Post on 18-Jun-2020
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CommunityClinicsHospitals PublicHealth CommunityPartners
COLUMBIAGORGEREGIONALCOMMUNITYHEALTHASSESSMENT2016CollaboratingforOptimumHealthandOptimizedHealthcare
AsummaryoftheneedsforimprovedhealthfortheresidentsoftheColumbiaGorgeRegionincludingHoodRiver,Wasco,Sherman,Gilliam,WheelercountiesinOregonandSkamaniaandKlickitatcountiesinWashington–Fall2016
NorthCentralPublicHealthDepartment
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AresultthatisrewardingInaruralcommunity,workingtogetherisparamountforsuccess.TheformationoftheColumbiaGorge
CoordinatedCareOrganizationwithPacificSourceCommunitySolutionsaidedustoturnanordinaryrequirementfromOregonlawmakersintoanextraordinaryopportunitytoimprovethehealthandwellnessofallresidents.WeareproudofouraccomplishmentsanddelightedthattheRobertWoodJohnsonFoundationrecognizedourwork.
Weinvitethecommunitytousethismaterialinthepursuitofbetterhealthforall.
***ForthefulldocumentlookontheColumbiaGorgeHealthCouncilwebsiteatcghealthcouncil.org
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20162013
QUESTIONS
COUNTY
COHORT
SOCIAL
DETERMINANTS
HEALTHCARE
CONNECTED
VS
6Counties:4Oregon+
2Washington
7Counties:5Oregon+
2Washington
65QuestionsincludingFood,
HousingandTransportation
72QuestionsincludingTrauma
andSupportforCaregivers
4hospitals;4HealthDeparts;
OneCommunityHealth;
CountyMentalHealth
ColumbiaGorgeCCO
2013cohort+UnitedWay;Four
RiversEarlyLearningHub
Housing&Food;
Transportation;Jobs
AdultDentalAccess;Physical
andMentalhealthtogether;
MentalHealthaccessfor
Children&Youth
Coordinationwithhealthcare&social
services;Healthinsurancere-
enrollment;SupportingDevelopmental
andHealthyGrowthintheEarlyYears
Employmentratebetter;
otherareasremainaconcern
DentalAccessremains#1gap;
ProgressonMentalHealthAccess;
PCPAccessharder
Coordinationwithprimarycareand
mentalhealth=good;Morepeopleare
insured;Familieswithchildren0-5more
likelytogowithoutbasicneeds
ColumbiaGorgeRegional
CommunityHealthAssessment
Hospitals:ProvidenceHoodRiver,Mid-ColumbiaMedicalCenter,KlickitatValleyHealth,SkylinePublicHealth:HoodRiverCounty,KlickitatValley,NorthCentral,Skamania
OneCommunityHealth,Mid-ColumbiaCenterforLiving,PacificSourceCommunitySolutionsUnitedWayoftheColumbiaGorge,4RiversEarlyLearningHubInpartnershipwith:
SURVEYS
Mail=457
Hand-fielded=691
Mail=674*statisticalsignificance
Hand-fielded=694
DEMOGRAPHICS
Non-HispanicWhite=827
Hispanic/Latino/Other=290
LowIncome=668
Non-HispanicWhite=1043
Hispanic/Latino/Other=301
LowIncome=631
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ColumbiaGorgeRegionalHealthAssessment-2016
GeneralPopulation
BasicNeeds
IncomeSecurity
FoodSecurityandHealthyEating
TransportationAccess
HousingSecurity
HealthInsurance
SocialCohesion
SupportforCaregivers
1in3hadtroublepayingforbasicneeds
7%hadtogowithoutstablehousing
25%areworriedabouttheirhousingsituation
morethan1in10hadtogowithoutfood
1in4hadtogowithoutabasicneedAND1in4hadtogowithoutahealthcareneed
13%hadtogowithouttransportation
8%areuninsured
1in3areworriedaboutrunningoutoffood*
oftheuninsured,21%liveinWashingtonand69%liveinOregon
21%donothavesomeonetomakethemfeellovedorwanted
22%donohavesomeonetogivethemgoodadvice
29%donohavesomeonetorelaxwith
26%donothavesomeonetotalktoaboutproblems
29%donothavesomeonetohelpiftheywereconfinedtoabed
1in5arecaregivers
6outof10caregiversdon'tfeelthattheyhaveadequatesupport
13%thinkpeopleintheircommunityareunwillingtohelp
25%feeltheycannottrustpeopleintheircommunity
20%cannotcountonadultsintheircommunity
10%donotfeelsafeintheircommunity
SocialSupport
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BasicNee
dsCo
mmun
ityand
Soc
ialE
nviro
nmen
t
*GorgeWideFoodSurvey
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ColumbiaGorgeRegionalHealthAssessment-2016
Populationswithdisparitiesbyrace/ethnicity,income,orinsurance
BasicNeeds
IncomeSecurity
FoodSecurityandHealthyEating
TransportationAccess
HousingSecurity
HealthInsurance
SocialCohesion
SupportforCaregivers
MorethanhalfoftheHispanic/Latino/Other,Lowincome,Uninsured,andMedicaidpopulationshadtroublepayingforbasicneeds
16%ofthesepopulationshadtogowithoutstablehousing
About40%inHispanic/Latino/Other,Uninsured,andMedicaidpopulationsareworriedabouttheirhousingsituation
1in4intheHispanic/Latino/Other,Uninsured,andMedicaidpopulationshadtogowithoutfood
4in10intheHispanic/Latino/Other,Lowincome,Uninsured,andMedicaidpopulationshadtogowithoutabasicneedandhealthcareneed
Hispanic/Latino/OtherandLowincomepopulationsareabouttwiceaslikelytobeuninsuredthanthegeneralpopulation
Lowincomewaslesslikelytofeelliketheyhadthesesocialsupportsthanhigherincomes
UninsuredandMedicaidpopulationswerelesslikelytofeelliketheyhadthesesocialsupportsthanthePrivateandMedicarepopulations.
6outof10caregiversdonotfeelliketheyhaveadequatesupport
25%oftheUninsuredthinkpeopleintheircommunityareunwillingtohelp
35%ofLowincome,Uninsured,andMedicaidpopulationsfeeltheycannottrustpeopleintheircommunity
25%ofHispanic/Latino/Other,Lowincome,Uninsured,andMedicaidpopulationscannotcountonadultsintheircommunity
20%oftheUninsureddonotfeelsafeintheircommunity
SocialSupport
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BasicNee
dsCom
mun
ityand
Soc
ialE
nviro
nmen
t
About1in4intheHispanic/Latino/Other,Lowincome,Uninsured,andMedicaidpopulationshadtogowithouttransportation
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Adults(ages18-98)
ChronicMedicalConditions
MentalHealthConditions
TraumaandResilience
GeneralHealth
Alcohol,Tobacco,OtherDrugs
PhysicalHealthcareAccess
MentalHealthcareAccess
DentalHealthcareAccess
SubstanceUseTreatment
Medications
Specialists
1in4ratedtheirhealthasfairorpoor
Highbloodpressureisthemostcommonchroniccondition
Depressionisthemostdiagnosedmentalhealthcondition
3outof4experiencedoneormoretraumaticevent
21%havethreeormoredrinksonthedaystheydrink19%usetobacco
1in5donothaveaprimarycareproviderandaregoingwithoutneededcare
Greatestunmethealthcareneed:344peoplearegoingwithoutcare
Accessgreatlyimprovedfrom2013
7%neededsubstanceusecare,ofthose68%arereceivingtreatment
1in10cannotgetalltheirmedications
Neurology,substanceusetreatment,andcancertreatmenthadhighestunmetneed
2outof3areoverweightorobese
Morethanhalfhaveachronicmedicalcondition
About4outof10hadsomeonedosomethingharmfultothem
Mostpeopleuselocalservices
ColumbiaGorgeRegionalHealthAssessment-2016
46%gotcarefromprimarycareprovider30%gotcarefromcountymentalhealthclinics
1in3haveamentalhealthcondition
1in4aregoingwithoutneededcare
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15%usemarijuana7%useotherdrugs
Hea
lthStatus
Hea
lthca
reAcc
ess
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Adultswithdisparitiesbyrace/ethnicity,income,orinsurance(ages18-98)
ChronicMedicalConditions
MentalHealthConditions
TraumaandResilience
GeneralHealth
Alcohol,Tobacco,OtherDrugs
PhysicalHealthcareAccess
MentalHealthcareAccess
DentalHealthcareAccess
SubstanceUseTreatment
Medications
Specialists
35%ofLowincomeandMedicaidpopulationsratedtheirhealthasfairorpoor
AnxietyisthemostdiagnosedmentalconditionforLowincomeandMedicaid
TheUninsuredandMedicaidpopulationweremorelikelytohavethreeormoredrinks,usetobacco,anduseotherdrugsthangeneralpopulation
HalfoftheMedicaidpopulationhasexperienced3ormoretraumaticevents
1in4oftheUninsuredandMedicaidpopulationsaregoingwithoutneededcare
15%ofMedicaidrecipientsneededsubstanceusecare
Nosignificantdisparities
Lowincomehadmoreunmetorthopedicneedsthanthegeneralpopulation
Privateinsurancehadmoreunmetcardiologyneedsthanthegeneralpopulation
Medicaidhadmoreunmetskinconditionneedsthanthegeneralpopulation
3outof4onMedicarehaveachronicmedicalcondition
Lowincomewasmorelikelytousetobaccothanthegeneralpopulation
ColumbiaGorgeRegionalHealthAssessment-2016
NearlytwiceasmanyMedicaidrecipientsaregoingwithoutneededcarethanthegeneralpopulation
2of5oftheLowincomepopulationhaveamentalhealthcondition
About37%oftheLowincome,Uninsured,andMedicaidpopulationsaregoingwithoutneededcare
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HealthStatus
HealthcareAccess
HalfofMedicaidrecipientshaveamentalcondition
MorethanhalfoftheUninsureddonothaveaprimarycareprovider
Highincome,Uninsured,andPrivateinsurancepopulationsweretwiceaslikelytogowithoutneededcarethanthegeneralpopulation
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Youth
ChronicMedicalConditions
MentalHealthConditions
TraumaandResilience
GeneralHealth
Alcohol,Tobacco,OtherDrugs
PhysicalHealthcareAccess
MentalHealthcareAccess
DentalHealthcareAccess
SubstanceUseTreatment
Medications
1in10ratedtheirhealthasfairorpoor*
Asthmaisthemostcommonchronicmedicalcondition
Anxietyisthemostdiagnosedmentalhealthcondition
Nearly1outof4hadanadulthurtthemonpurpose*
20%havehadalcohol*14%haveusedtobacco*
1in5youthfeeltheyarenotgettingallneededcare*
1in5teenshaven'tbeentothedentistinthepast12months
7%neededsubstanceusecare,ofthose22%arereceivingtreatment^
1in20teenshaveusedprescriptiondrugswithoutadoctor'sorders*
1outof3areoverweightorobese*
ColumbiaGorgeRegionalHealthAssessment-2016
1in10parentssaidtheirchildrenarenotgettingallneededcare
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1in10parentssaidtheirchildrenarenotgettingallneededcare
8%parentssaidtheirchildrenarenotgettingallneededcare
15%youthfeeltheyarenotgettingallneededcare*
1in4haveamentalhealthcondition
15%haveusedmarijuana*5%haveusedotherdrugs*
VS
VS
Health
Status
Health
careAccess
(ages0-17)
VS
*ThisinformationisfromtheOregonandWashingtonHealthyTeenSurvey^ThisinformationcamefromtheOregonHealthAuthority(OHA)BehavioralProfilesAllotherinformationisfromthe2016CommunityHealthSurvey
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ColumbiaGorgeRegionalCommunityHealthAssessment-2016TheCohortIn2013,theColumbiaGorgeRegioncametogethertocreateanintegratedColumbiaGorgeRegionalCommunityHealthAssessment.Thefirstintegratedassessmentrepresentedhealthcareprovidersfromsixcounties,aswellasnon-profitsandsocialserviceagencies.Theyworkedtogethertocreateaprioritizedsetofneedsfortheregion,aswellasidentifyuniqueneedsinspecificareasandgroupswithintheregion.
