

33458 33477 33478 33469 33455 33410 33418 33408 33403

25,035

6,074 6,426 6,962 9,70915,702 16,991

8,276 5,802

24,361

7,000 6,278 7,48710,271

16,868 19,026

8,6456,240

Figure2:2010PopulationbyGenderMale Female

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Income Below is a snapshot of income levels of households in Palm Beach County and Martin County as compared to the primary and secondary service areas JMC serves. Data demonstrates a correlation between health status and income. Figure 3 depicts the percent of households at each income category in both the primary and secondary service areas compared to households in Palm Beach and Martin Counties. The median household income in Palm Beach County is $52,951 and the median household income in Martin County is $53,612 compared to a national median of $47,827 (“State and County QuickFacts”).

"Income in Past 12 Months (In 2011 Inflation-Adjusted Dollars), 2011 American Community Survey 1-Year Estimates"

American FactFinder. 2010. United States Census Bureau. Web. 12 July 2013.

0.0%2.0%4.0%6.0%8.0%

10.0%12.0%14.0%16.0%18.0%20.0%

Percen

tofH

ouseho

lds

*Basedonanaverageofzipcodedata

Figure3:HouseholdIncome

Primary*

Secondary*

PalmBeachCounty

MartinCounty

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The federal poverty guidelines are a version of the federal poverty measure. They are issued each year by the Department of Health and Human Services and are a simplification of the poverty thresholds. Tables 2a and 2b show averages per service area of families and percentage of population who in the past 12 months for 2011 lived below the federal poverty level. Of families with children under the age of 18 who live in either the primary or secondary service areas, an average of 6.48% and 12.40% of those families lived below the poverty level for the primary and secondary service area, respectively. An average of 6.03% and 10.10% of the total population for the primary and secondary service areas, respectively, lived below the poverty level in 2011.

"Selected Economic Status, 2011 American Community Survey 1-Year Estimates"

American FactFinder. 2010. United States Census Bureau. Web. 5 Aug 2013.

Families with Children under 18

Families with Children under 5 All Families

P rimary S ervice Area* 6.48% 1.88% 3.85%

S econdary S ervice Area* 12.40% 18.00% 6.94%

Table 2a: Average Percentage of Families with Income in 2011 Below the Poverty Level

*Based on an average of zip codes in each service area

Under 18 18 - 64 65 and Over All ages

P rimary S ervice Area* 7.35% 6.33% 4.60% 6.03%S econdary S ervice Area* 13.52% 10.60% 5.36% 10.10%

*Based on an average of zip codes in each service area

Table 2b: Average Percentage of Population with Income in 2011 Below the Poverty Level

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Language The language spoken by a population also affects the health status of a community. Almost 85.5% and 83.4% of the primary and secondary service areas, respectively, speak only English in the home. Figure 4 shows the percent of population that speaks a language other than English in the home. For those households that don’t speak English in the home, Spanish is the most popular language in both counties, as well as in the primary service area.

"Language Spoken at Home, 2011 American Community Survey 1-Year Estimates, Florida." American

FactFinder. 2010. United States Census Bureau. Web. 11 July 2013.

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Table 3 represents the percent of households where no one age 14 or older speaks English only or English as defined as “very well.” This can have an impact on the household’s ability to understand and comprehend diagnosis information received in English and the ability to communicate while receiving or trying to receive care.

Table 3: Percent of Households Where No one age 14 and over Speaks English Only or Speaks English "Very Well"

Spanish

Speaking Households

All Households

Primary Service Area* 19.90% 2.10% Secondary Service Area* 21.78% 4.04%

Palm Beach County 31.50% 7.10%

Martin County 30.40% 3.10% *Based on an average of zip codes in each service area

"No one age 14 and over Speaks English Only or Speaks English "Very Well"" American FactFinder. 2010. United States Census Bureau. Web. 5 Aug 2013.

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Race In both the primary and secondary service areas, as shown below in Figures 5 and 6, the predominant race is White. Within the secondary service area, 8.5% of the population is African American, and 2.1% within the primary service area.

"Profile of General Population and Housing Characteristics: 2010 Demographic Profile Data, Florida."

American FactFinder. 2010. United States Census Bureau. Web. 11 July 2013.

92.5%

2.1%0.2%

2.1%0.0%

1.8%

1.4%

Figure5:PrimaryServiceArea

White(92.5%)

Black/AfricanAmerican(2.1%)

AmericanIndian/AlaskaNative(0.2%)

Asian(2.1%)

NativeHawaiian/OtherPacific(0%)

Other(1.8%)

TwoOther(1.4%)

86.5%

8.5%

0.2% 2.2%

0.3% 0.9%1.4%

Figure6:SecondaryServiceArea

White(86.5%)

Black/AfricanAmerican(8.5%)

AmericanIndian/AlaskaNative(0.2%)

Asian(2.2%)

NativeHawaiian/OtherPacific(.3%)

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Health Literacy According to the Florida Literacy Coalition, Inc. reference guide entitled, “Literacy and Health,” “functional health literacy relates the ability level of an individual to access, understand, and participate in health care for the benefit of the individual and his/her dependents.” The Florida Literacy Coalition has indicated that low levels of education are tied to high health care costs. The Coalition cited studies that found that the states that ranked in the lowest third of educational attainment also ranked the lowest on general health care. Out of all states, Florida ranks 35th in education and 42nd in health of the population (Florida Literacy Coalition). The reference guide provided by the Florida Literacy Coalition provides the following consequences of low health literacy:

• Those individuals with low health literacy incur higher health care costs. • Those individuals with low health literacy are less likely to comply with prescribed

treatment and self-care. • Individuals with low health literacy are less likely to seek preventative care and,

therefore, are at a much higher risk for hospitalization. • Those with low health literacy often cannot understand written directions for

medicines. Florida has the third lowest adult literacy level of all states, according to the Florida Literacy Coalition. Twenty percent of those age 16 and older (more than 2.6 million adults) lack the most basic reading skills according to a report issued in 2009 (Florida Literacy Coalition). In Palm Beach County, 14% of the population lacks the basic prose literacy skills, and in Martin County 11% of the population lacks those skills (Florida Literacy Coalition).

