Caro Community Hospital 2016 Community Health NeedsThe leaders of Caro Community Hospital understand...
Transcript of Caro Community Hospital 2016 Community Health NeedsThe leaders of Caro Community Hospital understand...
CaroCommunityHospital2016CommunityHealth
NeedsAssessment
AReporttotheCommunity
Caro Community Hospital Community Health Needs Assessment
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TableofContents
ContentsExecutiveSummary................................................................................................................................................................................................2
ProcessOverview....................................................................................................................................................................................................6
RepresentingtheCommunityandVulnerablePopulations..................................................................................................................7
2013CHNAPlanProgress...................................................................................................................................................................................9
CHNAMethodology..............................................................................................................................................................................................11
Findings.....................................................................................................................................................................................................................14
PrioritizationProcess..........................................................................................................................................................................................29
AssessExistingResourcesThatareAddressingPriorities..................................................................................................................32
WrittenCHNAReportandImplementationPlan.....................................................................................................................................33
AdditionalDocuments(AvailableUponRequest).....................................................................................................................................2
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ExecutiveSummary…
ExecutiveSummaryThisreportisaprimarydatasourcethatcomplementsotherprimaryandsecondarydatasourcescollectedbyCaroCommunityHospitalforits2016CommunityHealthNeedsAssessment.TheprimarydatacontainsinformationfromtheThumbCHNACollaborationCommunityHealthSurveydevelopedanddistributedbyhospitalsandpublichealthdepartmentsinHuron,Sanilac,andTuscolaCounties.CaroCommunityHospitaldistributedsurveysineightZIPcodesinitsservicearea.Theyalsoheldafocusgroupof8womenand5menwithagerangesfrommid/late30sto60s.Theattendeesrepresentedhospitalemployees,otherhealthprofessionals,schools,ISD,CountyCommission,lawenforcement,andcommunitymembers.Keystakeholderinterviewswereheldwithfiveindividualsfromfiveorganizations.Thesurveyfindingsarebasedontheresponsesof207individuals,three‐quarters(78.3%)ofwhomwerefemale.Respondentswerewelleducatedwiththree‐fifths(61.2%)earningsomecollegedegree,andalittleoverone‐quarter(27.7%)reportinghouseholdincomesof$75,000ormore.Thesurveycoveredfiveareasofconcerns:community’shealth,qualityoflife,availabilityofhealthservices,safetyandenvironment,deliveryofhealthservices,andvulnerablepopulations(seniors,females,loweducation,andlowincome).Italsoaskedaboutpreventingaccesstocare.Manyconcernswereaboutaccesstoandavailabilityofhealthcareprovidersandthecostsofhealthcare.Surveyrespondentswereconcernedaboutjobswithlivablewages,supplyofdoctorsandnurses,andalackofsubstanceabuse,mentalhealthanddentalservices.Theynotedthecostsofhealthinsurance,healthcareservicesandprescriptiondrugs.Focusgroupmembersidentifiedpovertyasamajorissuewhichincludednotenoughjobswithlivablewages.Theywerealsoconcernedaboutthecostsofhealthinsurance,healthcareservicesandprescriptiondrugs.Theyperceivedalackofmentalhealthservicesandthoughtthecommunityhaddifficultyretainingdoctorsandnurses.FocusgroupmembersthoughtmostpeopleuseCaroCommunityHospitalbecauseofitsstaff,location/convenience,qualityandbeingsafe,butusedotherprovidersbecausetheypreferredthestaffordoctorsatotherhospitalsandalackofprivacyatCCH.Theysuggestedthatthehealthofthecommunitywouldbeimprovedbyhavingbetterleadership,integratingthestaffintothecommunity,anewclinic,andafocusonrespondingtotrauma.Thestakeholderintervieweesindicatedthatalackoftransportation,especiallyforhealthandmedicalneedsasamajorchallenge.Theywereconcernedabouttheavailabilityofmentalhealthservices,youthobesityandyouthsubstanceuseandabuse,andtheavailabilityofresourcesforcaringfortheelderly.ThestakeholdersperceivedalackoftrustinthelocalTuscolacountyhospitalsbutheldthecountyhealthdepartmentinhighesteem.Theywantedtheproviderstobecomemoreinvolvedwiththecommunityandcollaboratetogetinformationoutaboutservices.
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BackgroundandOverview
BackgroundCaroCommunityHospitalisaCriticalAccessHospital.TheMedicareRuralHospitalFlexibilityProgram(FlexProgram),createdbyCongressin1997,allowssmallhospitalstobelicensedasCriticalAccessHospitalandoffersgrantstoStatestohelpimplementinitiativestostrengthentheruralhealthcareinfrastructure.CriticalAccessHospital(CAH)DesignationAMedicareparticipatinghospitalmustmeetthefollowingcriteriatobedesignatedasaCAH:•BelocatedinaStatethathasestablishedaStateruralhealthplanfortheStateFlexProgram;•BelocatedinaruralareaorbetreatedasruralunderaspecialprovisionthatallowsqualifiedhospitalprovidersinurbanareastobetreatedasruralforpurposesofbecomingaCAH;•DemonstratecompliancewiththeConditionsofParticipation(CoP)relevantto42CFRPart485Sub‐partFatthetimeofapplicationforCAHstatus;•Furnish24‐houremergencycareservices7daysaweek,usingeitheron‐siteoron‐callstaff;•Providenomorethan25inpatientbedsthatcanbeusedforeitherinpatientorswingbedservices;however,itmayalsooperateadistinctpartrehabilitationorpsychiatricunit,eachwithupto10beds;•Haveanaverageannuallengthofstayof96hoursorlessperpatientforacutecare(excludingswingbedservicesandbedsthatarewithindistinctpartunits);and•Belocatedeithermorethana35‐miledrivefromthenearesthospitalorCAHora15‐miledriveinareaswithmountainousterrainoronlysecondaryroadsORcertifiedasaCAHpriortoJanuary1,2006,basedonStatedesignationasa“necessaryprovider”ofhealthcareservicestoresidentsinthearea.CaroCommunityHospital:MissionCaroCommunityHospital,acommunity‐mindedhealthcaresystem,isdedicatedtoprovidingcompassionatecareandservicestoenhancethehealthofallpeopleweserve.Services:GeneralandAcuteServices
24/7EmergencyDepartment OB/GYN(evaluation&surgicalservices)
CardiologyOphthalmology(evaluationandsurgicalservices)
Dermatology Oral/MaxillofacialSurgeryEndocrinology Orthopedics(evaluation&surgicalservices)ENT&FacialPlasticSurgery PathologyFamilyPracticeClinics PharmacyHematology/Oncology Podiatry(evaluation&surgicalservices)Hospital(acutecare,includinghospitalist) PulmonologyNephrology RheumatologyNeurology StrokeRobotNeurosurgery SurgicalServicesNutritionCounseling Urology
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Screening/TherapyServices
ChronicDiseaseManagement PediatricservicesDOTPhysicals PhysicaltherapyHolterMonitoring RespiratorycareLaboratoryServices SleepStudiesLowerextremitycirculatoryassessment SocialServicesOccupationalphysicals Totalbodyfatanalysis
RadiologyServices
CTScan MRI(ThumbMRI)DigitalMammography Teleradiology(Afterhours)Generalx‐ray UltrasoundNuclearmedicine BoneDensityTestingTheleadersofCaroCommunityHospitalunderstandthatoperatingaCOMMUNITYhospitalmeansstrivingtounderstandandrespondtotheneedsofthecommunity‐you,yourfamilies,andyourfriends.Itwaswiththiscommunitymindset,in2016,thatCaroCommunityHospitallaunchedaCommunityHealthNeedsAssessment(CHNA).