Keepingwiththatspiritofcollaboration,theorganizationslistedworkedtogetheragainin2016tocreateanewregionalhealthassessment.Inadditiontothe2013cohortmembers,weaddedanewcountytotheregion,Wheelerandtwoneworganizations,UnitedWayoftheColumbiaGorgeandFourRiversEarlyLearningHub.WeusedtheColumbiaGorgeHealthCouncilwithitsConsumerAdvisoryCouncilastheorganizers.
Wewereonceagainabletolookatsocialandeconomicconditions,inadditiontokeyhealthcareinformationintheregion.Bydoingsowewereabletorecognizethemostimportantissuesthatfaceourpopulation.Thismethodofcrossorganizational,cross-countyforumwasabletoservetheneedsofmultipleorganizations.OurPrinciplesofCollaborationremainedthesameandoutlineourmutualintention:
• AcollaborativeapproachtotheCommunityHealthSurvey(CHA)andtheCommunityHealthImprovementPlan(CHIP)isbetterforourregion,yieldingmoreaccurateandmoreactionableproducts,ascommunityprovidersagreeontheneedswithinourregionandcommunitiesandaswealignourabilitiestoaddressthoseneedstogether.
• AcollaborativeapproachtotheCHAandCHIPwillmaximizecollectiveresourcesavailableforimprovinghealthintheregion.
• AcollaborativeapproachtotheCHAandCHIPmustbetrulycollaborative,requiringcommitmentsofcashorin-kindresourcesfromallparticipantswhowoulduseittosatisfyaregulatoryrequirement.
Therestofthisdocumentillustratesourcollaborativeeffort,andoursharedrecognitionofthegreatestneedsintheColumbiaGorgeRegion.
TheCohort
ColumbiaGorgeHealthCouncil
FourRiversEarlyLearningHub
HoodRiverCountyHealthDepartment
KlickitatValleyHealth
KlickitatPublicHealth
Mid-ColumbiaMedicalCenter
Mid-ColumbiaCenterforLiving
NorthCentralPublicHealthDistrict
OneCommunityHealth
PacificSourceCommunitySolutions
ProvidenceHoodRiverMemorialHospital
SkamaniaCountyHealthDepartment
SkylineHospital
UnitedWayoftheColumbiaGorge
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AbouttheRegionTheColumbiaGorgeRegioniscomprisedofsevencountiesandliesonbothsidesoftheColumbiaRiver.InOregon,theColumbiaGorgeregionisrepresentedbyHoodRiver,Wasco,Sherman,Gilliam,andWheelercounties.SkamaniaandKlickitatcountiesmakeuptheWashingtonsideoftheColumbiaGorgeregion.Thesecountiescover10,284squaremilesandarehometoapopulationofapproximately84,000.
TheColumbiaGorgeRegionisamostlyruralareawithonlyafewtownsthatarelargerthan1,000people.Agricultureisalargeindustryinalmosteverycounty.Tourism,healthcare,forestry,andgrowingtechnologyfirmsalsodrivetheeconomy.Manyofourindustriesrelyonseasonalemployment.Therefore,weexperiencealargeinfluxofworkers,especiallymigrantandseasonalfarmworkers.
Washington
Oregon
Figure1-MapofColumbiaGorgeRegion
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DemographicsOverallRegionDemographicsThecurrentpopulationoftheColumbiaGorgeRegionis84,234.HoodRiver,Klickitat,WascoandShermancountieshaveseenasteadyincreaseinpopulationsince2013,whileGilliamandSkamaniahaveseenanoverallpopulationdecrease.OverallthepopulationinthesecountiesisolderthanthegeneralpopulationofWashingtonandOregon.Also,theHispanicpopulationhasgrowninalmosteverycounty.TheregionisalsorepresentedbyrelativelysmallpopulationsofBlacks,AmericanIndians,andAsianorPacificIslanders.
SurveyParticipantDemographics TheColumbiaGorgeHealthSurveywascompletedby1,368adultsandwasrepresentativeof3,590adultsandchildren.84%ofparticipantswereEnglishspeakers,while10%wereSpanishspeakers.MostadultswereNon-Hispanicwhites.Therewasalsoahighervolumeofolderadultsinrelationtothegeneralpopulationofregion.Ofthosethatresponded48wereDualeligible.60%ofthemareundertheageof65.
Table2-SurveyParticipantDemographics
Source:DatafromTruvenMarketExpert2016
Table1-OverallDemographics
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ForcesofChangeForcesofchangeare“trends,factorsorevents—thatareorwillbeinfluencinghealthandqualityoflifeofthecommunityandthelocalpublichealthsystem”(NACCHO).ThereareseveralforcesofchangeaffectingtheColumbiaGorgeregionthatimpactourhealthandhealthsystem.
SourcesofInformationTocreatethe2016CommunityHealthSurvey,wepartneredwithProvidence’sCenterforOutcomesResearchandEducation(CORE)todesignabasesurveyof36questions.Inaddition,theCommunityAdvisoryCouncil(CAC)formulatedanadditional91questions.Fromwhich,36wereselectedtoappearonthesurvey.Theseadditionalquestionsenabledustocollectinformationaboutaccesstospecifickindsofcare,traumahistory,housingsecurity,andsocialsupport/socialcohesion.SurveyswereavailableanddistributedinbothSpanishandEnglish.Additionally,weusedseveralothersourcesofinformationfromthecommunitytosupplementourdataandprovideadditionalresources.
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Mailsurvey2,500householdsreceivedthesurveybasedonarandommailingaddressbasedsamplingmethod.Themailsurveywasrepresentativeofhealthcareneedsforthosewhohaveastableaddress.Iftheaddress’szipcodewasinanareawhereatleast10%ofthehouseholdsreportedSpanishwasspokenathome,aSpanishandEnglishsurveywasmailedtothem.Ofthe2,500surveysthatweremailed,675werereturned,13ofwhichwereSpanishlanguagesurveys.Althoughmoresurveyswasreturned,theresponseratewas27%comparedtoa35%responseratein2013.
Hand-fieldedsurveyThehand-fieldedsurveywasmeanttoreachthepopulationsthatdidnothavestablehousingorwhodidnotspeakEnglish,astheywerelesslikelytorespondtothemailedsurvey.Todothis,volunteershandedoutsurveysatlocationsthatmaybefrequentedbythosewhowerelesslikelytoparticipateinthemailedsurvey.PlacesthatthesurveywasavailableincludedMealsonWheels,DepartmentofHumanServicesSelfSufficiencyagencies,andcountymentalhealthclinics.Withthehelpoftheseagencieswewereabletocollect694surveys,whichwasslightlymorethanthenumbercompletedin2013.
OregonHealthyTeenSurveyTheOregonHealthyTeenSurveyisacompletelyanonymousandvoluntarysurveythatisconductedamongthe8thand11thgradersacrossOregon.Itattemptstomonitorthehealthandwell-beingofyouthinallcounties.Consequently,questionsthatarerelatedtoalcohol,tobacco,druguse,personalsafety,violence,diet,exercise,andaccesstocareareasked.Thesurveyisonlyconductedinoddyears,thereforethedataweuseisfrom2015.Thedataisrepresentativeof717teensfromWasco,HoodRiver,Gilliam,andShermancounties;Wheelerdidnotparticipate.
WashingtonHealthyTeenSurveyTheWashingtonHealthyTeenSurveyisalsoananonymoussurveygivento6th,8th,and10thgradersacrossWashington.ItaimstoprovideaglimpseofthehealthofadolescentsinWashingtonbyaskingquestionsabouthealth,risk,safety,andsubstanceusebehaviors.Thissurveyisconductedinevenyears,sothisdataisfrom2014.Thedataisrepresentativeof318studentsfrombothSkamaniaandKlickitatcounties.
GorgeWideFoodSurvey
TheColumbiaGorgeHealthCouncilandtheCommunityAdvisoryCouncilconductedasurveytoaddressfoodinsecurityintheGorge.Itaddressedquestionssuchas“didyouskipameal”,“areyouworriedaboutfoodrunningout”,and“whatmakesitdifficulttoaccessfood.”Thesurveywasdistributedinfivecounties:HoodRiver,Wasco,Sherman,SkamaniaandKlickitat.Duetothiscollaborativework,thesurveyisrepresentativeof4,664people,manyofwhichrepresentvulnerablepopulationsinourregion.ThemajorityofparticipantswereEnglishspeakingandaboutathirdidentifiedasHispanic.NearlyhalfoftheparticipantswerereceivingSNAP,WIC,orFreeandReducedLunch.