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Household Type In Palm Beach County, 61.8% of households are families, and in Martin County 63.4% of households are families. These families consist of a householder and one or more other persons related to the householder by marriage, birth, or adoption. Figures 7a-7d show the percentages for each type of household. Nonfamily households consist of people living alone and households which do not have any members related to the householder.

46%

4%12%

38%

Figure7a:HouseholdTypesofPalmBeachCounty

Husband-wifefamily

Malehouseholder,nowifepresent

Femalehouseholder,nohusbandpresent

Nonfamilyhouseholds

53%

3%

7%

37%

Figure7b:HouseholdTypesofMartinCounty

Husband-wifefamily

Malehouseholder,nowifepresent

Femalehouseholder,nohusbandpresent

Nonfamilyhouseholds

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"Selected Social Characteristics in the United States: 2007-2011 American Community Survey 5-Year Estimates, Florida." American FactFinder. 2010. United States Census Bureau. Web. 15 July 2013.

54%

4%8%

34%

Figure7c:HouseholdTypesofPrimaryServiceArea

Husband-wifefamily

Malehouseholder

Femalehouseholder

Nonfamilyhouseholds

47%

3%

9%

41%

Figure7d:HouseholdTypesofSecondaryServiceArea

Husband-wifefamily

Malehouseholder

Femalehouseholder

Nonfamilyhouseholds

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Education In JMC’s primary service area, 39.32% of the population has attained a Bachelor’s degree or higher, while in the secondary service area, 36.61% of the population has attained at least a Bachelor’s degree. Comparatively, 29.71% of the population of Palm Beach County has attained a Bachelor’s Degree or higher, and 28.02% of Martin County. Both service areas and both counties have the majority of the population with an education level of at least some college or greater. Specifically, 68.31% of the population in the primary service area, and 67.42% of the population in the secondary service area have at least some college.

"Educational Attainment: 2007-2011 American Community Survey 5-Year Estimates." American FactFinder - Results. Web. 31 July 2013.

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

PrimaryServiceArea


MartinCounty

PalmBeachCounty

Percen

tofP

opulation

Figure8:EducationAttainment

Lessthanhighschoolgraduate

Highschoolgraduate(includesequivalency)

Somecollegeorassociate'sdegree

Bachelor'sdegreeorhigher

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Health Profile Table 4 displays the health status of both Martin and Palm Beach Counties compared to the health status of Florida as well as the Healthy People 2020 goals. The Healthy People 2020 goals are science-based national objectives for improving the health of all Americans. These goals were launched in 2010 and are goals to achieve by 2020.

Martin County

How Martin County

compares to Florida

Palm Beach County

How Palm Beach County compares to

Florida

FloridaHealthy

People 2020 Goal

Health Status and Access to Care

Adults who rate their health status as "fair" or "poor"

13.4% √ 16.0% √ 17.1%

Adults who could not see a dentist in the past year because of cost

15.9% √ 16.9% √ 19.2%

Adults who received a flu shot in the past year

45.8% √ 42.5% √ 36.5%

Chronic DiseasesCoronary heart disease age-adjusted rate

60.60 √ 92.20 √ 105.80 100.80

Stroke age-adjusted death rate 24.60 √ 28.60 √ 31.40 33.80

Stroke age-adjusted hospitalization rate

191.60 √ 225.50 √ 266.60

Heart Failure age-adjusted death rate

4.10 √ 5.80 √ 8.40

Adults who have diagnosed high blood cholesterol

39.5% X 40.4% X 38.6% 13.5%

Colorectal cancer age-adjusted death rate

12.70 √ 12.00 √ 14.30 14.50

Breast cancer age-adjusted death rate

19.40 √ 20.10 √ 20.90 20.60

Prostate cancer age-adjusted death rate

17.50 √ 15.50 √ 18.00 21.20

Cervical cancer age-adjusted death rate

1.70 √ 2.10 √ 2.70 2.20

Melanoma age-adjusted death rate 2.40 √ 2.90 = 2.90 2.40

Chronic Lower Respiratory Diseases (CLRD) age-adjusted death rate

34.20 √ 26.30 √ 38.60

Unintentional Injuries

Unintentional injuries age-adjusted death rate

47.50 X 39.00 √ 41.6 36.0

Motor vehicle crash age-adjusted death rate

11.00 √ 11.00 √ 12.9 12.4

Communicable & Infectious Diseases

Vaccine preventable diseases 2.70 √ 2.80 √ 3.7

HIV/AIDS age-adjusted death rate 1.90 √ 5.90 X 5.6 3.7

TB cases reported 3.40 √ 4.70 X 4.3 1.0

Table 4: Health Status Summary

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Environment A community’s health is affected by the physical environment of the community. Access to healthy opportunities as well as a clean and safe environment can lead to improving and maintaining community health. Access to grocery stores is a large component of the physical environment of a community. Grocery stores are defined as supermarkets and smaller grocery stores primarily engaged in retailing a general line of food, such as canned and frozen foods; fresh fruits and vegetables; and fresh and prepared meats, fish, and poultry. Included are delicatessen-type establishments. Convenience stores and large general merchandise stores that also retail food, such as supercenters and warehouse club stores are excluded. As shown in Table 5, Palm Beach County falls below both the Florida and national rate of establishments per 100,000 people. The primary service area falls below the rate per population for both counties, as well as the state and national rates. This can be a contributing factor to the health and dietary behaviors of the community.