WhatisaCommunityHealthNeedsAssessment?Thefirststepinmeetingcommunityneedsisidentifyingtheneeds.Usinganobjectiveapproachhelpsensurethatprioritiesarebasedonevidenceandaccurateinformation.TheassessmentprocessusedbyCaroCommunityHospitalincludedatrifectaapproachofreviewingthreesourcesofprimarydata.Inthetrifectaapproach,whentherearethreesourcesofdatathatillustrateaneed,thereisagreaterlikelihoodthataddressingthatneedwillproduceapowerfulimpact.Threemethodswereusedtocollectprimarydata:
Surveys:SurveysweredistributedineightZIPcodesinthehospital’sservicearea.Thesurveywasalsopostedonlineusingwww.surveymonkey.com.
FocusGroups:TheHospitalheldonefocusgroup.Participantsincludedafocusgroupof8womenand5men.TheyrepresentedCaroCommunityHospitalemployees,otherhealthprofessionals,schools,ISD,CountyCommission,lawenforcement,andcommunitymembers,Agesrangedfrommid/late30s‐to‐60s
KeyStakeholderInterviews:Acountylevelcommitteeselectedkeyorganizationsandindividualsforstakeholderinterviews.Theseinterviewswereheldwithfiveindividualsfromfivedifferentorganizations.
Inadditiontotheprimarydata,secondarydatawasreviewedforcomparisontostateratesandacrosscountieslocatedintheThumb.ThisdatawasorganizedintoaThumbreportcard.The
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CHNAprocesswasfollowedbyaprioritizationprocessandimplementationmeeting.Onceprioritieswereselected,therewasanassessmentofexistingservicesandprograms.Thisassessmentwasusedtoidentifygapsinservicesanddevelopstrategiestoaddressthepriorityneeds.Thesestrategiesarethenorganizedintoanimplementationplanandprogresswillbemonitored.ThisisthesecondcycleofCommunityHealthAssessmentandPlanning.Thefirstcyclewascompletedin2012‐2013.TheprocessisintendedtobecompletedonathreeyearcyclethatalignswithAffordableCareActrequirements.The2016CHNAreportincludesareviewofthe2013implementationplanandprogresstowardtargets.
WhyisaCommunityHealthNeedsAssessmentvaluable?Mostexpertsagreethattherearemanychallengesfacinghealthcaretoday.Rapidlychangingtechnology,increasedtrainingneeds,recruitingmedicalprofessionals,andrespondingtohealthneedsofagrowingseniorcitizenpopulationarejustafewofthemostpressingchallenges.Thesechallengesoccuratatimewhenresourcesforfamiliesandhealthcareprovidersarestretched.TheseconditionsmaketheCommunityHealthNeedsAssessment(CHNA)processevenmorecritical.ACHNAhelpstodirectresourcestoissuesthathavethegreatestpotentialforincreasinglifeexpectancy,improvingqualityoflife,andproducingsavingstothehealthcaresystem.
BackgroundandAcknowledgmentsInAugust2015,theMichiganCenterforRural,HospitalCouncilofEastCentralMichigan,andThumbRuralHealthNetworkconvenedadiscussiongrouparoundtheCHNAprocessinHuron,Sanilac,andTuscolaCounties.Thisregion,oftenreferredtoastheThumbofMichigan,includeseighthospitalsandthreepublichealthdepartments.HospitalsandhealthdepartmentsinvitedrepresentativesfromtheCenterforRuralHealth(CRH),UniversityofNorthDakota,andSchoolofMedicine&HealthSciencestopresenttheirmethodforconductingCHNAsinruralareas.AttheendofthistrainingallthehospitalsandhealthdepartmentsdecidedtocollaborateusingacommonprocessforCommunityHealthNeedsAssessment.Theyagreedtodevelopandadministerasurveyofcommunitymembersandusethesamesetofquestionsandprocessesforfocusgroupsandkeystakeholderinterviews.EachhospitalreceivedresultsforitsserviceareabasedontheZIPcodeofsurveyrespondents.Individualhospitalsutilizedfindingsfromthesurvey,focusgroupsandkeystakeholderinterviewsfortheirlocalCHNA.Theuseofacommonsurveyinstrument,focusgroupandinterviewscheduleswillpermitaggregatingthehospitaldatabycountyandbythethreecountyThumbregion.Thiswillenablecooperativeinitiativeswithincountiesandtheregion.
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NeedsAssessm
entProcess
ProcessOverview
StepsinProcessInDecember2015,themembersoftheThumbCHNACollaborationreceivedtrainingfromtheUniversityofNorthDakotaonbestpracticesinthefieldofCommunityHealthNeedsAssessment.Basedonthistraining,aprocesswasdevelopedfortheThumbAreathatwouldallowforconsistentdatacollection.Thisconsistentdatacollectionwouldallowforcountyandregionalaggregationofdata.Inadditiontothelocalhospitalplansandactivities,thisprocesswouldallowforgreaterimpactofcountywideandregionalprojectsandinitiatives.TheprocesswasdevelopedbasedreviewoftheUniversityofNorthDakotaModel1:
Step1:Establishalocalandregionaltimeline Step2:Convenecountyteamstomanagerlogisticsofassessmentactivities Step3:DevelopandAdministerSurveyInstrument* Step4:DesignandimplementCommunityFocusGroupsinlocalhospitalcommunities* Step5:DesignandimplementKeyStakeholderInterviewsorcountyagencies* Step6:Producelocalizedhospitalreportsbasedonsurveyzipcodedata,localfocus
groups,andcountyinterviewdata Step7:HavelocalhospitalsholdImplementationPlanningMeetings Step8:HavelocalhospitalsprepareawrittenCHNAReportandImplementationPlan Step9:Producecountyandregionalreports Step10:Convenecountyandregionalmeetingstoreviewreports Step11:MonitorProgress
Timeline
*Inordertoutilizethetrifectamodel,thesethreedatacollectionmethodswereconsistentinscopeandquestiontopics.
Develop Standardized Methodology and Tools (September 2015)
Implement Surverys (January‐March 2016)
Stakeholder Interviews (February‐March 2016)
Conduct Focus Groups (March and November 2016)
Develop Reports (May‐November 2016)
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RepresentingtheCommunityandVulnerablePopulations
DefinetheCommunityServedTuscolaCountyisaruralcountylocatedintheThumbofMichigan.Apopulationof55,729residesinthecounty.Thefollowingchartsshowcasecharacteristicsofthepopulation.