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OregonHealthAuthorityBehavioralHealthProfilesThisOregonHealthAuthority(OHA)dataaddressesbothmentalhealthandsubstanceuseconditionsinMedicaidpatientsinHoodRiver,Sherman,andWascocounties.Thedataprovidesestimatesofthosethathaveamentalhealthorsubstanceusecondition.Toderivetheseestimates,OHAlookedatinsurancecodesonpatientsrecordsandrecordedanythathadtodowithamentalhealthservice,substanceuseservice,diagnosesofeither,orprescriptions,etc.Thisderivedprevalence,basedoninsurancecodes,indicatesactualdiagnoses.TheOHAdataalsoincludesthosethatarereceivingtreatmentfortheseconditions.
PacificSourceMedicaidUtilizationRates
ThisdataisrepresentativeofOregoniansintheColumbiaGorgeCCOregionthatareonMedicaid.Thedatapresentedshowsthenumberoftimesmembersvisitedtheirprimarycareprovider,behavioralhealth,ordentist.Thedatacovers2013-2016,howeverthereisnodatafordentalvisitsin2013becausedentalcoveragewasnotapartoftheCCOuntil2014.
CoordinatedHumanServicesTransportationPlanData
Mid-ColumbiaEconomicDevelopmentDistrictdistributedasurveyinWasco,HoodRiver,andShermancountiestogetabettersenseofthesecommunities’needsinregardstotransportation.Questionsregardedtheuseoftransportation,theirdestinations,whetheritwasabarriertoreceivingservices,etc.Thesurveywaspassedouttoclientsatsocialserviceagencies,aswellasthestaffthemselves.Itwasalsodistributedatseniorcenters,tothepublic,andtothepublictransportationprovidersineachcounty.About775peoplecompletedthesurvey.EmergencyDepartmentUtilizationCollectiveMedicalTechnologies(CMT)usesreal-timedata,riskanalytics,notifications,andsharedcareguidelinestopromptandguideproviderdecisionmakinginawaythatdrivesdifferentialoutcomesintermsofreducedEDutilizationandinpatientreadmissions.CMTwasabletoprovideuswithaccurateuptodateinformationaboutEmergencyDepartmentUtilizationbasedonEmergencyDepartmentInformationExchange(EDIE).
HealthcareandAgencyEcosystemDuetotherelativelysmallsizeoftheregionalpopulation,manyhealthcareprofessionals,socialserviceagencies,andnon-profitsintheColumbiaGorgeRegionservepatientsandclientsacrosscountyandstateboundaries.Therefore,thisregionalapproachtoacommunityhealthneedsassessmentprovidestheopportunityformultipleorganizationstoleverageourcollectiveworkforthebenefitoftheentirecommunity.
HealthcareProfessionalsTheColumbiaGorgeRegionisservedbyfourhospitals:ProvidenceHoodRiverMemorialHospital(HoodRiver^1),SkylineHospital(WhiteSalmon),Mid-ColumbiaMedicalCenter(TheDalles),andKlickitatValley
1HoodRiverCountyalsohasacitycalledHoodRiver.ThenotationHoodRiver^meansthecity.AllotherreferencesofHoodRivermeanthecountyofHoodRiver
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Hospital(Goldendale).EachhasbeendesignatedasaCriticalAccessHospital,exceptMid-ColumbiaMedicalCenter.
Eachofthesevencountieshasaccesstoaprimarycareprovider.Gilliam,Sherman,andWheelercountiesareabletoreceivecarelocallythroughmid-levelproviders.Fortherestofthecounties,bothmid-levelandphysiciansareavailableforcare.TheColumbiaGorgeRegionisalsoservedbyOneCommunityHealth,whichhasbeendesignatedasaFederallyQualifiedHealthCenter(FQHC).OneCommunityHealthhasofficesinTheDallesandHoodRiver^.
AcknowledgmenttotheClinicalAdvisoryPanel(CAP)TheClinicalAdvisoryPanel,orCAP,isapanelofprovidersspecializinginvarietyoffieldsincludingprimarycare,physicaltherapy,dental,familymedicine,psychiatrist,etc.Theirgoalsfocusonbuildingnetworksofcarethatpromoteimprovingcare,improvingexperienceofcare,andreducingcost.Theyhelpsetclinicalstandardswithinthecommunityanddeterminehowclinicalprioritiesareimplemented.
TheCAPhasbeeninvolvedinseveralprojectsaimedatbetteringcommunityhealth.Theyhaveadvocatedformentalhealthservices.Infact,asaresultoftheexpansionofbehavioralhealthconsultantsintoprimarycaresettings,morepeoplearegettingthementalhealthservicestheyneed.ThepanelwasalsosupportiveintheefforttoestablishthefirstschoolbasedhealthcenterintheregionatHoodRiverValleyHighSchool.Inshort,theCAPistryingtocreateabetterhealthandhealthcareenvironmentintheColumbiaGorgeRegion.
Table3-ParticipatinghealthorganizationsintheCAPAdvantageDentalColumbiaGorgeFamilyMedicineDeschutesRimHoodRiverCountyHealthDepartmentHoodRiverCountySchoolDistrictKidsDentalZoneLittleShreddersDentalMid-ColumbiaCenterforLiving
Mid-ColumbiaMedicalCenterNorthCentralPublicHealthDepartmentNorthwestPediatricsandAdolescentMedicineOneCommunityHealthOregonHealthandScienceUniversityOregonHealthAuthorityPacificSourceCommunitySolutionsProvidenceHoodRiverMemorialHospital
SocialServiceandGovernmentalAgencies AcknowledgmenttotheCommunityAdvisoryCouncil(CAC)TheCommunityAdvisoryCouncil,orCAC,iscomprisedofMedicaidconsumers,communitymembers,andlocalorganizations.Theirmissionistogivethecommunityavoicesothattheconsumerandcommunityhealthneedsareheard.Theyprovidefeedbackoncurrentservicesandprogramsandgivetheirinputonnewprogramideas.Theyalsohelpconnectorganizationswhichinturnimprovescommunityconnectedness.
TheCACalsoplaysalargeroleinoverseeingtheCommunityHealthAssessment.Aspartofthisrole,theCACplayedanintegralroleincreatingsurveyquestions.Theadditionalquestionstheydraftedhelpedtohighlightthecommunityneeds,suchastraumainformedcare.Additionally,manyCACagencieshelpedtodistributethehand-fieldedsurveysandenterthedata.
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TheCACisalsoresponsiblefortheCommunityHealthImprovementPlan(CHIP).ThroughtheCommunityHealthSurveydata,theyareabletocalloutareaofconcernsintheregion.Theygofurtherandsupportthecommunityinaddressingthesetopics.Byendorsingproposals,signinglettersofsupport,andcontinuouslyadvocatingforCHIPtopicstheyarethevoiceofcommunityinput.
Overall,theCommunityAdvisoryCouncilisanessentialvoiceofthecommunitytocreateabetterandhealthierregion.Table4-CommunityAdvisoryCouncil(CAC)members
• 211Info• AgingintheGorgeAlliance• ColumbiaGorgeHealthCouncil• HoodRiverCountySchoolDistrict• Mid-ColumbiaCouncilofGovernments
• Mid-ColumbiaHousingAuthority• OregonChildDevelopmentCoalition• GorgeGrown• HAVEN• HelpingHandsAgainstViolence• HoodRiverCountyPreventionDepartment
• OregonDepartmentofHumanServices
• OregonHealthAuthority• OregonStateExtensionProgram• PacificSource• RevellCoyInsurance• ShermanCountyCommissioner• TheNextDoor• UnitedWayoftheColumbiaGorge• YOUTHTHINK
• AdvantageDental • ColumbiaGorgeFamilyMedicine • KlickitatPublicHealth • KlickitatValleyHospital • Mid-ColumbiaCenterforLiving • Mid-ColumbiaMedicalCenter • NorthCentralPublicHealthDistrict • OregonHealthandScienceUniversity • GreaterOregonBehavioralHealthInc.
• OneCommunityHealth • ProvidenceHoodRiverMemorialHospital
• SkylineHospital
• Parentofchildwithdisabilities• Grandparentofchildwithdisabilities
• Adultwithdisabilities• Adultwithdualdiagnosis• Parentofchildwithbehavioralissues
• Low-income• Englishasasecondlanguage• Migrant/SeasonalFarmworkerliaison
Healthcare MemberPerspectives SocialServiceandGovernmentalAgencies
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HowtoReadtheResultsoftheAnalysisThefollowingdiagramwillhelpyoureadtheresultsthatwillbepresentedinthefollowingpages.These
pagesincludetheresultsofhandfieldedsurveys,mailbasedsurveys,andalternatedatasourcestosupplementthehealthassessmentdata.
1. Thetopicheadingreferstotheoveralltopicthatwillbeanalyzed.2. Thesubtopicsofeachmainsectionwithimportantdatapointsorsurveyquestions.
a. Eachquestionisbasedonanegativeview,suchasdidnotreceivecare,soinmostcaseslowernumbersarebetter.
3. TheRegioncolumnrepresentstheresultsofall7countiestogether.4. TheChangecolumncomparesdata,whereapplicable,fromthe2013communityhealthassessment
tothe2016communityhealthassessment.Thiscolumnfirstdisplaysanarrowfollowedbyagraph.
Ifthearrowisgreenandpointingdown ,thetopicimproved,whileared,pointingupwardsarrowindicatesthetopicworsenedfrom2013.Inthebargraph,thedarkbluerepresents2016andthelightbluerepresents2013.**Itshouldbenotedthatthe2016mailsurveydatawasweightedbasedonagebecausetheolderpopulationrespondedatamuchhigherrateandwasnotreflectiveofthegeneralpopulation.Therefore,weneedtotakenoticethatthecomparisonsarenotperfect.
5. Race/EthnicityView(red)showsresultsforNon-HispanicwhitesandHispanic/Latino/Others.TheothercategoryincludesAsian,Black,NativeHawaiianorPacificIslander,andAmericanIndianorAlaskaNative.
6. IncomeView(green)showsresultsforthoseunder200%FederalPovertyLevel(FPL)andthoseabove201%FederalPovertyLevel.
7. InsuranceView(purple)showstheresultsforthosewithPrivateinsurance,Medicare,Medicaid,andthosethatareuninsuredorhaveanothertypeofinsurance.
FederalPovertyLevelGuidelines
2013
200%FPL2016
200%FPL1personhousehold $22,980 $23,7604personhousehold $44,100 $48,600
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**Ifaboxhasadoublelinedborderandthenumberisinthemiddle,thisrepresentsthatthenumberissignificantlydifferentfromtheresultsoftheoverallregion**Ifdatahadlessthan25peopleanswerthequestiontheinformationwasomitted
Additionally,thisdocumentisbestreadincolor.Withinthenarratives,iftextisboldandblackitmeansthatthetopicisofnotableconcernforthewholeregion.Ifthetextisboldandcolored,thecolorindicatesthatthetopicisadisparityforaparticulargroup.Ifthecoloris….