Table 5: Accessibility to Grocery Stores

Total Population

Number of Establishments

Establishment Rate per 100,000 Population

Primary Service Area 89,623 14 15.62%

Secondary Service Area 117,530 24 20.42%

Palm Beach County 1,320,134 235 17.80%

Martin County 146,318 29 19.82% Florida 18,801,310 3,601 19.15% United States 308,745,538 64,366 20.85%

"2011 ZIP Code Business Patterns (NAICS)." Censtats Database. U.S. Census Bureau. Web. 31 July 2013.

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Another factor in the physical environment of the community is access to recreation and fitness facilities as defined by North American Industry Classification System (NAICS) Code 713940. Shown below in Table 6 are the rate of recreational and fitness facilities per 100,000 people within each service area and Martin and Palm Beach counties, compared to the rates for the State of Florida overall and the national rate.

Table 6: Recreational and Fitness Facility Access

Total Population

Number of Establishments

Establishment Rate per 100,000

Population

Primary Service Area 89,623 8 8.92%


Palm Beach County, Florida 1,320,134 147 11.14% Martin County, Florida 146,318 23 15.72%

Florida 18,801,310 1,628 8.66%

United States 308,745,538 29,506 9.56% "2011 ZIP Code Business Patterns (NAICS)." Censtats Database. U.S. Census Bureau.

Web. 31 July 2013 Accessibility to fast food restaurants is also an indicator within the population’s physical environment that directly contributes to a community’s overall health and dietary behaviors. Fast food restaurants are defined as limited-service establishments primarily engaged in providing food services (except snack and nonalcoholic beverage bars) where patrons generally order or select items and pay before eating. As shown in Table 7, both Palm Beach and Martin Counties are above the Florida rates of establishments per 100,000 people.

Table 7: Accessibility to Fast Food Total

Population Number of

Establishments Establishment Rate per

100,000 Population Primary Service Area

89,623 55 61.37%


Palm Beach County 1,320,134 822 62.27%

Martin County 146,318 99 67.66%

Florida 18,801,310 11,471 61.01% United States 308,745,538 216,243 70.04%

"2011 ZIP Code Business Patterns (NAICS)." Censtats Database. U.S. Census Bureau. Web. 31 July 2013

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Leading Causes of Death The two leading causes of death in both Palm Beach and Martin Counties, as well as the primary and secondary service areas, are cancer and heart disease. Table 8 below shows the number of deaths in each of the counties as well as in the primary and secondary service areas served by JMC for 2012.

"Resident Death Counts by Year by Residence Zip code by 50 Leading Rankable Causes of Death."

Florida Charts Death Query. Florida Charts. Web. 18 July 2013.

Primary Service

Area

Secondary Service

AreaMartin County

Palm Beach County Florida

CANCER68 326 445 3,208 41,696

HEART DISEASE 65 343 359 3,549 41,643

CHRONIC LOWER RESPIRATORY DISEASE

11 72 136 629 10,525 UNINTENTIONAL INJURIES 12 68 70 533 8,561 STROKE 12 65 76 701 8,372

ALZHEIMER'S DISEASE4 33 60 354 4,379

DIABETES MELLITUS5 18 28 259 5,064

CHRONIC LIVER DISEASE AND CIRRHOSIS 4 14 27 168 2,574

PARKINSON'S DISEASE1 14 20 192 1,824

HYPERTENSION 4 10 13 106 1,944

KIDNEY DISEASE2 15 19 221 2,898

PNEUMONIA/INFLUENZA 3 17 12 149 2,304

BENIGN NEOPLASM - 9 14 104 1,117 SEPTICEMIA - 11 4 158 2,037 HIV - 4 1 65 923 HOMICIDE - 5 8 83 1,195

Table 8: Leading Causes of Death Counts

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Cancer Cancer is the first leading cause of death in Martin County, and the second leading cause of death in Palm Beach County. Table 9 shows a snapshot of cancer screenings in Martin and Palm Beach Counties compared to Florida. The percent of women age 18 and older who had received a pap test during 2010 was higher in Martin and Palm Beach Counties than the state average. However the percent of women age 40 and older who had received a mammogram was approximately 4% lower in Martin County than the state average. The data sources did not explore reasons why the cancer screenings are not being performed, but it would not be unreasonable to assume that for the vulnerable population living below the poverty level with no health insurance, cost would be a prohibitive factor in these expensive screening tests.

Table 9: Cancer Screening for 2010

CANCER SCREENING Martin County Palm Beach County Florida

% of women 18+ who received a Pap test in the past year 57.20% 61.40% 57.10%

% of women 40+ who received a mammogram in the past year 57.60% 71.20% 61.90%

% of adults 50+ who received a sigmoidoscopy or colonoscopy in the past five years

60.90% 62.60% 56.40%

% of adults 50+ who received a blood stool test in the past year 14.20% 17.90% 14.70%

"Florida Behavioral Risk Factor Data." Behavioral Risk Factor Surveillance System. Florida Charts. Web. 18 July 2013.

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Figure 9 shows the aggregate of the primary service area zip codes compared to the aggregate of the secondary service area zip codes.



0

50

100

150

200

250

300

350

2008 2009 2010 2011 2012

Figure9:DeathCountbyPrimary&SecondaryServiceAreas

PrimaryServiceArea SecondaryServiceArea

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The types of cancer deaths across Martin and Palm Beach Counties for 2012 are shown below.

"All Cancer Deaths." Florida Charts Death Query. Florida Charts.Web. 17 July 2013.

Martin County

Palm Beach County

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Heart Disease Heart disease is the first leading cause of death in Palm Beach County, and the second leading cause of death in Martin County. Heart disease includes conditions affecting the heart, such as coronary heart disease, heart attack, congestive heart failure, and congenital heart disease. Figure 10 shows the death count by each service area of JMC.

"Resident Death Counts by Year by Residence Zip code by 50 Leading Rankable Causes of

Death." Florida Charts Death Query. Florida Charts. Web. 18 July 2013.