Indicator Michigan Huron Sanilac TuscolaPopulation 9,909,877 32,065 41,587 54,000%below18yearsofage 22.40% 19.60% 22.20% 21.40%%65andolder 15.40% 23.40% 19.50% 18.30%Non‐HispanicAfricanAmerican 13.90% 0.50% 0.50% 1.20%%AmericanIndianandAlaskanNative 0.70% 0.40% 0.60% 0.60%%Asian 2.90% 0.50% 0.40% 0.40%%NativeHawaiian/OtherPacificIslander
0.00% 0.00% 0.00% 0.00%
%Hispanic 4.80% 2.10% 3.70% 3.30%Non‐HispanicWhite(belowHispanic) 75.80% 95.70% 94.10% 93.70%%NotProficientInEnglish(2014) 1% 0% 0% 0%%Females 50.90% 50.50% 50.40% 49.90%%Rural 25.40% 89.50% 90.20% 84.20%
EducationLevels
Indicator Michigan Huron Sanilac TuscolaHighschoolgraduation** 78% 90% 87% 80%Somecollege 66% 54% 52% 57%
HouseholdIncome
Indicator Michigan Huron Sanilac TuscolaMedianHouseholdIncome $49,800 $41,700 $42,100 $43,200
PovertyRates
Indicator Michigan Huron Sanilac TuscolaChildreninPoverty:underage18livinginpoverty
23% 21% 23% 24%
ALICElevel:householdabovepovertylevel,butlessthanthebasiccostoflivingforcounty
NA 27% 27% 22%
PovertyRate–USCensus 16.9% 15.5% 15.6% 15.3%
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Unemployment
Indicator Michigan Huron Sanilac TuscolaChildreninPoverty:underage18livinginpoverty 23% 21% 23% 24%
ALICElevel:householdabovepovertylevel,butlessthanthebasiccostoflivingforcounty
NA 27% 27% 22%
PovertyRate–USCensus 16.9% 15.5% 15.6% 15.3%CommonOccupationsandIndustries Healthcareandsocialassistance Manufacturing Retailtrade Educationservices Construction
Uninsuredrates
Indicator Michigan Huron Sanilac TuscolaUninsured 13% 15% 15% 14%Uninsuredadults 16% 18% 19% 18%Uninsuredchildren 4% 6% 6% 4%
SurveysandFocusGroupsDistributionofsurveyswasintentionallyplannedtoincludeindividualsfromvulnerablepopulationgroupssuchasseniorcitizens,under‐resourcedfamilies,veterans,andwomen.Dataanalysisincludedcrosstabulationofresultsforvulnerablepopulations.Hospitalsinvitedavarietyofindividualsthatrepresentedmultiplesectorsofindustry,age,andhealthconditions.Seniors58orolderaccountedforonequarter(26.7%)ofrespondents;thosewithahighschooleducationorlessaccountfor19.9%oftherespondents,andaboutone‐third(30.7%)reportedhouseholdincomes$24,999orless.
Healthcare/SocialServiceOrganizationsProvidingInputParticipantsinstakeholderinterviewswerechosenbasedontheirexpertiseinservingvulnerablepopulationsandtheirexperiencewithcommunityissues.Organizationswerechosenbyeachcountylevelcommitteeandvariedslightlybycounty.
StakeholdersInterviewedName Title Affiliation ChristineTrish CountyCommissioner TuscolaCountyGovernmentSharonBeals ChiefExecutiveOfficer TuscolaBehavioralHealthSystemsSusanWalker Coordinator HumanServicesCommunityCollaborativeKarenSouthgate ProgramManager Tuscola/HuronCountyDHHSJulieBooms FamilyIndependenceManager HuronDHHS
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ConsultantsDuringtheprocess,variousconsultantswereutilizedtomanagetheworkflowandensureconsistency,including: BalcerConsulting&PreventionServices,KayBalcer:Overallprojectcoordinationandfacilitation,
stakeholderinterviews,templatedevelopment. MichiganCenterforRuralHealth,CrystalBarterandSaraWright:Notetaking,andcodingoffocusgroup
andinterviewresponses. InstituteforPublicPolicyandSocialResearch,MichiganStateUniversity:Papersurveyprocessing,coding
ofsurveydata,andproductionofstatisticaldataforanalysis. IndependentConsultants,HarryPerlstadt,PhD,MPHandTravisFojtasek,PHD:Dataanalysisandreports.
SomehospitalsalsochosetocontractwithBalcerConsultingorMichiganCenterforRuralHealthforfocusgroupfacilitation,facilitationofimplementationmeetings,andpreparationoftheCHNAreportandimplementationplan.QuestionsabouttheCHNAprojectandrequestsfordocumentscanbemadebycontactingKayBalcerat(989)553‐[email protected].
2013CHNAPlanProgressIn2013,theCommunityHealthNeedsassessmentprioritiesidentifiedbyCaroCommunityHospital(CCH)included:
1.AfterHoursClinic2.TransportationNeeds3.Cooperationbetweenneighboringhospitals4.Communitysupportofavailableservices5.Publicize211
Thefollowingtableincludesanupdateontheprogresstowardactivitiesinthe2013ImplementationPlan:
Priority Progress/UpdateAfterHoursClinic CCHhasworkeddiligentlytofindanappropriatelocationforan
afterhoursclinic.TheyhaverecentlysecuredabuildingindowntownCaroforanurgentcare/afterhoursclinicthatisscheduledtoopen7daysaweekinSpring2017.
TransportationNeeds CCHhasworkedwiththeTuscolaCountyTransitAuthorityaswellasTRHNtohelpmarkettheservicestothepublic.TheyhavealsodiscussedroutesandavailabilityoftransportationtoThumbMRI.
CooperationBetweenNeighboringHospitals TheyhaveworkedextensivelywithTRHNtoprovidehealthandwellnessservicestotheentirethumbandcollaboratedonpotentialgrants.CCHhasalsoworkedwithotherhospitals(ThumbaswellasSaginaw)oncommunityeducation–specificallyPATHforDiabetes.
CommunitySupportforAvailableServices CCHcontinuestoprovideextensivecoverageinmultiplemediaareasincludingsocialmedia,billboards,directmailings,newspaperads(TuscolaCountyAdvertiser,ReeseReporter,FrankenmuthNews,CassCityChronicle,VassarPioneerTimes,HuronDailyTribune,ThumbAreaSeniorNewsandVarsity
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Monthly).Inthelast2years,theyhavecompletelyupdatedallmarketingmaterialstobetterpromotehospitalandclinicservices.CCHhasprovidedpubliceducationatlocalExchangeClubandRotarymeetingsaswellastheCaroSeniorCommons.TheyalsohostannualcommunityhealthfairsaswellasaMammPartytoeducatethepublicaboutearlydetectionandbreasthealth.
Publicize211 CCHinvites211totheirannualhealthfair,thereisalinkonthehospitalwebsite,theyPRtheserviceregularlyonsocialmedia,thereisinformationthroughoutthehospitalandclinicsandtheyhaveinvited211tospeakatCaroRotary.
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CHNAMethodologySurveys:Sample/TargetPopulation:TheThumbCHNACollaborationmembersdecidedtousenonprobabilitysampling,combiningconveniencesamplingwithpurposive(judgmental)sampling.Inaconveniencesample,respondentscanbeanyonewhocomesincontactwiththeresearcherorhasaccesstothesurvey‐frompeopleonastreetcornerorinamalltothosewhocomeacrossthesurveyonline.Inapurposivesample,respondentsarerecruitedbasedonsomecharacteristicwhichwillbeusefulforthestudy.Forexample,apurposiveCHNAsurveywouldtargetmembersofclubsandreligiouscongregationsinlowincomeneighborhoodsorseniorsresidinginindependentlivingandassistedlivingfacilities.Inaddition,amixedsamplingdesignintendedtogatherasufficientnumberoflowincome,loweducationandseniorcitizenstopermitananalysisoftheirhealthconcernsandviewsonhealthcareservices.Finally,sinceeachhospitalusedthesamesurveymethodology,theresultscanbeanalyzedandcompared.Althoughthefindingscannotbegeneralized,theycanpointoutcommonneedsandsolutions.