1. Red-thedisparityiswithinaparticularraceorethnicity2. Green-thedisparityiswithintheincomepopulation3. Purple-thedisparityiswithinaparticularinsurancepopulation4. Blue-thisisimportantdatafromanothersurvey
*Alldataisfromthe2016CommunityHealthSurveyunlessotherwisenoted
BasicNeedsSocialDeterminantsofhealth,orbasicneeds,are“theconditionsintheplaceswherepeoplelive,learn,
work,andplay”(CDC)thatdirectlyimpactpeople’shealth.Examplesofthesebasicneedsinclude:
• Income• Food• Housing• Transportation• HealthInsurance
IntheColumbiaGorgeRegion,nearly1in4peoplearegoingwithoutabasicneed.Thosewithlowerincomesare7timesmorelikelytogowithoutabasicneedthansomeonewithahigherincome.Despitedisparitiesacrosspopulationcategories,allgroupssaidthatfoodandtransportationarethebiggestunmetneeds.Similarly,1in4peoplearegoingwithoutahealthcareneed.Thehealthcareneedpeoplearegoingwithoutthemost,inallpopulationcategories,isdentalhealthcare.Thisunmetneedisaffectingabout1outof3peopleintheuninsuredpopulation.Inshort,goingwithoutanyoneofthesenecessitiescangreatlyaffecthealth.
IncomeSecurityIncomesecuritymeanshavingtheamountofincomenecessarytocoverthebasicnecessitiesoflife.Following
thisdefinition,1outof3peopleareexperiencingsomekindoffinancialinstability.IncomeinsecurityaffectedtheHispanic/Latino/other,lowincome,Medicaid,anduninsuredpopulationsatamuchhigherratethanotherpopulations.
FoodSecurityandHealthyEatingIn2013foodsecuritywasidentifiedasaCommunityHealthImprovementPlan(CHIP)topic.Toaddressthis
issue,programssuchasVeggieRxwereinitiatedinthehopesofmakinghealthyfoodmoreaccessible.However,the2016CommunityHealthSurveyrevealedthatfoodsecurityisstillamajorissuefortheColumbiaGorgeRegion.AccordingtotheGorgeWideFoodSurvey,1in5peopleranoutoffoodand1in3wereworried
19
aboutrunningout2.ItalsoindicatedthatfoodsecuritywasamajorissueespeciallyforpeoplereceivingWIC,SNAP,andFreeandReducedLunchprograms.TheCommunityHealthSurveyshowedthatmorethan1in10peoplearegoingwithoutfood.However,thoseintheMedicaid,uninsured,orHispanic/Latino/Otherpopulationsgowithoutfoodatarateof1in4.Infact,thosewithlowerincomesarealmost10timesmorelikelytogowithoutfoodthanthosewithhigherincomes.Additionally,intheHealthyTeenSurvey,1in7teenssaidthattheyatelessthantheyshouldbecausetherewasn’tenoughmoneytobuyfood3.
Foodsecurity,however,doesnotstopwithhavingenoughfoodbutalsohavingaccesstohealthyfood.Inaregionwhereagricultureisalargeindustryonemaybelievethathealthyfoods,suchasfruitsandvegetables,
wouldbeeasilyaccessible.However,thisdoesnotseemtobethecase.AccordingtotheUnitedStatesDepartmentofAgriculture,weshouldbeeatingatleast5servingsoffruitsandvegetablesaday.Yet,4in10peopleareeatinglessthanhalfoftherecommendedamountandonlyaquarteraregettingtherecommendedaverage.Similarresultsappearedinthehealthyteensurvey.Halfoftheteensate2orlessservingsoffruitandvegetableswhileonlyaquartergottherecommendedamount3.Thiswasthecaseforallpopulationsregardlessofrace,
income,orinsurance.Ifarespondentdidnothavechildren,theyweremorethan2timesaslikelytoeatlessthantherecommendedamountthanthosewithchildren.
HousingSecurityHousingSecuritywasalsochosen
asaCHIPtopicin2013.Withhousingandrentpricesontheriseandlimitedlongtermhousingoptions,housingsecurityremainsalargesourceofdisparityintheColumbiaGorgeRegion.Approximately1outof10peoplehadtogowithouthousingin2016.Evenmore,aboutaquarterofthepopulationisworriedabouttheircurrenthousing
situation.Thisinsecurityfacedthelowerincome,Hispanic/Latino/Other,uninsured,andMedicaidpopulationsthemost.10%ofthepopulationispayingmorethan$1,500forhousingamonth.Ofthe10%
2Source:GorgeWideFoodSurvey3Source:OregonandWashingtonHealthyTeenSurvey
4in10eat2orlessservingsoffruitandveggiesaday
1outof4areworriedabouthousing
Onlyaquartereatrecommended
servings
20
paying$1,500,13%ofthemfallbelow200%FPL.Approximatelyhalfofthepopulationarecostburdened,whichmeanstheyspendmorethan30%oftheiryearlyincomeonhousing.
TransportationAccessAccesstotransportationwasthefinalCHIPtopicof2013inthesocialandeconomicconditionscategory.Itwas
thesecondmostcommonbasicneedpeoplehadtogowithoutbehindfood.DespiteeffortsmadetocombatthisproblemandduetolimitedpublictransportationintheGorge,transportationisstillasignificantproblem.Thedisparitywasmostnotableamongthoseofthelowerincomepopulation,whowere10timesmorelikelytogowithouttransportationthanthosewithhigherincomes.
AccordingtotheCoordinatedHumanServicesTransportationPlansurvey,mostpeopleneedtransportationfor:
• Medicalcare• Essentialshopping• Goingtowork
Lackoftransportationisafrequentbarriertogettingnecessaryhealthcareforbothadultsandyouth.Furthermore,inthelocaltransportationsurvey,socialserviceagencieswereaskediftransportationwasaninterferenceintheeffectivenessofservingtheirclients.Ofthecountiesthatparticipated,lackoftransportationwascitedasabarrieratthefollowingrates4
• Wasco:49%• HoodRiver:38%• Sherman:60%
Thus,lackoftransportationisnotonlyinhibitingpeoplefromthemedicalcaretheyneed,butalsosocialserviceprogramstheycouldgreatlybenefitfrom.
HealthInsuranceStatusSince2013andtheimplementationoftheAffordableCareActthe
numberofuninsuredintheregionhasbeencutinhalf.ThosethatremainuninsuredaremorelikelytobeapartofthelowerincomeandHispanic/Latino/Otherpopulations.AmajorityoftheuninsuredarealsofromOregon.ThemostcommonformofinsuranceisMedicarefollowedbyMedicaid.
4Source:CoordinatedHumanServicesTransportationPlanSurvey
34%
27%1%
30%
8%InsuranceType
Medicare Private Military
Medicaid Uninsured
0%1%2%3%4%5%6%7%
Physcial Dental Mental Prescriptions
BarrierstoHealthcareAccessNeededTransportation
21
*refertopage14forinstructionsonhowtoreaddatatables
Figure2-BasicNeeds/SocialDeterminants
22
AdultHealthStatusOverallHealthStatus-Adult
Aquarterofthepopulationratedtheirphysicalhealthasfairorpoor.ThisratingwasmoretypicalamongstthosewithonlyahighschooldiplomaorGEDandtheunemployed.
Additionally,theBMIforadultswascalculatedbasedontheheightandweighttheyprovided.Thisrevealedthatthe40to64yearoldcategorywasthemostlikelytobeoverweightorobese.Italsoshowedthatabout2outof3peopleintheregionare
overweightorobese,whichisaboutthesameasthenationalaverage.
ChronicMedicalConditions-AdultAchronicmedicalconditionisaconditionor
diseasethatlastsforlongerthanthreemonths.IntheGorgemorethanhalfoftheadultpopulationisaffectedbyatleastoneoftheseconditions.Themostcommonconditionishighbloodpressurefollowedbyhighcholesterol.Non-HispanicwhitesandMedicarerecipientsaremorelikelytohaveachronicdiseasethanotherpopulations.
MentalHealthConditions-AdultMentalhealthdiagnosesaremorewidespreadamongtheNon-Hispanicwhites,lowincome,andMedicaidpopulations.Morethan1in3haveamentalhealthcondition,themostcommonbeingdepression.Aquarterofthepopulationisexperiencingonephysicalconditionandonementalcondition.
0%10%20%30%40%50%
18-39years
40-64years
65-79years
80+years
OverweightandObesity
Overweight Obese
0% 10% 20% 30% 40%
HighBloodPressure
HighCholesterol
Asthma
Diabetes
ChronicMedicalCondtions
1outof4thinktheyhavefairorpoorhealth
37%haveatleastonementalhealthcondition
23
TraumaandResilience-AdultAtraumaticeventisany
eventthatcausesphysical,emotional,spiritual,orpsychologicalharm.Scientificevidencehasshownhowthesetraumaticevents,especiallythosethathappeninouryouth,canleadtolongtermhealthoutcomes.Peoplewhohaveexperiencedatraumaticeventaremorelikelytohaveachronicmedicalcondition,mentalhealthcondition,andanearlydeath.Withmoreemphasisbeingplacedontraumainformedcare,wethoughtitwasimportanttoseehowtraumaticeventshaveimpactedthosewithinourcommunity.Assuch,the2016surveyfeaturedanewsectioncenteredontraumaticevents.ManyofourquestionswerebasedontheAdverseChildhoodExperiences(ACEs)studyquestionsaswellasafewofourown.Whileafewofthesequestionswereaskedinthe2013CommunityHealthSurvey,theywerepresentedinadifferentwayin2016.Inthemostrecentsurveytherewasonequestionthataskedparticipantstowhatextenttheyhadexperiencedsomeeventintheirlifeasopposedtoseparatequestionsforeachhardship.Whengroupedthiswaytheresponsesweredrasticallydifferent.Forexample,in2013thequestion“Haveyoubeenforcedtodosomethingsexualthatyoudidn’twanttodo”hadaresponseratearound1%;whengroupedwithotherquestionstheresponsewas15.7%.