050

100150200250300350400

2008 2009 2010 2011 2012

Figure10:HeartDiseaseDeathsbyPrimaryandSecondaryServiceAreas


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As shown in Table 10, Palm Beach County and Martin County have a higher age-adjusted rate for hospitalizations from congestive heart failure than the State of Florida average. All age adjusted rates are 3-year rates and are calculated using the 2000 U.S. Population. The death rate from heart failure is lower in Palm Beach and Martin Counties than the state average. However, there are more hospitalizations from congestive heart failure in Martin and Palm Beach Counties than the state average.

Table 10 : Heart Failure Occurrences

Age-Adjusted Rates

Heart Failure Average Annual

Occurrences Palm Beach

County Martin County Florida

Deaths 165 5.8 4.1 8.4 Hospitalizations from congestive heart failure 3,139 137.4 180 131.5 "Heart Disease Deaths." Florida Department of Health, Bureau of Vital Statistics. Florida Charts. Web. 18

July 2013.

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Chronic Lower Respiratory Disease Chronic obstructive pulmonary disease (COPD, also known as CLRD) includes emphysema, chronic bronchitis and asthma--diseases that are characterized by obstruction to air flow. The impairment in lung function resulting from COPD is largely irreversible and progressive. CLRD ranks as the third leading cause of death in the secondary service area as well as both Martin and Palm Beach Counties. CLRD ranks as the fourth leading cause of death in the primary service area. Figure 11 shows the death counts for the primary and secondary service areas for chronic lower respiratory diseases.

"Chronic Lower Respiratory Disease Deaths." Florida Charts Death Query. Florida Charts.

Web. 5 Aug 2013.

0102030405060708090

2008 2009 2010 2011 2012

Figure11:DeathCountforChronicLowerRespiratoryDiseaseDeaths

PrimaryServiceArea


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Unintentional Injury Unintentional injury ranks fifth in both Martin and Palm Beach Counties for leading cause of death. According to the Centers for Disease Control and Prevention (CDC), unintentional injuries primarily consist of falls, vehicle traffic deaths, and poisoning deaths. Motor vehicle traffic death ranks as most common within the U.S., followed by unintentional poisoning and falls. Table 11 shows Martin County having the highest age-adjusted death rate, surpassing not only Palm Beach County, but also state and national averages. Figure 12 shows death counts for unintentional injuries from 2008-2012 for both service areas. From 2011 to 2012, there has been an increase in deaths in the primary service area and also in the majority of the zip codes in the secondary service area as seen in Figure 12.

Table 11: Accident Mortality Rates 2006 - 2010

Average Annual

Deaths Crude Death

Rate*

Age-Adjusted Death Rate,

Accident Mortality*

Martin County 79 54.47 51.06 Palm Beach County 652 50.19 45.74 Florida 8,918 48.2 45.03 United States 121,217 39.89 39.07

"Unintentional Falls Deaths. Palm Beach County, Martin County, Florida." Florida Charts. Florida Department of Health. Web. 17 July. 2012.



01020304050607080

2008 2009 2010 2011 2012

Figure12:UnintentionalInjuryDeathRatesinPrimaryandSecondaryService

Areas


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According to the CDC, one in every three adults age 65 and older falls each year (Falls Among Older Adults). Falls can cause moderate to severe injuries, such as hip fractures and head injuries, or can result in death. In nonfatal falls, the number of falls increases dramatically with age. The number of nonfatal fall injuries for individuals age 85 and older is 87% higher than for individuals age 60-64, as shown in Figure 13. Figure 13: Number of Nonfatal Fall Injuries ages 60 and older for 2011 – United States

"Unintentional All Injury Causes Nonfatal Injuries and Rates per 100,000." Centers for

Disease Control and Prevention. Web. 28 Feb 2013. Falls are such an important health issue that the Florida Department of Health’s Office of Injury Prevention has established a five-year strategic plan that includes the goal to focus more attention on fall-related injury prevention.

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Stroke Stroke is one of the leading causes of death in Palm Beach and Martin Counties. According to the 2009 Florida Mortality Atlas, the likelihood of having a stroke increases with age. As shown in Figure 15, it is clear that African Americans have a much higher chance of having a stroke than any other race. Table 12 shows the death rates for stroke by county compared to the Florida and national rates.

Table 12: Stroke Mortality Rates

Average Annual

Deaths Crude Death

Rate Age-Adjusted

Death Rate Martin County 94 65.28 31.14 Palm Beach County 703 54.1 29.45 Florida 8,624 46.61 34.98 United States 133,107 43.81 41.78 "Stroke Deaths." Florida Department of Health, Bureau of Vital Statistics. Florida Charts. Web.

18 July 2013.



0102030405060708090

100

2008 2009 2010 2011 2012

Figure14:StrokeDeathCountsforPrimaryandSecondaryServiceAreas


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Table 13 shows the stroke rates in Palm Beach and Martin Counties including the hospitalization rate, the death rate, and the average number of both hospitalizations and deaths. Even though Martin County has a higher percentage of the population that is elderly, Palm Beach County has higher rates of hospitalization and death from strokes.

Table 13: Stroke Rates 2009 - 2011

Average Annual Hospitalizations

Hospitalizations -Age Adjusted

Rate

Deaths - Avg. Number of

Annual Events

Deaths - Age Adjusted

Rate Martin County 562 191.60 82 24.60 Palm Beach County 4,712 225.50 718 28.60 "Hospitalizations from Stroke." Florida Department of Health, Bureau of Vital Statistics. Florida Charts.

Web. 18 July 2013.

"Population by Race / Ethnicity, Stroke Mortality, Age-Adjusted Rate (Per 100,000 Pop.)." Chna.org.

Web. 17 July 2013.