Table1:DemographichighlightsAge Respondentswereaskedtheiryearofbirthwhichwasthenrecodedintoquartiles.Ofthe
validcases,23.0%were35oryounger,26.2%between36and48,24.1%between49and57,and26.7%were58orolder.
Gender Three‐quarters(78.3%)oftherespondentswerefemaleand21.7%male.MaritalStatus
Alittleoverhalf(56.7%)weremarriedorremarried.
Children Alittleovertwo‐fifths(43.8%)ofhouseholdshadchildrenunder18.Education Aboutone‐fifth(19.9%)hadahighschooldiplomaorless,18.9%somecollege,18.9%a
technical/Jrcollegedegree,one‐fifth(20.9%)abachelor’sdegreeand21.4%agraduateorprofessionaldegree.
EmploymentStatus
Alittleoverhalf(56.4%)workedfulltime,10.9%workedparttimeand2.5%heldmultiplejobs.Retireesaccountedfor10.3%.
HealthSector Alittlelessthanone‐third(31.2%)workedforahospital,clinicorpublichealthdept.Race 90.3%self‐identifiedasWhite/Caucasian.Householdincome
Aboutone‐third(30.7%)reportedhouseholdincomes$24,999orless;one‐fifth(20.0%)between$25,000and$49,999,15.1%betweenonebetween$50,000and$74,999(26.1%)andalittleoverone‐quarter(27.7%)$75,000ormore.
HealthInsurance
Almostthree‐fifths(57.4%)hadhealthinsurancethroughanemployerorunion,16.8%wereonMedicare,one‐fifth(20.3%)onMedicaidand9.4%individuallypurchasedaplan.Only1.0%reportednothavinganyhealthinsurance.
Hospitalsusedinpast2years
CaroCommunityHospitalwasthemostfrequentlyusedhospitalwithhalf(52.2%)oftherespondentsreportingtheyuseditinthepasttwoyears.ThiswasfollowedbyHills&DalesinCassCitywithone‐third(34.1%),andCovenantHospitalinSaginaw(28.3%).
ZIPCodes Ofthe8Zipcodes,half(49.8%)livedin48723(Caro).SurveyInstrumentandProcedures:Thesurveyinstrumentcontained34questionscoveringCommunityAssets,CommunityConcerns,DeliveryofHealthCareandDemographicInformation(AppendixA).Thesurveywasprintedandpostedonline.Eachcountydevelopedadistributionlistidentifyingpubliclocationsforenvelopesandsurveys.Surveyswerealsodistributedatmeetings.Printedsurveyscouldbeleftindropboxesor
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mailedintotheInstituteforPublicPolicyandSocialResearch(IPPSR)atMichiganStateUniversity.Theon‐lineversionofthesurveywaspostedatwww.surveymonkey.com.Surveylinkswereincludedinpressreleasesandregionalpromotionefforts.Linksweredistributedbydirectemailandforwardedtohospitalsandserviceproviderswhocouldforwardittotheirstaffandtheiremailpatientbase.SurveyswereenteredanddatasetspreparedbyIPPSR.DatawasanalyzedusingtheStatisticalPackagefortheSocialSciences(SPSS)Version20multipleresponsesetsfrequenciesandcross‐tabulations.FocusGroups:Afocusgroupof5menand8womenwasheldonSeptember27,2016from6:00‐7:30pmatCaroCommunityHospital.Thegrouprepresentedhospitalemployees,otherhealthprofessionals,schools,ISD,CountyCommission,lawenforcement,andcommunitymembers.Agesrangedfrommid/late30s‐to60s.ThegroupwasfacilitatedbySaraWright,notesbyVictoriaLantzy,bothfromtheMichiganCenterforRuralHealth.
Participantsweretold(verbally)thattheirresponseswillbetreatedinawaythatwillnotrevealtheirnameandthattheirresponseswillbecombinedwithothersinanyreports.Theyweretoldthatduetotheclosenessofthecommunity,completeconfidentialityinreportingtheirresponsescannotbeensured.
Thefacilitatorfollowedascript(seeAppendixE)andengagedthegroupinseveralproceduresincludingaskingparticipantstoreviewandcommentonalistofpotentialhealthconcernsthatmayaffectthecommunityasawhole;usingpostitnotesonaneaselpad;andgroupdiscussion/brainstorming.APowerPointpresentationviaaprojectorwasusedtoshowthequestioninthefrontoftheroomaswellasverbally.Aprioritizationprocesswasnotconductedsincethatwillhappeninthefollowupfocusgroupafterthesurveyandinitialreportissharedandreviewed.
StakeholderInterviews:TheTuscolacountycommitteeselectedthreeorganizationsforinputandsuggestedanindividualattheseorganizations.Theindividualsinterviewedagreedandprovidedconsenttoparticipateandhavetheirnameincludedinalistofinterviewparticipants.Individualsparticipatingininterviewsbutwereassuredthattheirresponseswouldnotbeconnectedtotheirname.KayBalcer,ofBalcerConsultingandPreventionServicesconductedtheinterviewsinperson,andSaraWrightofMichiganCenterforRuralHealthtooknotesviaphone.Theinterviewfollowedasimilarscriptaswasusedforthefocusgroups.
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SecondaryDataTable1:MajorDataSourcesforCHNA
PublicHealthStatistics
Source/Participants
URLorCitation DatesofData
AdditionalDescriptors
UnitedStatesCensusBureau
http://quickfacts.census.gov
2010 IncludesdatafromtheAmericanCommunitySurvey(5‐yearaverages),CensusDemographicprofilesfromthe2010Census,andsubtopicdatasets.
MichiganLaborMarket
http://www.milmi.org 2016 UnemploymentData
MichiganDepartmentofCommunityHealth
http://milmi.org/cgi/dataanalysis/?PAGEID=94
2000to2014
Daterangesvariedbyhealthstatistic.Somestatisticsrepresentoneyearofdataasothersarelookingat3or5yearaverages.
MichiganBehavioralRiskFactorSurvey
http://www.michigan.gov/mdch/0,1607,7‐132‐2945_5104_5279_39424‐‐‐,00.htmlandwww.trhn.org
2003‐2015
Localdataavailablefor2003and2008only.CountydatathatismorerecentwaspulledfromCountyHealthRankings.
HealthResources&ServicesAdministration(HRSA)
http://bhpr.hrsa.gov/shortage/ 2016 ShortagedesignationsaredeterminedbyHRSA.
MichiganProfileforHealthyYouth(MIPHY)
http://michigan.gov/mde/0,1607,7‐140‐28753_38684_29233_44681‐‐‐,00.html
2014 Localdatafromsurveysof7th,9th,and11thgradestudentsiscomparedtocountydata.StateandnationaldatausingtheMIPHYwasnotavailable.9th‐12thgradeYouthBehaviorRiskFactorsurveydatawasusedforstateandnationalstatistics.
CountyHealthRankings
www.countyhealthrankings.org 2005to2013
Includesawidevarietyofstatistics.Manystatisticsrepresentacombinedscoreandreflectmultipleyearsofdata.