Theresultsofthisnewsectionshowedthatmorethan3outof4peoplehaveexperiencedatleastonetraumaticevent,while2outof5peoplehaveexperiencedthreeormoretraumaticeventsintheirlives.Ofthosethathaveexperiencedatraumaticevent,40%hadsomeonedosomethingharmfultothem.Thisincludesthecategoriesofneglectorabuseofanykind,physicallyhurtbyapartner,witnessedorexperiencedviolence,andforcedtodosomethingsexualtheydidn’twanttodo.Therewerenotsignificantdisparitieswithinanysubpopulationgroup.Themostcommon
traumaticeventsexperiencedwerelifechangingillnessorinjury,livedwithsomeonewithmentalillnessorsubstanceabuse,andtheunexpecteddeathofalovedone.
3outof4haveexperiencedatleastone
traumaticevent
2outof5peoplehaveexperienced3ormoretraumaticevents
24
Alcohol,Tobacco,andOtherDrugs-Adult AlcoholUse
1in5adultsdrink4ormoretimesaweek.ThiswasmoreusualforNon-Hispanicwhitesandthosewithhigherincomes.Onthedaysthatonedrank,1in5arehaving3ormoredrinks.Having3ormoredrinksadayismostcommonamongtheuninsured.
TobaccoUse1in5peopleusetobacco.Thisismorecommonamonglowerincome,Medicaid,anduninsuredpopulations.Useoftobaccowasalsohigherforthosethathadexperiencedatraumaticevent.
OtherDrugsUseSince2013marijuanaandotherdrugusehasincreased.Theuseofmarijuanaisconsistentthroughoutallpopulationgroups.However,otherdruguseismostprevalentinthelowerincome,Medicaid,anduninsuredpopulation.Nonprescribedopioidswerethemostuseddrugbesidesmarijuana.Thosethathaveexperiencedatraumaticeventusedmarijuanaandotherdrugsatamuchhigherratethanthegeneralpopulation.
25
*refertopage14forinstructionsonhowtoreaddatatables
Figure3-AdultHealthStatus
26
AdultHealthcareAccessPhysicalHealthcareAccess-AdultPhysicalhealthcareaccessimprovedin2016.
Incomparisonwith2013,peoplearenowmorelikelyto:
• Haveanormalsiteforhealthcare• Haveaprimaryhealthcaredoctor• Receiveallthecaretheyneed
Themostcommonplacestoreceivecareare:
• Doctor’soffice• Publichealthclinic
Themajorityofadultsreceivedcarein:
• HoodRiver^• TheDalles• Portland/Vancouver• WhiteSalmon
Whilethenumberofthosereceivingcaredidimprove,about1in5adultsarestillgoingwithoutnecessarycare.Thisunmetneedisgreateramongpeoplewithlowerincomes.Themostcommonbarrierstocarearecost,notbeingabletogetanappointmentquicklyenough,andnothavingaregularprovider.AccordingtoareportaboutMedicaidmembersinOregon,thenumberofprimarycarevisitshasbeenonadownwardtrendsince2013.
DentalHealthcareAccess-AdultDentalhealthcareaccessremainsthegreatest
unmethealthcareneedin2016.Aquarterofthepopulationisnotgettingnecessarydentalcare.Thisismainlyduetocostandnothavingaregularprovider.Thosethatfaceunmetneedthemostarelowincome,Medicaid,anduninsured.Infact,morethan1in3Medicaidrecipientshaveanunmetneed.Ofthosewithunmetneed,63%ofWashingtonMedicaidusersand52%ofOregonMedicaiduserssaiditwasduetocost.However,dentaliscoveredunderMedicaidandassuchthereshouldbenocost.
0%
5%
10%
15%
20%
25%
30%
BarrierstoPhysicalHealthcare
18%ofadultshaveunmethealthcareneeds
0%
10%
20%
30%
40%
BarrierstoDentalHealthcare
27
About1in3peoplealsosaidthattheydidnotneeddentalcare.AccordingtoanOHAsurvey,ofOregonMedicaiduserstheaveragenumberoftimesamemberseesadentistisaboutonceayear.However,preventativedentalhealthcaresuggestspeopleshouldbevisitingthedentisttwiceayear.Theseresultssuggestthateducationaboutgooddentalhealthcareandinsurancebenefitscouldplayabigroleindentalaccess.
MentalHealthcareAccess-AdultAccordingtothe2016survey,mentalhealthcareaccessgreatlyimprovedfrom2013.Lessthan1in10peoplearenotgettingalloftheirmentalhealthcareneedsmet.
Mostcommonplacestoreceivecareare:
• Primaryhealthcareprovider• Countymentalhealthclinic
LowincomeandMedicaidpopulationsfacedthisaccessdisparitythemost.Mostunmetneedsarearesultofcost,notknowingwheretogo,andnothavingaregularprovider.
DatafromOregonHealthAuthority(OHA)sourcesonWasco,HoodRiver,andShermancountiesshowsthat39%ofadultsinthethreecountiesareestimatedtohaveamentalhealthcondition.Only11%ofthosewithamentalhealthconditionarereceivingtreatmentwhile28%arenotgettingthenecessarycare.5However,accordingtotheCommunityHealthSurveyonly18%ofadultsreportedhavingmentalhealthcondition.About11%arereceivingallthecaretheyneedwhile7%haveunmetneeds.
5Source:OregonHealthAuthorityBehavioralHealthProfiles
26%ofadultshaveunmetdentalneeds
61%
11%
28%39%
OHAMentalHealthWasco-HoodRiver-Sherman(estimates)
NoMHcondition Receivedcare Unmetneed
82%
11%
7%
18%
2016SurveyMentalHealthWasco-HoodRiver-Sherman(responses)
NoMHcondition Receivedcare Unmetneed
0%5%
10%15%20%25%30%35%
BarrierstoMentalHealthcare
28
Figure4-AdultUtilization-PacficSourceMedicaidUtilizationRatesSubstanceUseTreatment-AdultAccordingtothe2016surveyresponses,lessthan100peopleneededsubstanceusetreatmentintheGorge.Ofthosethatdidneedsubstanceusetreatment,2outof3peoplereceivedlocalservices,asmall
percentageusedoutofareaservices,andtherestarenotgettingtheneededservices.Theuninsuredhavemoretroublegettingtheneededservicesthanotherpopulationgroups.
DatafromOHAsourcesonWasco,HoodRiver,andShermancountiesshowsthat9.1%ofadults,or815adults,inthethreecountiesareestimatedtohaveasubstanceuseissue.Havingasubstanceuseproblemwasmorepronouncedinthe18-25category.Inthisagerangeabout20%wasestimatedtohaveasubstanceuseproblem.6%ofthoseonMedicaidintheseregionsarereceivingsomesortofsubstanceusetreatment.6
6Source:OregonHealthAuthorityBehavioralHealthProfiles
00.51
1.52
2.53
3.54
4.5
2013 2014 2015 2016
HoodRiver^&TheDalles18-64Utilization
primarycarevisits behavioralhealthvisits
dentalvisits
00.51
1.52
2.53
3.54
4.5
2013 2014 2015 2016
Rural18-64Utilization
primarycarevisits behavioralhealthvisits
dentalvisits
0
1
2
3
4
5
2013 2014 2015 2016
HoodRiver^&theDalles65+Utilization
primarycarevisits behavioralhealthvisits
dentalvisits
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5
2013 2014 2015 2016
Rural65+Utilization
primarycarevisits behavioralhealthvisits
dentalvisits
29
Medications-AdultAmajorityoftheadultpopulationneededsomekindofprescriptionmedicationinthelast12months.However,1in10arenotgettingalltheprescriptionsthattheyneed.Thisproblemismorepronouncedinthelowincome,Medicaid,anduninsuredpopulations.Costisthelargestbarriertogettingalltheprescriptionsneeded.
Specialists-AdultSpecialistsareproviderswhofocusinoneareaofhealthcare.HereintheGorge,morethanhalfofadultsneededcarefromsometypeofspecialist.
Themostneededtreatment:
• Skinconditions(acne,moles,skincancers,etc)
• Orthopedics
Thetreatmentwithmostunmetneed(intermsofnumbersnotpercent):
• Neurology• SkinConditions• Orthopedics
Thosethatdidreceivetheneededservicesweretypicallyabletouselocalservices.Orthopedicshadthelargestnumberofpeopleusingnonlocalservices.
2013CHIPTopics-AdultDentalAccessDentalaccessstillremainsthegreatestunmethealthcareneed.Although,someimprovementhasbeenmadesince2013.
PhysicalandMentalHealthTogetherNearlyhalfofadultsthatneededmentalhealthusedtheirprimarycareofficetoreceivecare.Ofthosethatwenttotheirprimarycareoffice,morethanhalfgotallthecaretheyneeded.Thiswasalsothecaseiftheywentelsewheretoreceivetheirmentalhealthcare.
60%ofadultsneededspecialistcare
0%
5%
10%
15%
20%
25%
0%
20%
40%
60%
80%
100%
Needofspecialistcareandhowitisbeingmet
Usedlocalservices Usedoutofareaservices
Hadunmetneeds NeededCare
2061397915387235189
**Numberontopisnumberofpeoplethatneededservices
need
edcare
Howneedsweremet
30
*refertopage14forinstructionsonhowtoreaddatatables
Figure5-AdultHealthcareAccess
31
YouthHealthStatusThedataonouryouthcomesfromavarietyofsurveys.AportionofthedatacomesfromtheOregonHealthyTeensurveyandtheWashingtonHealthyTeensurvey.Wealsohaveparentresponsesabouttheirchildrenfromthecommunityhealthassessment.Thisprovidedaninterestingcomparisonintohowthekidsfelttheirneedswerebeingmetversushowparentsviewedtheirchildren’sneedsbeingmet.
OverallHealthStatus-YouthWhenaskedtoratetheirownphysicalhealth,themajorityoftheteensthoughttheywereingood,verygood,
orexcellentphysicalhealth.Oftheteensparticipatingnearly1in5areoverweightandslightlymorethan1in10youthareobese.7
ChronicMedicalConditions-YouthAbout14%ofyouthswerediagnosedwithachronicmedicalcondition.Thiswasmorenotableamongthe
Non-Hispanicwhitesandhigherincomepopulations.Themostcommonchronicmedicalconditionisasthma.
MentalHealthConditions-YouthNearly1in5teensrespondedthattheythoughtthattheirmentalhealthwasfairorpoor.Aquarteroftheyouthpopulationhasbeendiagnosedwithamentalhealthcondition.ThiswasmorecommonamongtheNon-HispanicwhitesandMedicaidpopulations.Themostcommonmentalhealthconditionisanxiety.