0

10

20

30

40

50

60

White Black Asian AmericanIndian/AlaskanNative

Hispanic/Latino

NotHispanic/Latino

Occuran

cesp

er10

0,000pe

ople

Figure15:OccurrencesofStrokebyRace

MartinCounty,FL

PalmBeachCounty,FL

Florida

UnitedStates

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Access to Health Care A lack of access to care has been proven to be a barrier to good health. The accessibility to physicians, as well as facilities, greatly affects a community’s overall health status. As shown in Table 14, both Martin and Palm Beach Counties have a higher rate of primary care providers than that of the State of Florida. This can have a positive impact on the service area’s overall health. It is the understanding of the members of the Steering Committee, however, that very few, if any, primary care providers in the primary and secondary service areas accept Medicaid patients. Thus, access to health care may be hindered for uninsured and underinsured individuals, notwithstanding the higher rate of primary care providers in the primary and secondary service areas.

Table 14: Access to Primary Care

Total Population Total Primary Care

Providers Primary Care Provider Rate (Per 100,000 Pop.)

Martin County 146,318 117 79.96 Palm Beach County 1,320,134 1,062 80.44 Florida 18,801,310 14,334 76.2 United States 312,471,327 264,897 84.7

US Health Resources and Services Administration Area Resource File, 2011 There are 17 census tracts designated as medically underserved by the Health Resources and Services Administration in JMC’s primary service areas. The MUP designation is reserved for populations with economic barriers or cultural and/or linguistic access barriers to primary medical care services.

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There are 4,174 licensed hospital beds in Martin and Palm Beach Counties. JMC represents only 163 of those beds. Table 15 is a snapshot of some of the types of licensed beds in these counties.

In Martin County, 18% of adults could not see a doctor at least once a year due to cost. In Palm Beach County only 9.7% of adults did not see a doctor at least once a year due to cost. Across the state of Florida, 17.3% of adults could not see a doctor at least once a year due to cost.

Level II Level III AdultChild / Adol

Martin Memorial Hospital South 100 100Martin Memorial Medical Center 244 239 5

A.G. Holley State Hospital -100 -100Bethesda Memorial Hospital 401 355 12 6Boca Raton Regional Hospital 400 390 10Columbia Hospital (West Palm Hospital) 245 157 61 27Delray Medical Center 493 350 36Good Samaritan Medical Center 333 326 7JFK Medical Center 460 429 31Jupiter Medical Center 163 163Kindred Hospital The Palm Beaches 70 70Lakeside Medical Center 70 70Palm Beach Gardens Medical Center 199 199Palms West Hospital 175 175Select Specialty Hospital - Palm Beach, Inc. 60 60St. Mary's Medical Center 464 329 25 20 40The Jerome Golden Center for Behavorial Health, Inc. 44 44Wellington Regional Medical Center 158 133 10 15West Boca Medical Center 195 161 14 20

Total Beds 4,174 3,476 130 78 66 212 27

Table 15: Licensed beds in Palm Beach and Martin Counties

Palm Beach County

Martin CountyTotal Beds

NICULTC Hospital

BedsAcute

Care Beds

Psychiatric

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Insurance There are 50 million people nationwide without insurance. Figure 16 shows the percentage of population within Palm Beach County, Martin County and the State of Florida with any type of health insurance coverage.

"Adults with Any Type of Health Care Insurance Coverage." Florida Charts BRFSS Indicators Dataview

Page. Web. 19 July 2013.

76.0%

78.0%

80.0%

82.0%

84.0%

86.0%

88.0%

90.0%

92.0%

2002 2007 2010

Figure16:PopulationwithAnyTypeofHealthInsuranceCoverage

MartinCounty

PalmBeachCounty

Florida

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Figures 17a and 17b show the percentages of the population for both Martin and Palm Beach Counties and the breakdown of types of insurances for those that have one type of insurance. In Martin County, 15.22% of the population has no health insurance coverage and 20.17% in Palm Beach County, as seen in Figure 17c.

57%15%

14%

11%

3% 0%

Figure17a:MartinCountyPercentofPopulationwithOneTypeofInsurance

Employer-basedhealthinsuranceonly

Direct-purchasehealthinsuranceonly

Medicarecoverageonly

Medicaid/means-testedpubliccoverageonly

TRICARE/militaryhealthcoverageonly

VAHealthCareonly

60%11%

12%

17%

0% 0%

Figure17b:PalmBeachCountyPopulationwithOneTypeofInsurance

Employer-basedhealthinsuranceonly

Direct-purchasehealthinsuranceonly

Medicarecoverageonly

Medicaid/means-testedpubliccoverageonly

TRICARE/militaryhealthcoverageonly

VAHealthCareonly

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“Types of Health Insurance Coverage by Age." Martin County, Palm Beach

County, Florida." American FactFinder. 2010. United States Census Bureau. Web. 2 Aug. 2013. Medicaid is a federally and state funded health program in the United States that provides health services to low income individuals and families. Figures 18a, 18b, and 18c show the average number of Medicaid patients for Martin County, Palm Beach County and in Florida from 2005-2011. In both counties and in Florida, the number of Medicaid patients has been increasing.

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

MartinCounty PalmBeachCounty

Percen

tageofP

opulation

Figure17c:PercentageofPopulationwithnoHealthInsuranceCoverage

MartinCounty

PalmBeachCounty

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

2005 2006 2007 2008 2009 2010 2011

Figure18a:AverageNumberofMedicaidPatients,MartinCounty

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"Median Monthly Medicaid Enrollment." Agency for Health Care Administration.

Florida Charts,. Web. 2 Aug 2013.

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

2005 2006 2007 2008 2009 2010 2011

Figure18b:AverageNumberofMedicaidPatients,PalmBeachCounty

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

2005 2006 2007 2008 2009 2010 2011

Figure18c:AverageNumberofMedicaidPatients,Florida

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Transportation A critical factor in regards to access to health care is transportation. Within Palm Beach County, Palm Tran is a source of public transportation that serves more than 3,400 bus stops across the county with 142 buses (“Quick Facts”). Palm Tran runs during peak season every 30 minutes on weekdays. During off-peak season, Palm Tran runs every 60 minutes on weekdays. Palm Tran offers services for $1.50 for adults and seniors, students, and those with disabilities can receive services for half the fare. In addition, Medicare recipients can show their Medicare card to receive a half-fare discount.