KidsCount http://www.mlpp.org/kids‐count/michigan‐2/mi‐data‐book‐2016
2016 IncludesavarietyofdatafromMichiganDepartmentofCommunityHealth,DepartmentofHumanServices,andDepartmentofEducation.
HealthcareUtilizationData
CommunitySurvey
CommunitySurvey 207communitymembersparticipatedinsurvey.
2016 Questionsincludedratingdraftpriorities,openendedquestions,andinputonthecurrenthealthcareservicesprovidedinthecommunity.
FocusGroup/StakeholderInterviews
FocusGroup 13communitymembersparticipatedinfocusgroup
2016 Meetingincludeddiscussionofquestionsthatwerealsoutilizedinindividualinterviews.
IndividualInterviewsandFocusGroups
2016FocusGroupParticipantsandKeystakeholders
2016 Resultsfrominterviews&meetingswereincludedinsurveyreport.
LimitationsThesurveyemployedanon‐probabilitysampling,combiningconveniencesamplingwithpurposive(judgmental)sampling.Surveyswereavailableon‐lineandpapersurveysweredistributedatavarietyoflocations.Thisresultedinsomeskeweddemographics.Respondentsweredisproportionatelyfemale(78.3%),hadsomecollege
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degree(61.2%),and27.7%hadhouseholdincomesof$75,000ormore.Alittlelessthanone‐third(31.2%)workedforahospital,clinic,orpublichealthdepartment.Censusinformationongender,educationandincomearegroupedbycensustractswhicharenotalwayscongruentwithZIPcodes.Itisnotpracticabletoadjustthesurveyresponsesforgender,educationandincomeforthenineZIPcodes.However,thiscouldbedoneatthecountylevel.Surveyswereavailableonlineandpapersurveysweredistributedatavarietyoflocations.Thisresultedinsomeskeweddemographics.Respondentsweredisproportionatelyfemale(78.3%),hadsomecollegedegree(61.2%),andone27.7%hadhouseholdincomesof$75,000ormore.Alittlelessthanone‐third(31.2%)workedforahospital,clinic,orpublichealthdepartment.
FindingsCompaniondocumentsareavailablefortheinformationincludedinthisreport.Thefollowingpagessummarizethekeyinformationutilizedbythecommittee.Informationhasbeenorganizedintothreecategories;howevermostofthedataisinter‐related.AccesstoCare
Table2containsresponsestoQ17.Pleaseratehowmuchthefollowingissuespreventyouorothercommunityresidentsfromreceivinghealthcare.Responseswereonafourpointscalefrom1=notaproblemto4=majorproblem.Meansandstandarddeviationswerecalculatedforeach.
Table2:Q17Issuesthatpreventreceivinghealthcare
Inthistable,ahighermeanscoreindicatesahigherperceivedproblem.
N Mean
μ
Std.Deviation
Q17.Notenoughspecialists 193 2.55 1.35
Q17.Notenougheveningorweekendhours 197 2.51 1.28
Q17.Notenoughdoctors 191 2.42 1.31
Q17.Notabletogetappointment/limitedhours 198 2.29 1.14
Q17.Don’tknowaboutlocalservices 193 2.27 1.20
Q17.Can’tgettransportationservices 198 2.26 1.25
Q17.Distancefromhealthfacility 195 2.21 1.15
Q17.Notacceptingnewpatients 195 2.08 1.20
Q17.Notabletoseesameproviderovertime 194 1.99 1.20
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Q17.Poorqualityofcare 192 1.85 1.13
Q17.Barrierstoaccessingveteransservices 196 1.76 1.39
Q17.Lackofdisabilityaccess 194 1.55 1.07
Q17.Iamafraidortoouncomfortabletogo 189 1.52 1.11
Q17.Limitedaccesstotelehealthtechnology 196 1.48 1.33
Q17.Concernsaboutconfidentiality 197 1.48 0.96
Q17.Ihaveother,moreimportantthingstodo 193 1.33 1.08
Q17.Don’tspeaklanguageorunderstandculture 194 1.18 0.76
Thetablerevealsthatthetopthreeissuesthatpreventreceivinghealthcarewerenotenoughspecialists(meanofμ=2.55),notenougheveningorweekendhours(μ=2.51),andnotenoughdoctors(μ=2.42).Thesewereconsideredtobebetweenaminorandmajorproblem.Minorproblemswerenotabletogetappointment/limitedhours(μ=2.29),don’tknowaboutlocalservices(μ=2.27),can’tgettransportationservices(μ=2.26),anddistancefromhealthfacility(μ=2.21).
Thetopthreerefertothesupplyofphysicianswhichishighlydependentontheratioofphysicianper100,000population.This,combinedwithissuesoftransportationanddistancefromhealthfacility,reflectstheruralnatureofTuscolaCounty,whichhadapopulationof55,729in2010.2
Table3containsresponsestoQ16:“Whatcostconsiderationspreventyouorothercommunityresidentsfromreceivinghealthservices?”RespondentswereencouragedtochooseALLthatapply.
Table3showsthatthenumberonecostconsiderationpreventingreceivinghealthserviceswashighdeductibleorco‐paywithone‐third(33.9%)oftheresponsesandchosenbythree‐quarters(74.2%)oftherespondents.Thesecondlargestwasnothavinginsurancewith18.9%oftheresponsesandchosenbytwo‐fifth(41.4%)oftherespondents.
TABLE3Q16.Costconsiderationspreventreceivinghealthservices
Timeschosen
Percenttimeschosen
PercentofRespondentschoosing
Q16aQ16.Highdeductibleorco‐pays 138 33.9% 74.2%
Q16.Noinsurance 77 18.9% 41.4%
2 Popula on of Michigan Coun es 2000 and 2010. Available at h p://www.michigan.gov/cgi/0,1607,7‐158‐54534‐252541‐‐,00.html
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Q16.Insurancedeniesservices 67 16.5% 36.0%
Q16.NotaffordableServices 64 15.7% 34.4%
Q16.Providersdonottakemyinsurance 61 15.0% 32.8%
Total 407 100.0% 218.8%
a.Dichotomygrouptabulatedatvalue1.
Itisnotsurprisingthatasolidmajority(74.2%)ofrespondentspickedhighdeductiblesandcopays.Intheory,bothdeductiblesandcopaysarecostsharingdevicesdesignedtopreventpolicyholdersfrommakingsmallnuisanceclaimsorseekinghealthcareunnecessarily.Thechargeshavetobejustlargeenoughtoinfluencepeople'sdecisions,andnotsobigastokeeppeoplefromgettingthecaretheyneed.Consumersareaskedtodecideaheadoftimebetweenplansthathavelowerpremiumsbuthigherdeductible(whichtheywouldpreferiftheyarelesslikelytoneedhealthcare)vshigherpremiumsbutlowerdeductibles(whichtheywouldpreferiftheyaremorelikelytoneedhealthcare).Theoretically,thisbalancesriskwithcost.3Unfortunately,thecostsofpremiums,deductiblesandcopayshavesteadilyincreased,makingcostadeterminingfactorinobtaininghealthinsurance.
IntermsofCHNAimplementation,althoughhospitalsandhealthdepartmentsmayadjusttheirowncopays,theyhavealmostnoabilitytochangeinsurancedeductibles.