TraumaandResilience-YouthIntheOregonHealthyTeenSurveytherewereseveralquestionsaboutunwantedsexualencountersandviolence.Thesequestionswereonlygiventothe11thgraders.Ofthe11thgraders,morethan1in5hadbeenintentionallyhitorhurtbyanadult.Also7%hadbeenforcedtodosomethingsexualthattheydidnotwanttodo.
Bullyingisalsoatraumaticeventthatmanyyouthfaceduringtheirteenyears.21%ofteensarebeingbulliedbysomeoneusingaformoftechnology.
Themainreasonsteensarebeingbullied:
• Physicalappearances• Friendgroup• Receivingunwantedsexualcomments
Also,about10%ofteensarenotgoingtoschoolbecausetheyfeltasthoughtheywouldbeunsafeatschoolorontheirwaytoorfromschool.Finally,1in10studentshavebeeninoneormorefightsatschool.7
7Source:OregonandWashingtonHealthyTeenSurvey
18%thinktheyhavefairorpoormentalhealth
32
Alcohol,Tobacco,andOtherDrugs-Youth8 AlcoholUse
1in5teenshadatleastonedrinkofalcoholinthepastthirtydays.Themostcommonbeveragewhentheydodrinkisliquor.Mostofthosethatdrankwere11thgraders.Finally,themajorityof11thgraderssaidthatobtainingalcoholwouldberelativelyeasy,whilemorethanhalfof8thgradersthoughtitwouldbedifficult.
TobaccoUseAlmost1in5teenshaveusedtobaccointhepastthirtydays.Mosthadneverfinishedawholecigarette,justtookoneormorepuffs.Moreover,abouthalfoftheteensagreethatcigarettecompaniesdeliberatelyadvertiseandpromotecigarettestoyouthunder18.
MarijuanaUse15%haveusedmarijuanainthepastthirtydays.29%ofthe11thgradershadmarijuanainthepast30dayswhichwasadrasticincreasefrom2013whenonly19%hadusedmarijuana.However,theuseofmarijuanaforthe8thgradersdecreased.In2015,5%hadusedmarijuanacomparedto9%in2013.Themostcommonwaypeoplegotmarijuanawasthroughfriends.
OtherDrugsUse1in20teensareusingprescriptiondrugswithoutadoctor’sorder.
8Source:OregonandWashingtonHealthyTeenSurvey
33
*refertopage14forinstructionsonhowtoreaddatatables
Figure6-YouthHealthStatus
34
YouthHealthcareAccess9PhysicalHealthcareAccess-YouthPhysicalhealthcareaccessremainsthesameas2013.Accordingtoparent
responsesabout1in10childrenarenotgettingallthecaretheyneed.Thiswastrueforallpopulationgroups.Thereasonfortheunmetneedwasmostlyduetocostandnotbeingabletogetanappointmentquicklyenough.However,whentheyouthanswerthisquestionnearly1in5teensfelttheywerenotgettingthenecessarycare.
DentalHealthcareAccess-YouthDentalhealthcareaccessremainsthelargestunmetneedamongchildren.However,accessdid
improveslightlyfrom2013.Accesswasmoredifficultforthoseamongthelowerincomeanduninsuredpopulations.Costisthebiggestbarriertoreceivingdentalcare.TheHealthyTeenSurveyalsoaskedwhenwasthelasttimetheteenhadseenadentist.1in5youthhadnotbeentothedentistinthepastyear.Again,preventativedentalhealthsuggeststhatwevisitthedentisttwiceayear.Educationisparticularlyimportantindentalhealthcareaccess.
MentalHealthcareAccess-YouthAccesstomentalhealthcareforyouthgreatlyimprovedin2016.Lessthan10%ofchildrenhad
anunmetneedaccordingtotheparents.However,theteenresponsetounmetcarewasnearlytwicetheparentresponseat15%.Themainbarriertoaccessingmentalhealthcarewascost.
9Source:OregonandWashingtonHealthyTeenSurvey
1in10parentsfeltasthoughtheirchildhadunmethealthcareneeds
2in10youthfeelasthoughtheyhaveunmethealthcareneeds
1in5youthhavenotbeentodentistinpastyear
84%
9%
7%
16%
2016SurveyMentalHealthYouthWasco-HoodRiver-Sherman(responses)
NoMHcondition Receivedcare Unmetneed
72%
10%
18%
28%
OHAMentalHealthYouthWasco-HoodRiver-Sherman(estimates)
NoMHcondition Receivedcare Unmetneed
35
DatafromOHAonWasco,HoodRiver,andShermancountiesillustratedthatabout28%ofyouthinthethreecountiesareestimatedtohaveamentalhealthcondition.However,only1in10childrenarereceivingtreatment.Accordingtothe2016survey16%ofyouthhavebeendiagnosedwithamentalhealthcondition.Morethanhalfaregettingallthecaretheyneed.10
SubstanceAbuseTreatment-YouthAccordingtodatafromOHAsourcesonWasco,HoodRiver,andShermancounties,about7%ofyouthinthe
threecountiesareestimatedtohaveasubstanceuseissue.However,only1%ofyoutharereceivingtreatment.10
Figure7-YouthUtilization-PacficSourceMedicaidUtilizationRates2013CHIPTopics-Youth PhysicalandMentalHealthTogether
Morethanaquarterofchildrenthathadamentalhealthneedusedtheirprimarycaretoreceivecare.Ofthosethatwenttotheirprimarycareofficeforcare,morethan80%gotallthecaretheyneeded.
MentalHealthAccessforChildren MentalHealthAccessimprovedforchildrensince2013.
SupportingDevelopmentalandHealthyGrowthintheEarlyYears 251householdsfromthosethatparticipatedinthe2016surveyhadchildrenages0-5.Ofthosehouseholds,morethanhalfarebelow200%FPLandabout44%areonMedicaid.Additionally,about1in3ofthesehouseholdsaregoingwithoutabasicneedorhealthcareneed.Finally,theratesofadultssmokingtobaccoandmarijuanaarehigherinthispopulationthaninthegeneralpopulation.
10Source:OregonandWashingtonHealthyTeenSurvey
0
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2013 2014 2015 2016
HoodRiver^&TheDalles0-17Utlization
primarycarevisits behavioralhealthvisits
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Rural0-17Utlization
primarycarevisits behavioralhealthvisits
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36
*refertopage14forinstructionsonhowtoreaddatatables
2013CHIPTopicSocialServiceAgenciesandHealthcareProvidersinthecommunitywereasked10questionsregardingtheirreferralprocesstootherorganizationsincludingPrimaryCare,MentalHealth,Dental,PublicHealth,Transportation,Housing,FoodandotherSocialServices.Thequestionssurveyedtheorganizationsonthefrequencyofreferrals,howreferralsaremade,thedegreeofcarecoordinationforsharedclientsandinformationshared.Inaddition,surveyparticipantsindicatedbarrierstheyfacewhenreferringclients.Thesequestionswereinresponsetothe2013CHIPtopicsofCoordinationAcrossallHealthcareProvidersandCoordinationAcrossHealthcareandSocialServices.
CoordinationAcrossallHealthcareProviders Coordinationbetweenprimarycareandmentalhealthprovidersiscommonandthecommunicationandcoordinationbetweentheseprovidersgenerallyworkswell.However,primarycareandmentaldentalgeneratefarfewerreferralstodentalandcommunicationisnotaseffectiveasthecommunicationbetweenprimarycareandmentalhealth.
CoordinationAcrossHealthcareandSocialServices Coordinationacrosshealthcareandsocialservicesisinitiatedoftenandworkswell.Coordinationwithprimarycarehappensthemostfrequentlyandisthemosteffectivefollowedbymentalhealth.However,thereferralloopisnotalwaysclosedandthisvariesbasedontheorganizationtheyarereferringto.ThemostfrequentsocialservicereferralisTransportationfollowedbyfood.
AssetsandBarriersintheReferralprocess Localproviderssaidthathavingsocialworkers,casemanagers,orcommunityhealthworkershelpscoordinatingcare.Theysaidthatthebiggestbarrierstocoordinatingcarewasnothavingreleaseofinformationfromtheclient,lackofconnectivitytoreferringorganizations,andlackoflocalservicesfortheirclients.
Figure8-YouthHealthcareAccess
37
CommunityandSocialEnvironmentSocialconnectednessreferstorelationshipswehavewithothers.Theserelationshipswithfriendsandfamily,aswellasourcommunitycaninfluenceourhealthinbothpositiveandnegativeways.Assuch,socialconnectednesshasproventobeamajorpredictorofgoodhealth.Accordingtomanystudies,goodrelationshipswiththoseinourcommunitycanorareassociatedwith:
• Lowerriskofchronicmedicalconditions• Healthierhabits• Promotepositivementalhealth• Betterrecoveryafteramajorillness
Therefore,ourfeelingsaboutoursocialsupportorsocialcohesioncouldbeagoodexplanationofouroverallhealth.
SocialSupportSocialsupportmeansfeelingasthoughyouhavesomeoneinyourlifetosupportyouinavarietyofways.Thefeelingsofsocialsupportimprovedfrom2013.Thebiggestdisparitiesinthistopicarewiththelow
incomepopulation.Themainareaswherepeopledonotfeelthattheyhadsupportwasiftheywereconfinedtoabedandnothavingsomeonetogettogetherwithforrelaxation.
SocialCohesionSocialcohesionreferstohowpeopleperceivethecommunityandpeopleinthecommunityinwhichtheylive.Ingeneral,peopleintheGorgefeelpositiveaboutthecommunitytheylivein.Hispanic/Latino/Other,lowincome,Medicaid,anduninsuredpopulationsaremorelikelytohavehesitationsabouttheircommunity.Forexample,intheoverallpopulation1in10peopledidnotfeelsafeintheircommunity.Butthoseoflowerincomeswereabout5timesmorelikelytofeelunsafethanthoseofhigherincomes.
SupportforcaregiversWithanagingpopulation,theroleofcaregiverhasbecomemorecommoninoursociety.IntheColumbiaGorge1in5peoplearecurrentlyprovidinghelptoarelativeorlovedone.However,morethanhalfofthesecaregiversdonotfeelasthoughtheyhaveadequatesupportfortheircaregivingrole.Thiswassimilaracrossallpopulationgroups.