However, Palm Tran only offers one route around the town of Jupiter. Route 10 follows Military Trail north/south starting at Burns Road in Palm Beach Gardens on the south end and going as far north as Indiantown Road in Jupiter. The picture to the left displays the stops and points of interest along Palm Tran’s Route 10. In addition to Route 10 offered by Palm Tran, the Connection service allows for a shared ride, door-to-door, for disabled residents and visitors in Palm Beach County. However this service is offered only as far north as Donald Ross Road, which is still three miles south of JMC. As shown in Table 16, ridership for FY2011 was up from the previous year.

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Table 16: Palm Tran Connection Ridership FY2010 and FY2011

FY2010 FY2011 Ridership 825,295 836,204 Medical 305,359 309,395 Employment 82,530 75,258 Education/Training/Daycare 148,553 150,517 Nutrition 82,530 91,982 Life Sustaining/Other 206,323 209,052 Elderly Low Income 811 725 Disabled 416,115 424,384 Both 31,289 24,151 Other 27,257 22,002

“Palm Beach County Community Health Assessment.” Health Council of Southeast Florida, June 2012. Web. 8 Aug. 2013.

In addition to Palm Tran, Tri-Rail provides public transportation to South Florida in the form of trains that run from Miami and Hialeah to West Palm Beach. As shown to the right, the northernmost train stop is at Mangonia Park Station, which is in West Palm Beach and is still approximately eight miles south of the service areas of JMC. Therefore, the Tri-Rail does not address the need for accessible health care within the JMC community. In Martin County, free buses are offered around south Martin County, Stuart, and across the Treasure Coast. However, the southernmost point of that route is 18 miles north of JMC. Therefore the gap between public transportation offered in West Palm Beach and around Martin County means that Jupiter is an area in need of transportation options, especially for those trying to get to medical appointments.

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IV. Input from Persons who Represent Broad Interests of Community

Purpose As part of the CHNA process, interviews were conducted with community leaders in order to identify the health needs of the community. Furthermore, health survey data from the Hispanic community was examined, because Jupiter’s Hispanic population makes up approximately 12.7% of the total population of Jupiter (City-Data.com Profile for Jupiter, FL), and Jupiter has a significant day laborer population, a majority of whom are Hispanic.

Community Leader Interviews Interview questions were distributed via email on Monday, July 8, 2013 to the Director at the Florida Department of Health – Palm Beach County, the Chief Operating Officer at Florida Public Health Institute, the Mayor of the Town of Jupiter, and the Executive Director of El Sol Neighborhood Resource Center. By way of background, El Sol is Jupiter’s Neighborhood Resource Center to improve the quality of life of all residents of the Town of Jupiter by providing services to those in need, especially day laborers and their families. El Sol was formed as a result of a community effort to transform the problem of an unsafe and contentious open air day labor market into a safe and productive resource center in which all people can achieve their highest potential. According to the Executive Director of El Sol, a total of 10,616 day jobs were filled in 2012, a 16% increase from 2011. Members of the Steering Committee believed that El Sol’s input into this CHNA was very important to understanding the health needs of the Hispanic population within the community. Some of the surveys were completed and sent back via email, and others were completed over the phone with a member of the Steering Committee. The same questions were asked in each interview:

• What are the top 3 strengths of the community? • What are the top 3 health concerns of the community? • What are the barriers to obtaining health services in the community?

Community Strengths: Strong volunteerism was noted by all the survey participants as a top strength in the community. Considering it was noted by all interviewees, the impact volunteers have on the community as a whole is significant. Another community strength noted by participants was strong collaboration. Collaborating between different community

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organizations as well as healthcare providers and physicians is necessary to improve the overall health status of a community. Furthermore, participants noted that strong and engaged hospital leadership and town/government leadership were significant strengths within the community. Health Concerns: When asked about health concerns, two common themes among participants were the need for access to health care for the medically underserved and uninsured within the community, and the need for health care and health care education for the non-English speaking population within the community. Healthcare Barriers: When asked about barriers to health care, participants noted a lack of health care resources for uninsured residents, and language and cultural differences as the primary barriers to health care within the community. Additionally, geographic (distance) and lack of transportation were perceived as significant impediments to health care within the community.

Health Survey Data from the Hispanic Community Project SALUD was an assessment done between January and March of 2013 to learn about the general health conditions and access of health services in the Hispanic community of Jupiter. Health survey data was gathered by lay-health workers, using a random approach. The Project SALUD assessment was produced and analyzed by the Rural Women's Health Project, Gainesville, FL. The Project SALUD Assessment was carried out by Project SALUD promotores de salud of El SOL between January and March of 2013. The assessment was funded by PIRSC (Program for Immigration Religion and Social Change) of the University of Florida's Center for Latin American Studies, with funding from the Ford Foundation. The Rural Women's Health Project collaborates with El SOL Jupiter's Neighborhood Center for the Project SALUD program. Betzey Rega serves as Promotor coordinator. The El SOL health program is funded by Allegany and Quantum Foundations. According to the results obtained from the Project SALUD assessment, 78.5% of those surveyed were from the zip code 33458, part of JMC’s primary service area; 92.5% of those surveyed had no insurance and are forced to self-pay for their medical services. When asked if in the last year there were any barriers to obtaining medical services for themselves or their family, 60.6% of respondents answered “yes.” In addition, 48.1% of the women who participated had never received a PAP test, 98.1% had never received a colonoscopy, and 77.4% have never received a mammogram. Of the men who participated, 84.9% had never received a prostate exam, 86.8% had never received a

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testicular exam, and 90.6% had never received a colonoscopy. This survey highlights the lack of access to health care for many of the low-income individuals in the community.