Althoughonly1.0%ofrespondentsansweredthattheyhadnohealthinsurance,41.4%thoughtthatnothavinginsurancepreventsthemselvesorcommunityresidentsfromreceivinghealthservices.ThisismorethandoubletheCensusBureau’s2014estimate4of15.1%to20.0%uninsuredinTuscolaCounty.Thequestionmayreflectaconcernwiththecostsofpurchasinghealthinsurancethroughhealthcare.govratherthanindirectlymeasuringthepopulationnothavinganyhealthinsurance.
CommunityConcerns
Thesurveyaskedquestionsaboutfiveareasofconcerns.ThetopconcernsaresummarizedfromthelistedtablesinAppendixC.
3 Kunreuther, H. and Pauly, M. (2005). Insurance Decision‐Making and Market Behavior. Founda ons and Trends® in Microeconomics. 1:2 p 63‐127. 4 US Census Bureau 2014 Small Area Health Insurance Es mates (SAHIE) Insurance Coverage Es mates: Percent Uninsured: 2014 h p://www.census.gov/did/www/sahie/data/files/F4_Map.jpg
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Theconcernsaboutthecommunity’shealthincluded: Table5.Q7
Accesstohealthyfood Assistanceforlow‐incomefamilies Awarenessoflocalhealthresourcesandservices Accesstoexerciseandfitnessactivities Understanding/NavigatingHealthcareReform
Concernsaboutthequalityoflifeinthecommunity: Table6.Q8
Jobswithlivablewages Attractingandretainingyoungfamilies Affordablehousing Adequateschoolresources
Concernsaboutavailabilityofhealthservices: Table7.Q9
Availabilityofdoctorsandnurses Abilitytogetappointments Availabilityofsubstanceabuse/treatmentservices Availabilityofdentalcare Availabilityofmentalhealthservices
Concernsaboutthecommunity’ssafetyandenvironment: Table8.Q10
Publictransportation(optionsandcost) Waterquality(i.e.wellwater,lakes,rivers) Crimeandsafety Emergencyservicesavailable24/7
Concernsaboutthedeliveryofhealthservices: Table9.Q11
Costofhealthinsurance Costofhealthcareservices Abilitytoretaindoctors,nurses,andotherhealthcareprofessionals Costofprescriptiondrugs
ConcernsrelatedtoVulnerablePopulations
OnepurposeoftheCHNAistoaddressperceptionsandconcernsofandaboutvulnerablepopulations.Vulnerablepopulationsincludeyouth,seniors,females,loweducation,lowincomeandrace/ethnicity.
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Thesurveyinstrumentaskedallrespondentsfortheirconcernsaboutyouthandseniors(seeAppendixC).
Table4belowshowsthatthelargestconcernaboutyouthphysicalhealthwasyouthobesity,whichaccountedforone‐quarter(26.1%)oftheresponses.Itwasselectedbyalittleoverone‐third(35.7%)oftherespondents.Thesecondlargestconcernwasyouthhungerandpoornutrition,chosen22.4%ofthetimeandselectedby30.6%oftherespondents.
Table4.Q12bTop3concernsphysicalhealthinyourcommunity(youthfrequencies)
Timeschosen
Percenttimeschosen
PercentofRespondentschoosing
Q12ba
Q12b.Youthobesity 35 26.1% 35.7%
Q12b.Youthhungerandpoornutrition 30 22.4% 30.6%
Q12b.Wellnessanddiseaseprevention,includingvaccine‐preventable 25 18.7% 25.5%
Q12b.Teenpregnancy 23 17.2% 23.5%
Q12b.Youthsexualhealth(includingsexuallytransmitteddiseases) 21 15.7% 21.4%
Total 134 100.1% 136.7%
a.Dichotomygrouptabulatedatvalue1.
Table5showsthatthelargestconcernwithyouthmentalhealthandsubstanceabusewith26.1%oftheresponseswasyouthdruguseandabuse(includingprescriptiondrugabuse).Itwaschosenbyalmosthalf(47.3%)oftherespondents.Thesecondlargestconcern(25.6%oftheresponses)wasyouthbullyingcheckedby46.6%oftherespondents.
Table5.Q13bTop3concernsmentalhealthsubstanceabuseinyourcommunity(youthfrequencies)
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Timeschosen
Percenttimeschosen
PercentofRespondentschoosing
Q13ba
Q13b.Youthdruguseandabuse(includingprescriptiondrugabuse) 62 26.1% 47.3%
Q13b.Youthbullying 61 25.6% 46.6%
Q13b.Youthalcoholuseandabuse(includingbingedrinking) 36 15.1% 27.5%
Q13b.Youthmentalhealth 35 14.7% 26.7%
Q13b.Youthsuicide 22 9.2% 16.8%
Q13b.Youthtobaccouse(includingexposuretosecond‐handsmoke) 22 9.2% 16.8%
Total 238 99.9% 181.7%
a.Dichotomygrouptabulatedatvalue1
AsshowninTable6,below,thetopconcernwiththeseniorpopulationintheircommunitywasthecostofmedicationswith17.5%oftheresponse).Itwaschosenbyhalf(52.7%)oftherespondents.Thesecondlargestat15.7%oftheresponsesandselectedby47.3%oftherespondentswastheavailabilityofresourcestohelptheelderlystayintheirhomes.Thethirdlargestconcernwastransportation(12.1%)chosenbyalittlemorethanone‐third(36.5%)oftherespondents.Table6.Q14Top3concernsaboutseniorpopulationinyourcommunity
Timeschosen Percenttimeschosen
PercentofRespondentschoosing
Q14a
Q14.Costofmedications 107 17.5% 52.7%Q14.Availabilityofresourcestohelptheelderlystayintheirhomes 96 15.7% 47.3%Q14.Transportation 74 12.1% 36.5%Q14.Availabilityofresourcesforfamilyandfriendscaringfor 61 10.0% 30.0%Q14.Assistedlivingoptions 55 9.0% 27.1%Q14.Dementia/Alzheimer’sdisease 55 9.0% 27.1%Q14.Availabilityofactivitiesforseniors 50 8.2% 24.6%Q14.Hungerandpoornutrition 39 6.4% 19.2%
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Q14.Long‐term/nursinghomecareoptions 38 6.2% 18.7%Q14.Elderabuse 21 3.4% 10.3%Q14.Costofactivitiesforseniors 15 2.5% 7.4%Total 611 100.0% 300.9%
a.Dichotomygrouptabulatedatvalue1
Anadditionalanalysisexaminedthetopconcernsofrespondentswhoself‐identifiedasmembersofvulnerablepopulations:lowincome,loweducation,seniorsandfemales(seeAppendixD).