22%ofadultsareactingasacaregiver 60%ofcaregiversdon'tfeelthey
haveadequatesupport
38
*refertopage14forinstructionsonhowtoreaddatatables
Conclusion Overall,the2016communityhealthassessmentillustratedthattheregionhasthesameneeds,despitecountylines.Thus,itagainshowedtheimportanceofworkingtogethertoaddressareasofconcernintheregion.Italsoshowedusseveralissuesaboutthecurrenthealthandhealthcaresystemoftheregion.
1. Foodandhousingsecurityarestillhighconcernareas.2. Thenumberofinsuredgrew.Despitemorecoverage,thenumberofthosereceivingcaregotslightly
better.3. Whilethosereceivingdentalcaredidimproveitisstillthelargestunmetneedintheregion.4. Transportationcontinuestobeabarrierandthusutilizationoftransportationservicesislower.5. Parentsunderestimatetheneedsthattheirchildrenface.6. Householdswithchildren0-5aremorelikelytogowithoutbasicneedsthanthosewithoutchildren
0-5.7. Aswecanseethroughthesurveyresults,traumaisarealpartofourcommunityandweneedto
acknowledgeit.
Figure9-CommunityandSocialEnvironment
39
Appendix ListofFiguresandTables
Table1-OverallDemographics...................................................................................................................................11Table2-SurveyParticipantDemographics.................................................................................................................11Table3-ParticipatinghealthorganizationsintheCAP...............................................................................................15Table4-CommunityAdvisoryCouncil(CAC)members..............................................................................................16Figure1-MapofColumbiaGorgeRegion...................................................................................................................10Figure2-BasicNeeds/SocialDeterminants................................................................................................................21Figure3-AdultHealthStatus......................................................................................................................................25Figure4-AdultUtilization-OregonHealthAuthorityBehavioralHealthProfiles.......................................................28Figure5-AdultHealthcareAccess..............................................................................................................................30Figure6-YouthHealthStatus.....................................................................................................................................33Figure7-YouthUtilization-OregonHealthAuthorityBehavioralHealthProfiles......................................................35Figure8-YouthHealthcareAccess..............................................................................................................................36Figure9-CommunityandSocialEnvironment.............................................................................................................38
40
MSFW-MigrantandSeasonalFarmWorker Aseasonalfarmworkerissomeonewhohasdonefarmworktoearnatleasthalfoftheirincome,howevertheyarenotemployedinfarmworkyearroundorbythesameemployer.Amigrantseasonalfarmworkerisaseasonalfarmworkerwhohastotraveltoworkandcanthereforecannotreturntotheirpermanentplaceofresidence.
MigrantandSeasonalFarmWorkersareanimportantpopulationintheColumbiaGorgeRegion.Theymakeupabout7%ofthepopulation.Ofthose,about2/3areunder200%FPLandareHispanic.ThemajorityareonMedicaid.
TheMSFWpopulationwasmorelikelytogowithoutabasicneedorhealthcareneedthantheoverallpopulation,howevertheirratesofgoingwithouttheseitemsweresimilartothelowincomepopulation.Theywerealsomorelikelytohavetogowithoutfoodandhousing.Finally,abouthalfofthispopulationhadsometypeoffinancialinsecurity.
Morefarmworkersratedtheirhealthasfairorpoorthantheregion.However,theirratesofchronicdiseaseandmentalhealthconditionsweremuchlowerthanthegeneralpopulation.Alsotheirtroubleaccessingcarerivaledthatofthegeneralpopulation.Therewasnonotabledisparityingettingallthecaretheyneededforbothchildrenandadults.
Finally,theirfeelingsaboutsocialsupportandsocialcohesionweresimilartothegeneralpopulation.Infact,theyfeltaslightlybetterabouttheircommunitythanthegeneralpopulation.
**percentdon’talwaysaddupto100duetonoresponsesanswers
Number Percent
93 6.8%
200%andbelow 61 65.6%
201%andabove 13 14.0%
Hispanic/Latino/Other 64 68.8%
NonHispanicwhites 27 29.0%
Uninsured 18 19.4%
Medicaid/Dual 40 43.0%
Medicare 9 9.7%
Private 16 17.2%
18-39years 50 53.8%
40-64years 30 32.3%
65-80years 7 7.5%
80+years 1 1.1%
Worriedabouthousing 19 20.4%
Payslessthan750 40 43.0%
Pays750-1500 24 25.8%
Paysmorethan1500 7 7.5%
Wentwithoutabasicneed 35 37.6%
Wentwithouthealthcare 34 36.6%
Wentwithoutfood 21 22.6%
Wentwithouttransportation 14 15.1%
Wentwithouthousing 16 17.2%
Anyfinancialinsecurity 50 53.8%
Generalhealth-fairorpoor 27 30.1%
Overweight 26 28.0%
Obese 26 28.0%
ChronicDisease 23 24.7%
MentalHealthCondition 22 23.7%
MentalandPhysical 10 10.8%
TraumaticEvent 58 62.4%
3ormoretraumaticevents 26 28.0%
Doesn'thaveusualplaceof
care 10 10.8%
UnmetPhysicalNeed 15 16.1%
UnmetDentalNeed 23 24.7%
UnmetMentalNeed 4 4.3%
UnmetPrescriptionNeed 11 11.8%
NeededSpecialistcare 29 31.2%
UnmetPhyscialNeed 4 7.7%
UnmetDentalNeed 12 23.1%
UnmetMentalNeed 2 3.8%
Peopleinmycommunity
arewillingtohelp 13 14.0%
Peopleinmycommunity
canbetrusted 17 18.3%Ifeelsafeinmy
community 13 14.0%
Caregiversfeellikethey
haveadequatesupport
12
(21arecg) 57.1%
Hassomeonetolovethem
andmakethemfeel 19 20.4%
Hassomeonetoconfidein 25 26.9%
*cg=caregiver
Socialand
Community
Environment
(%disagree)
MigrantandSeasonalFarmWorkers
Youth
Healthcare
Access (n=52)
HealthStatus
Healthcare
Access
BasicNeeds
Age
TotalPopulation
FPL
Race/Ethnicity
Insurance
41
CaregiversCaregiversareunpaidpeoplewhohelpotherswiththeirdailylifeactivities.Duetotheincreasingageofthepopulation,caregivinghasbecomeamorecommonroleinoursociety.IntheColumbiaGorgeRegion1in5adultsactasacaregiverforalovedone.
Ofthecaregivers,2outof5arelowincomeandthemajorityareNon-Hispanicwhites.About1in3caregiversareonprivateinsurance.Themostcommonageofthispopulationisthe40-64yearoldcategory.
Thispopulationofcaregiverswasmorelikelytogowithoutahealthcareneedthanthegeneralpopulation.Theywerealsomorelikelythanthegeneralpopulationtoexperiencefinancialinsecurity.However,theyexperiencethesehardshipslessthanthevulnerablepopulations,Hispanic/Latino/Other,lowincome,uninsured,andMedicaid
Caregiversalsoweremorefrequentlydiagnosedwithamentalhealthconditionandweremorelikelytosufferfromonementalhealthconditionandonephysicalhealthcondition.Theywerealsomorelikelytohaveexperiencedatraumaticeventintheirlife.Alsotheirtroubleaccessingcarerivaledthatofthegeneralpopulation.Therewasnonotabledisparityingettingallthecaretheyneededforbothchildrenandadults.
Finally,theirfeelingsaboutsocialsupportandsocialcohesionweresimilartothegeneralpopulation.