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V. Prioritized Description of Significant Health Needs of the Community

Significant Health Needs Identified and Prioritized The goal in conducting the CHNA is to identify significant health needs within the community served by JMC, prioritize those health needs, and identify potential measures and resources (such as programs, organizations, and facilities in the community) available to address the health needs. A list of significant health needs was compiled by the Steering Committee based on its review and discussion of the primary and secondary data. In order to identify and prioritize the significant health needs, the Steering Committee considered such factors as the impact of the health need on community health improvement, the scope of the community affected by the health need, the threat to long term quality of life, the lack of resources in the community to address the health need, and the consequences of inaction related to the health need. The significant health needs identified (in order of priority) are as follows:

• Cancer • Cardiac Wellness • Access to Health Care – Establishing Community Access Points

Discussion of Significant Health Needs This section discusses each of the significant health needs identified in this CHNA:

• CANCER - Cancer is the first leading cause of death in Martin County, and the second leading cause of death in Palm Beach County. Cancer is also the first leading cause of death in JMC’s primary service area, and the second leading cause of death in JMC’s secondary service area. Steering Committee members discussed various aspects related to the delivery of cancer care within the community that currently need to be addressed in order to improve cancer care. Although there are a variety of settings within the community that offer cancer care, from screenings through treatment; access to care can be fragmented. The coordination of care requires patients to be able to navigate the health care system, various physician practices, understand risk factors, and have access to financial resources, either with insurance coverage or ability to pay for regular screenings, and for those with a cancer diagnosis, the ability to cover the high cost of cancer treatment(s). Screenings for breast cancer, for example, are offered at imaging centers, including those offered by JMC at various convenient locations; prostate cancer screenings are typically

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conducted in physician offices, either primary care physicians and/or urologists; colonoscopies, a common screening for colorectal cancer are conducted within specialized GI suites. Although nurse navigator teams have been implemented at JMC to address some of these navigation concerns; more are needed. Some of the needs that have been identified by the Steering Committee are:

o Funding for screenings - Funding for screenings for low income patients, which has been declining as the number of uninsured and underinsured has increased the past few years, evidenced by the increased number of financial assistance requests.

o Information - At risk populations appear to lack access to information regarding screenings, education regarding healthy living, and may be impacted by socioeconomic factors which limit their ability to attend community education offered at cancer centers, such as JMC, or through community outreach programs.

o Transportation - Transportation has been identified as a need outside of the Jupiter/Palm Beach Gardens area served by JMC’s Motor Aid.

If these needs are not addressed, patients may search for services outside of the community in order to receive care; delays in receiving care can result in extensive treatment and subsequently increased costs for advanced disease, or worse, a poor prognosis.

• CARDIAC WELLNESS – Heart disease is the first leading cause of death in Palm Beach County, and the second leading cause of death in Martin County. Heart disease includes conditions affecting the heart, such as coronary heart disease, heart attack, congestive heart failure, and congenital heart disease. Heart disease is also the first leading cause of death in JMC’s secondary service area, and the second leading cause of death in JMC’s primary service area. Steering Committee members discussed various aspects related to the delivery of cardiac care within the community that currently need to be addressed in order to improve cardiac care. Specifically, prevention of heart disease through cardiac health and wellness is very important. Cardiac wellness programs reduce cardiovascular risk and improve the quality of life of patients. Additionally, embracing a holistic approach to preventing and treating heart disease and to managing chronic diseases is essential—for example, simultaneously managing non-cardiac comorbid conditions, such as diabetes, that complicate heart disease. Failure to address these needs could lead to a generally “sicker” population. Also, if cardiac wellness services are not readily available within the community, patients may choose not to seek out such services. Currently, patients needing certain cardiac wellness services are required to travel at least 7 or 8 miles away. Steering Committee members believed that certain populations may be less likely to travel in order to receive cardiac wellness services—such as the elderly population.

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• ACCESS TO HEALTH CARE – ESTABLISHING COMMUNITY ACCESS POINTS - Health care access was identified as a significant need in the community based on primary and secondary data collected. There are many factors that affect access to health care, including the need for adequate transportation to and from health care providers, the availability of health resources in languages other than English, the ability of patients to read and understand health information, access to insurance, and patients having access to a “medical home”—a patient’s consistent point of access for health care from a primary care provider who oversees and coordinates care. The medical home model of care has been shown to prevent sickness, manage chronic illness effectively, mitigate disparities, and reduce the need for avoidable, costlier care such as emergency department visits or hospitalizations. To illustrate this point, in 2012 the number of visits to the JMC emergency department by individuals with no insurance, self-pay or Medicaid coverage who sought primary care services totaled 2,639 visits. Building a network of community access points to improve access to healthcare is an important element in creating a medical home environment and making more efficient and effective use of healthcare resources.

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VI. Measures and Resources Identified to Address the Significant Health Needs

Community Resources to Address Health Needs This section contains a description of the potential measures and resources identified through the CHNA to address the significant health needs identified. Cancer The Steering Committee discussed the current measures and resources that are available to the community for comprehensive cancer care. JMC’s Ella Milbank Foshay Cancer Center is accredited, with commendation, by the Commission on Cancer as a Comprehensive Community Cancer Program. Only 25 percent of cancer programs in the United States hold this accreditation. The Foshay Cancer Center is also accredited by the American College of Radiology and is the only radiation center in Palm Beach County to hold this accreditation. To address the importance of cancer treatment and prevention in the community, as stated above, Steering Committee members discussed a need for better coordination of cancer care for at risk patients, as well as a need for an academic cancer program in the community. Some options outside of the Foshay Cancer Center that are available to community residents include:

• Boca Raton Regional Hospital Lynn Cancer Institute (Boca Raton, FL) – 47 miles away

• University of Miami Sylvester Comprehensive Cancer Center (Miami, FL) – 88 miles away

• Moffitt Cancer Center (Tampa, FL) – 190 miles away • University of Florida Shands Cancer Center (Gainesville, FL) – 255 miles away