Income
Respondentswithhouseholdincomeslessthan$25,000weremorelikelythanthosewithhigherincomestobeconcernedabout:
Assistanceforlowincomefamilies Affordablehousing Availabilityofdentalcare Crimeandsafety Availabilityofaffordabledentalcare Wellnessanddiseaseprevention
Respondentswithhouseholdincomeslessthan$25,000werelesslikelythanthosewithhigherincomestobeconcernedabout:
UnderstandingandnavigatingHealthcareReform Availabilityofsubstanceabuseandtreatmentservices Publictransportationandwaterquality Retainingdoctorsandhealthcareprofessionals Youthdruguseandabuse
Education
Respondentswithahighschooleducationorlessaremorelikelythanthosewithmoreeducationtobeconcernedabout:
Affordablehousing Costofhealthcareservices Youthhungerandpoornutritionandwithwellnessanddiseaseprevention
Respondentswithhighschooleducationorlesswerelesslikelythanthosewithmoreeducationsbeconcernedabout:
Adultdruguseandabuse
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Seniors
Respondents58yearsofageorolderaremorelikelythanyoungerrespondentstoconcernedabout:
Changeinpopulationsize Wellnessanddiseaseprevention,includingvaccinepreventableconditions Youthmentalhealth
Respondents58yearsofageorolderwerelesslikelythanyoungerrespondentstobeconcernedabout:
Youthsexualhealth Youthalcoholuseandabuse
Gender
Femalesweremorelikelythanmalestobeconcernedabout:
Youthsexualhealth Adultdruguseandabuse
Femalesareslightlymorelikelythanmalestobeconcernedabout:
Accesstoexerciseandfitnessactivities
Malesweremorelikelythanfemalestobeconcernedabout:
Prejudiceanddiscrimination Diabetes Wellnessanddiseaseprevention Youthdruguseandabuse Dementia/Alzheimer’sdisease
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SecondaryDataThefollowingThumbReportCardillustrateshoweachcountycomparestodatafromthestate.
Source Indicator Year Michigan Huron Sanilac Tuscola
CHR
HealthOutcomes(countyrank) 41 33 28
CHR LengthofLife(countyrank) 41 51 36CHR YearsofPotentialLifeLostper100,000 2011‐2013 7,200 7,100 7,300 6,900CHR AgeAdjustedMortalityper100,000 2011‐2013 360 350 360 350MDCH HeartDiseaseDeaths 2012‐2014 199.3 203.3 233.2 196.9MDCH CancerRelatedDeaths 2012‐2014 173 176.9 164.5 176.4MDCH DiabetesRelatedDeaths 2012‐2014 73.7 86.1 84.4 65.9MDCH DeathsduetoSuicide 2010‐2014 13.2 14.6 18.5 13.1CHR ChildMortality(under18)per100,000 2010‐2013 50 50 40 50CHR InfantMortality(underage1)per1000 2006‐2012 7 NA NA NA
CHR QualityofLife(countyrank) 40 19 23
CHR PoororFairHealth 2014 16% 14% 13% 13%
CHRAverage#ofPoorphysicalhealthdays(Inpast30days)
2014 3.9 3.5 3.4 3.5
CHRFrequentphysicaldistress(>14days‐past30whenphysicalhealthwasnotgood)
2014 12% 11% 10% 11%
CHRAverage#ofPoormentalhealthdays(Inpast30days) 2014 4.2 3.6 3.6 3.7
CHR
FrequentMentalHealthdistress(>14days‐past30whenmentalhealthwasnotgood)
2014 13% 11% 11% 11%
PHY
7thgradestudentswhofeltsosadorhopelessalmosteverydayfortwoweeksormoreinarowthattheystoppeddoingsomeusualactivities‐past12months
2014H‐T2010SC
NA 20.6% NA 35.7%
PHY
9thgradestudentswhofeltsosadorhopelessalmosteverydayfortwoweeksormoreinarowthattheystoppeddoingsomeusualactivities‐past12months
2014H‐T2010SC
NA 23.9% 45.0% 34.3%
PHY
11thgradestudentswhofeltsosadorhopelessalmosteverydayfortwoweeksormoreinarowthattheystoppeddoingsomeusualactivities‐past12months
2014H‐T2010SC
NA 19.3% 34.0% 30.3%
CHR LowBirthweight(<2500grams;5lbs,8oz) 2007‐2013 8% 8% 7% 7%
MDCH CancerIncidence(AgeAdjustedRate) 2010‐2012 471.8 441.0 356.5 436.9
MDCHCardiovascularDischargesIncidence(AgeAdjusted‐AcuteMyocardialInfarction) 2011‐2013 200.3 225.2 275.8 251.6
MDCHCardiovascularDischargesIncidence(AgeAdjustedRate‐CongestiveHeartFailure)
2011‐2013 284.8 245.2 260.2 288.1
MDCH CardiovascularDischarges(Stroke) 2011‐2013 226.4 218.7 207.0 225.2
MDCH DiabetesDischargesIncidence 2011‐2013 183.0 122.7 176.2 138.8
CHRDiabetesPrevalence**(age20+diagnosedwithdiabetes,2012) 2012 10% 11% 11% 10%
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CHR HIVPrevalence2012)per100,000 2012 178 18 42 26
Source Indicator Year Michigan Huron Sanilac Tuscola
CHR HealthFactors(countyrank) 17 49 43CHR HealthBehaviors(countyrank) 16 53 41CHR AdultObesity**(BMI>30) 2012 31% 31% 34% 31%
PHY7thGradeObesity(>95thand85thpercentile)
2014H‐T2010SC
NA 12.9%/13.4% 16.3%/14.3% 13%/16.8%
PHY9thGradeObesity(>95thand85thpercentile)
2014H‐T2010SC NA 13.6%/18.4% 18%/16.9% 20.3%/18.7%
PHY11thGradeObesity(>95thand85thpercentile)
2014H‐T2010SC
NA 15.3%/24.1% 17.1%/19% 19.3%/15.8%
0‐8 Obesityamonglowincomechildren 2014 13% 12% 11% 11%
CHR
LimitedAccessToHealthyFoods:%oflowincomewhodon'tliveclosetogrocerystore
2010 6% 11% 2% 3%
CHR
Indexoffactorsthatcontributetoahealthyfoodenvironment,0(worst)to10(best).
2013 7.1 6.9 7.7 7.6
CHRFoodInsecurity(didnothaveaccesstoreliablesourceoffoodinthepastyear)
2013 16% 14% 15% 15%
CHRPhysicalInactivity:noleisure‐timephysicalactivity.
2012 23% 28% 22% 30%
PHY7thGrade‐60minutesofphysicalactivityforatleast5of7pastdays.
2014H‐T2010SC NA 24.6% 58.0% 59.5%
PHY9thGrade‐60minutesofphysicalactivityforatleast5of7pastdays.
2014H‐T2010SC
NA 38.4% 62.7% 66.5%
PHY11thGrade‐60minutesofphysicalactivityforatleast5of7pastdays.
2014H‐T2010SC
NA 26.7% 36.4% 47.6%
CHR
%ofindividualsinacountywholivereasonablyclosetoalocationforphysicalactivitysuchasparks.