**percentdon’talwaysaddupto100duetonoresponsesanswers
Number Percent
268 19.6%
200%andbelow 104 38.8%
201%andabove 93 34.7%
Hispanic/Latino/Other 71 26.5%
NonHispanicwhites 190 70.9%
Uninsured 25 9.3%
Medicaid/Dual 66 24.6%
Medicare 71 26.5%
Private 81 30.2%
18-39years 59 22.0%
40-64years 131 48.9%
65-80years 57 21.3%
80+years 14 5.2%
Worriedabouthousing 61 22.8%
Payslessthan750 142 53.0%
Pays750-1500 81 30.2%
Paysmorethan1500 21 7.8%
Wentwithoutabasicneed 75 28.0%
Wentwithouthealthcare 87 32.5%
Wentwithoutfood 38 14.2%
Wentwithouttransportation 41 15.3%
Wentwithouthousing 22 8.2%
Anyfinancialinsecurity 111 41.4%
Generalhealth-fairorpoor 72 26.9%
Overweight 78 29.1%
Obese 93 34.7%
ChronicDisease 158 59.0%
MentalHealthCondition 116 45.0%
MentalandPhysical 87 32.5%
TraumaticEvent 229 85.4%
3ormoretraumaticevents 139 51.9%
Doesn'thaveusualplace
ofcare 18 6.7%
UnmetPhysicalNeed 58 21.6%
UnmetDentalNeed 85 31.7%
UnmetMentalNeed 34 12.7%
UnmetPrescriptionNeed 28 10.4%
NeededSpecialistcare 147 54.9%
UnmetPhyscialNeed 8 10.7%
UnmetDentalNeed 14 18.7%
UnmetMentalNeed 7 9.3%
Peopleinmycommunity
arewillingtohelp 34 12.7%
Peopleinmycommunity
canbetrusted 64 23.9%Ifeelsafeinmy
community 27 10.1%
Caregiversfeellikethey
haveadequatesupport
153
(268arecg) 57.1%
Hassomeonetolovethem
andmakethemfeel 54 20.1%
Hassomeonetoconfidein 80 29.9%
*cg=caregiver
BasicNeeds
HealthStatus
HealthcareAccess
YouthHealthcare
Access (n=75)
SocialandCommunityEnvironment(%disagree)
Age
Caregivers
TotalPopulation
FPL
Race/Ethnicity
Insurance
42
CountySlices
Number Percent110 8.0%
200%andbelow 33 30.0%
201%andabove 31 28.2%
Hispanic/Latino/Other 12 10.9%
NonHispanicwhites 95 86.4%
Uninsured 5 4.5%
Medicaid/Dual 37 33.6%
Medicare 29 26.4%
Private 28 25.5%
18-39years 21 19.1%
40-64years 52 47.3%
65-80years 24 21.8%
80+years 9 8.2%
Worriedabouthousing 24 21.8%
Payslessthan750 69 62.7%
Pays750-1500 25 22.7%
Paysmorethan1500 8 7.3%
Wentwithoutabasicneed 33 30.0%
Wentwithouthealthcare 38 34.5%
Wentwithoutfood 12 10.9%
Wentwithouttransportation 21 19.1%
Wentwithouthousing 8 7.3%
Generalhealth-fairorpoor 40 36.4%
Overweight 36 32.7%
Obese 37 33.6%
ChronicDisease 73 66.4%
MentalHealthCondition 53 48.2%
MentalandPhysical 38 34.5%
TraumaticEvent 93 84.5%
3ormoretraumaticevents 53 48.2%
Has3ormoredrinksaday 20 18.2%
TobaccoUse 10 9.1%
MarijuanaUse 9 8.2%
Otherdruguse 8 7.3%
Doesn'thaveusualplaceof
care 4 3.6%
UnmetPhysicalNeed 27 24.5%
UnmetDentalNeed 40 36.4%
UnmetMentalNeed 15 13.6%
UnmetPrescriptionNeed 18 16.4%
NeededSpecialistcare 61 55.5%
ChronicDisease 6 22.2%
MentalHealthCondition 8 29.6%
MentalandPhysical 2 7.4%
UnmetPhyscialNeed 4 14.8%
UnmetDentalNeed 6 22.2%
UnmetMentalNeed 4 14.8%
Peopleinmycommunity
arewillingtohelp 11 10.0%
Peopleinmycommunity
canbetrusted 18 16.4%
Ifeelsafeinmycommunity 10 9.1%
Caregiversfeellikethey
haveadequatesupport
18
(29arecg) 62.1%
Hassomeonetolovethem
andmakethemfeelwanted 24 21.8%
Hassomeonetoconfidein 30 27.3%
Age
SkamaniaCounty
TotalPopulation
FPL
Race/Ethnicity
Insurance
*cg=caregivers
BasicNeeds
HealthStatus
HealthcareAccess
YouthHealthStatus(n=27)
YouthHealthcare
Access(n=27)
SocialandCommunityEnvironment(%disagree)
Number Percent340 24.9%
200%andbelow 94 27.6%
201%andabove 152 44.7%
Hispanic/Latino/Other 34 10.0%
NonHispanicwhites 293 86.2%
Uninsured 17 5.0%
Medicaid/Dual 57 16.8%
Medicare 104 30.6%
Private 126 37.1%
18-39years 81 23.8%
40-64years 134 39.4%
65-80years 97 28.5%
80+years 20 5.9%
Worriedabouthousing 62 18.2%
Payslessthan750 173 50.9%
Pays750-1500 95 27.9%
Paysmorethan1500 37 10.9%
Wentwithoutabasicneed 59 17.4%
Wentwithouthealthcare 80 23.5%
Wentwithoutfood 25 7.4%
Wentwithouttransportation 36 10.6%
Wentwithouthousing 16 4.7%
Generalhealth-fairorpoor 66 19.4%
Overweight 95 27.9%
Obese 120 35.3%
ChronicDisease 202 59.4%
MentalHealthCondition 122 35.9%
MentalandPhysical 87 25.6%
TraumaticEvent 278 81.8%
3ormoretraumaticevents 142 41.8%
Has3ormoredrinksaday 51 15.0%
TobaccoUse 63 18.5%
MarijuanaUse 51 15.0%
Otherdruguse 24 7.1%
Doesn'thaveusualplaceof
care 19 5.6%
UnmetPhysicalNeed 56 16.5%
UnmetDentalNeed 90 26.5%
UnmetMentalNeed 28 8.2%
UnmetPrescriptionNeed 32 9.4%
NeededSpecialistcare 180 52.9%
ChronicDisease 11 14.7%
MentalHealthCondition 18 24.0%
MentalandPhysical 8 10.7%
UnmetPhyscialNeed 5 6.7%
UnmetDentalNeed 7 9.3%
UnmetMentalNeed 3 4.0%
Peopleinmycommunity
arewillingtohelp 41 12.1%
Peopleinmycommunity
canbetrusted 83 24.4%
Ifeelsafeinmycommunity 31 9.1%
Caregiversfeellikethey
haveadequatesupport
40
(70arecg) 57.1%
Hassomeonetolovethem
andmakethemfeelwanted 62 18.2%
Hassomeonetoconfidein 72 21.2%
Age
KlickitatCounty
TotalPopulation
FPL
Race/Ethnicity
Insurance
*cg=caregiver
BasicNeeds
HealthStatus
HealthcareAccess
YouthHealthStatus(n=75)
YouthHealthcare
Access(n=75)
SocialandCommunityEnvironment(%disagree)
43
Number Percent
392 28.7%
200%andbelow 145 37.0%
201%andabove 131 33.4%
Hispanic/Latino/Other 77 19.6%
NonHispanicwhites 309 78.8%
Uninsured 30 7.7%
Medicaid/Dual 126 32.1%
Medicare 96 24.5%
Private 118 30.1%
18-39years 93 23.7%
40-64years 164 41.8%
65-80years 86 21.9%
80+years 32 8.2%
Worriedabouthousing 90 23.0%
Payslessthan750 206 52.6%
Pays750-1500 116 29.6%
Paysmorethan1500 33 8.4%
Wentwithoutabasicneed 87 22.2%
Wentwithouthealthcare 94 24.0%
Wentwithoutfood 49 12.5%
Wentwithouttransportation 43 11.0%
Wentwithouthousing 29 7.4%
Generalhealth-fairorpoor 109 27.8%
Overweight 110 28.1%
Obese 126 32.1%
ChronicDisease 217 55.4%
MentalHealthCondition 154 39.3%
MentalandPhysical 101 25.8%
TraumaticEvent 314 80.1%
3ormoretraumaticevents 169 43.1%
Has3ormoredrinksaday 40 10.2%
TobaccoUse 97 24.7%
MarijuanaUse 45 11.5%
Otherdruguse 26 6.6%
Doesn'thaveusualplaceof
care 39 9.9%
UnmetPhysicalNeed 65 16.6%
UnmetDentalNeed 111 28.3%
UnmetMentalNeed 33 8.4%
UnmetPrescriptionNeed 42 10.7%
NeededSpecialistcare 200 51.0%
ChronicDisease 12 11.4%
MentalHealthCondition 32 30.5%
MentalandPhysical 9 8.6%
UnmetPhyscialNeed 16 15.2%
UnmetDentalNeed 12 11.4%
UnmetMentalNeed 11 10.5%
Peopleinmycommunityare
willingtohelp 55 14.0%
Peopleinmycommunitycan
betrusted 89 22.7%
Ifeelsafeinmycommunity 46 11.7%
Caregiversfeelliketheyhave
adequatesupport
37
(72arecg) 51.4%
Hassomeonetolovethem
andmakethemfeelwanted 76 19.4%
Hassomeonetoconfidein 98 25.0%
Age
WascoCounty
TotalPopulation
FPL
Race/Ethnicity
Insurance
*cg=caregivers
BasicNeeds
HealthStatus
HealthcareAccess
YouthHealthcare
Access(n=105)
SocialandCommunityEnvironment(%disagree)
YouthHealthStatus(n=105)
Number Percent398 29.1%
200%andbelow 151 37.9%
201%andabove 130 32.7%
Hispanic/Latino/Other 152 38.2%
NonHispanicwhites 235 59.0%
Uninsured 40 10.1%
Medicaid/Dual 108 27.1%
Medicare 82 20.6%
Private 136 34.2%
18-39years 138 34.7%
40-64years 145 36.4%
65-80years 65 16.3%
80+years 31 7.8%
Worriedabouthousing 69 17.3%
Payslessthan750 164 41.2%
Pays750-1500 112 28.1%
Paysmorethan1500 56 14.1%
Wentwithoutabasicneed 85 21.4%
Wentwithouthealthcare 86 21.6%
Wentwithoutfood 53 13.3%
Wentwithouttransportation 46 11.6%
Wentwithouthousing 34 8.5%
Generalhealth-fairorpoor 75 18.8%
Overweight 114 28.6%
Obese 98 24.6%
ChronicDisease 173 43.5%
MentalHealthCondition 117 29.4%
MentalandPhysical 67 16.8%
TraumaticEvent 275 69.1%
3ormoretraumaticevents 136 34.2%
Has3ormoredrinksaday 46 11.6%
TobaccoUse 48 12.1%
MarijuanaUse 53 13.3%
Otherdruguse 17 4.3%
Doesn'thaveusualplaceofcare 24 6.0%
UnmetPhysicalNeed 58 14.6%
UnmetDentalNeed 80 20.1%
UnmetMentalNeed 25 6.3%
UnmetPrescriptionNeed 28 7.0%
NeededSpecialistcare 177 44.5%
ChronicDisease 18 11.8%
MentalHealthCondition 28 18.4%
MentalandPhysical 7 4.6%
UnmetPhyscialNeed 11 7.2%
UnmetDentalNeed 16 10.5%
UnmetMentalNeed 5 3.3%
Peopleinmycommunityare
willingtohelp 38 9.5%
Peopleinmycommunitycanbe
trusted 65 16.3%
Ifeelsafeinmycommunity 29 7.3%
Caregiversfeelliketheyhave
adequatesupport
49
(83arecg) 59.0%
Hassomeonetolovethemand
makethemfeelwanted 64 16.1%
Hassomeonetoconfidein 82 20.6%
Age
HoodRiverCounty
TotalPopulation
FPL
Race/Ethnicity
Insurance
*cg=caregivers
BasicNeeds
HealthStatus
HealthcareAccess
YouthHealthStatus(n=152)
YouthHealthcare
Access(n=152)
SocialandCommunityEnvironment(%disagree)
44
EmergencyRoomUtilizationTheERdatawasprovidedbyCollectiveMedicalTechnologies.Itisrepresentativeofresidentsofallzip
codesfoundinthe7countiesacrossallhospitals.ThereasonsforvisitingtheERwasbasedondxcodes.ThehospitalsthatwerevisitedthemostwereMid-ColumbiaMedicalCenter,ProvidenceHoodRiverMemorialHospital,KlickitatValleyHealthandSkylineHospitalintherespectiveorder.MostvisitswerepayedthroughMedicare,MedicaidOregon,PacificSourcePlus,andAARP.Thedataisbrokenintofourdifferentagecategoriessothatwecanseewhatmedicalneedsaffectseachagecategorythemost.
45
LeadingCausesofDeath Thistableshowsthenumberofdeathsineachcountyin2015duetothereasonlisted.Thenumbersarebasedonarateof100,000.ThedatawasprovidedthroughWashingtonandOregonstatewebsites.
46
CommunityHealthSurvey
47
48
49
50
51
52
MOUfromCohort
53
54
55
56
57
58
59
60
61