While the above programs are notable cancer programs, it would be a hardship on members of the JMC community to seek regular treatment at facilities so far away from their homes. Cardiac Wellness The Steering Committee discussed the current measures and resources that are available to the community for certain cardiac procedures as well as cardiac wellness activities. JMC’s cardiology department provides non-invasive, diagnostic cardiac procedures, and also has a cardiac catheterization lab. Residents of the JMC community, however, must travel in order to receive invasive and interventional cardiac procedures at this time. For example, The Heart Institute at Palm Beach Gardens Medical Center performs open-heart surgeries, but the facility is located 8 miles from JMC. JMC offers certain cardiac wellness services at this time, although Steering

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Committee members discussed a need for expansion of those services. Cardiac wellness services are so fundamental to improving overall health that Steering Committee members believed such services must be comprehensive in nature and readily available to the community. The need for even minimal travel for cardiac wellness services could deter certain populations (such as the elderly) from engaging in the activities. At this time, outside of JMC’s current cardiac wellness offerings, residents of the JMC community must travel 8 miles to Palm Beach Gardens for such services. Access to Healthcare – Establishing Community Access Points The Steering Committee members discussed a need for improvement in health care access throughout the JMC community by establishing community access points. Many residents in the JMC community who do not have a “medical home” visit local hospital emergency rooms when they need medical attention. One recent resource has been established in the JMC community to improve healthcare access—in 2012, JMC, the Town of Jupiter, Palm Beach County Health Department and El Sol (Jupiter's Neighborhood Resource Center), announced the opening of the Jupiter Volunteer Clinic. The Clinic was established, along with input from the Florida Public Health Institute, in response to the growing number of uninsured/underinsured individuals living in the Jupiter area, who have limited access to health care. In addition, Jupiter Medical Center acquired a medical screening vehicle in 2012 called the "Wellness in Motion" van equipped with digital mammography, bone density screening, blood draws, patient education and outreach. This mobile program can reach populations who may not have access to health care programs due to transportation challenges or other barriers to access.

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VII. Works Cited "2011 ZIP Code Business Patterns (NAICS)." Censtats Database. 31 July 2013

<http://censtats.census.gov/cgi-bin/zbpnaic/zbpsect.pl>. "Adults with Any Type of Health Care Insurance Coverage." Florida Charts BRFSS

IndicatorsDataview Page. Web. 19 July 2013. "All Cancer Deaths." Florida Charts Death Query. Florida Charts.Web. 17 July 2013. "Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2011. Miami,

Florida." American FactFinder. 2010. United States Census Bureau. Web. 17 July. 2013.

"Chronic Lower Respiratory Disease Deaths." Florida Charts Death Query. Florida

Charts.Web. 5 Aug 2013. "Educational Attainment: 2007-2011 American Community Survey 5-Year Estimates."

American FactFinder – Results. Web. 31 July 2013. Falls Among Older Adults: An Overview. Centers for Disease Control and Prevention, 20 Sept. 2012. Web. 11 July. 2012. "Florida Behavioral Risk Factor Data." Behavioral Risk Factor Surveillance System.

Florida Charts. Web. 18 July 2013. Florida Literacy Coalition, Inc. Literacy and Health. Web. 17 July. 2013. "Heart Disease Deaths." Florida Department of Health, Bureau of Vital Statistics. Florida

Charts. Web. 18 July 2013. "Hospitalizations from Stroke." Florida Department of Health, Bureau of Vital Statistics. Florida Charts. Web. 18 July 2013. "Income in Past 12 Months (In 2011 Inflation-Adjusted Dollars), 2011 American

Community Survey 1-Year Estimates" American FactFinder. 2010. United States Census Bureau. Web. 12 July 2013.

"Language Spoken at Home, 2011 American Community Survey 1-Year Estimates,

Florida." American FactFinder. 2010.United States Census Bureau. Web. 11 July 2013.

"No one age 14 and over Speaks English Only or Speaks English "Very Well"" American FactFinder. 2010. United States Census Bureau. Web. 5 Aug 2013.

“Palm Beach County Community Health Assessment.” Health Council of Southeast

Florida, June 2012, Web. 8 Aug. 2013.

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"Physical Environment." Community Commons. 17 July 2013

<http://assessment.communitycommons.org/CHNA/Report.aspx?page=3>. "Population by Race / Ethnicity, Stroke Mortality, Age-Adjusted Rate (Per 100,000

Pop.)." Chna.org. Web. 17 July 2013 "Profile of General Population and Housing Characteristics: 2010 Demographic Profile

Data, Florida." American FactFinder. 2010. United States Census Bureau. Web. 11 July 2013.

"Resident Death Counts by Year by Residence Zip code by 50 Leading Rankable

Causes of Death." Florida Charts Death Query. Florida Charts. Web. 18 July 2013.

"Selected Economic Status, 2011 American Community Survey 1-Year Estimates"

American FactFinder. 2010. United States Census Bureau. Web. 5 Aug 2013. "Selected Social Characteristics in the United States: 2007-2011 American Community

Survey 5-Year Estimates, Florida." American FactFinder. 2010. United States Census Bureau. Web. 15 July 2013.

"Stroke Deaths." Florida Department of Health, Bureau of Vital Statistics. Florida

Charts. Web. 18 July 2013. "Types of Health Insurance Coverage by Age. Martin County, Florida." American FactFinder. 2011 American Community Survey 1-Year Estimates. United States Census Bureau. Web. 17 July. 2013. “Quick Facts.” Palm Tran Public Transportation, Sept. 2009. Web. 8 Aug. 2013. "Unintentional Falls Deaths. Martin County, Florida." Florida Charts. Florida Department of Health. Web. 17 July. 2012. "Unintentional Falls Deaths. Palm Beach County, Florida." Florida Charts. Florida Department of Health. Web. 17 July. 2012.

Documents

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