2010&2014
84% 53% 13% 43%
CHR AdultSmoking(everydayormostdays) 2014 21% 16% 18% 17%
PHY7thGradeyouthwhosmokedcigarettesduringthepast30days
2014H‐T2010SC
NA 0.9% 5.1% 2.4%
PHY9thGradeyouthwhosmokedcigarettesduringthepast30days
2014H‐T2010SC NA 8.1% 15.7% 11.0%
PHY11thGradeyouthwhosmokedcigarettesduringthepast30days
2014H‐T2010SC
NA 21.5% 19.6% 18.7%
0‐8LiveBirthstoWomenWhoSmokedDuringPregnancy
2011‐2013 21.6% 24.7% 26.3% 32.9%
CHRExcessiveDrinking(Binge‐5+drinksordailydrinking) 2014 20% 19% 20% 21%
CHRAlcoholImpairedDrivingDeaths(%ofalldrivingdeaths)
2010‐2014 30% 27% 36% 39%
PHY7thgradestudentswhohadatleastonedrinkofalcoholduringthepast30days
2014H‐T2010SC
NA 4.8% 6.1% 9.3%
PHY9thgradestudentswhohadatleastonedrinkofalcoholduringthepast30days
2014H‐T2010SC NA 24.4% 32.2% 21.2%
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PHY11thgradestudentswhohadatleastonedrinkofalcoholduringthepast30days
2014H‐T2010SC NA 48.2% 46.2% 38.6%
Source Indicator Year Michigan Huron Sanilac Tuscola
PHY7thgradestudentswhousedmarijuanaduringthepast30days
2014H‐T2010SC NA 1.4% 1.0% 3.5%
PHY9thgradestudentswhousedmarijuanaduringthepast30days
2014H‐T2010SC
NA 6.2% 5.1% 11.3%
PHY11thgradestudentswhousedmarijuanaduringthepast30days
2014H‐T2010SC
NA 17.8% 13.9% 21.0%
CHRDrugOverdoseDeaths:drugpoisoningdeathsper100,000 2012‐2014 16 NA 14 12
CHR
DrugOverdoseDeathsModeled:estimateofthenumberofdeathsduetodrugpoisoningper100,000
2014 18 6.1‐8.0 12.0‐14.0 12.0‐14.0
CHRMotorVehicleCrashDeaths:trafficaccidentsinvolvingavehicleper100,000 2007‐2013 10 11 16 17
CHRSexuallytransmittedinfections:diagnosedchlamydiacasesper100,000 2013 453.6 141.7 158.5 217.7
PHY7thgradestudentswhoeverhadsexualintercourse
2014H‐T2010SC
NA 4.5% 4.0% 9.7%
PHY9thgradestudentswhoeverhadsexualintercourse
2014H‐T2010SC
NA 14.4% 29.0% 17.5%
PHY11thgradestudentswhoeverhadsexualintercourse
2014H‐T2010SC NA 41.3% 51.1% 43.9%
CHRTeenBirths(#ofbirthsper1,000femalepopulation,ages15‐19)
2007‐2013 29 21 25 26
MDCHPercentofTotalBirthstoMothersAge<20
2011‐2013 7.8 6.3 7.3 7.5
CHRInsufficientSleep:adultswhoreportfewerthan7hoursofsleeponaverage 2014 38% 32% 30% 32%
CHR ClinicalCare(countyrank) 48 75 71
CHRUninsured:<65thathasnohealthinsurancecoverage 2013 13% 15% 15% 14%
CHR
UninsuredAdults:18to65thathasnohealthinsurancecoverageinagivencounty
2013 16% 18% 19% 18%
CHRUninsuredChildren:<19thathasnohealthinsurancecoverage 2013 4% 6% 6% 4%
CHR
Healthcarecosts:price‐adjustedMedicarereimbursements(PartsAandB)perenrollee
2013 $10,153 $10,391 $10,117 $10,808
CHR
PrimaryCare:ratioofthepopulationtototalprimarycarephysicians.Higher=lessaccess
2013 1,240:1 1,530:1 3,490:1 3,190:1
CHR
RatioofotherPrimaryCareProviders:nursepractitioners(NPs),physicianassistants(PAs),andclinicalnursespecialists
2015 1,342:1 1,458:1 2,079:1 2,348:1
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CHRDentists:ratioofthepopulationtototaldentists.Higher=lessaccess 2014 1,450:1 2,290:1 3,470:1 2,840:1
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Source Indicator Year Michigan Huron Sanilac Tuscola
CHR
MentalHealth:ratioofthepopulationtototalmentalhealthproviders.Higher=lessaccess
2015 450:01:00 1,280:1 670:01:00 430:01:00
HPSA
ProviderShortageDesignations Varies NAPrimaryCare
DentalMentalHealth
PrimaryCareDentalMentalHealth
PrimaryCareDental
MentalHealth
0‐8LiveBirthstoWomenWithLessThanAdequatePrenatalCare
2011‐2013 29.9% 16.0% 29.7% 24.3%
0‐8ToddlersAges19‐35MonthsWhoAreImmunized4:4:1:3:3:1:4
2014 73.8% 73.3% 75.0% 73.9%
CHR
PreventableHospitalStays:dischargerateforambulatorycare‐sensitiveconditionsper1,000Medicareenrollees
2013 59 52 72 72
CHR
DiabeticMonitoring:Medicareenrolleesages65‐75thatreceiveHbA1cmonitoring
2013 86% 85% 87% 83%
CHR
MammographyScreening:femaleMedicareenrolleesages67‐69thatreceivemammographyscreening
2013 65% 66% 64% 64%
CHRSocial&EconomicFactors(countyrank) 12 35 32
CHRHighSchoolGraduation:%ofstudentswhograduatehighschoolinfouryears. 2012‐2013 78% 90% 87% 80%
CHR
SomeCollege:adultsages25‐44withsomepost‐secondaryeducation;nodegree
2010‐2014 66% 54% 52% 57%
0‐8BirthstoMothersWithoutaHighSchoolDiploma/GED 2011‐2013 13.8% 10.3% 17.0% 10.9%
KC Childrenage3‐4enrolledinpreschool. 2009‐2013 47.5% 57.9% 48.0% 45.5%
0‐8Changeinlicensedchildcareproviders
From2011‐2015 NA ‐2 ‐3 ‐13
CHRUnemployment:ages16+butseekingwork
2014 7.30% 6.80% 8.40% 8.50%
CHR
MedianHouseholdIncome:halfthehouseholdsearnmoreandhalfthehouseholdsearnlessthanthisincome.
2014 $49,800 $41,700 $42,100 $43,200
CHR
Incomeinequality:Higherinequalityratioindicatesgreaterdivisionbetweenthetopandbottomendsoftheincomespectrum
2010‐2014 4.7 4.1 3.9 3.7
CHR ChildrenInSingleParentHouseholds 2010‐2014 34% 33% 26% 27%
CHR
ChildrenEligibleForFreeLunch:%enrolledinpublicschoolseligibleforfreelunch
2012‐2013 42% 39% 44% 49%
CHRChildreninPoverty:underage18livinginpoverty
2014 23% 21% 23% 24%
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Alice
ALICElevel:householdsabovepovertylevel,butlessthanthebasiccostoflivingforcounty.
2014 NA 27% 27% 22%
census Povertyrate‐USCensus 2014 16.9% 15.5% 15.6% 15.3%
Source Indicator Year Michigan Huron Sanilac Tuscola
0‐8
Rateper1,000ChildrenAges0‐8WhoAreSubstantiatedVictimsofAbuseorNeglect
2014 20.6 13.0 24.1 25.2
0‐8
Changeinrateper1,000ChildrenAges0‐8SubstantiatedVictimsofAbuseorNeglect
From2010to2014
2.6 ‐6.6 4.6 6.9
0‐8Rateper1,000ofChildrenAges0‐8inFosterCare
2014 5.9 5.7 10.3 5.8
PHY
7thgradestudentswhohaveseenstudentsgetpushed,hit,orpunchedoneormoretimesduringthepast12months
2014H‐T2010SC NA 62.1% 89.2% 71.6%
PHY
9thgradestudentswhohaveseenstudentsgetpushed,hit,orpunchedoneormoretimesduringthepast12months
2014H‐T2010SC NA 57.7% 82.0% 60.9%
PHY
11thgradestudentswhohaveseenstudentsgetpushed,hit,orpunchedoneormoretimesduringthepast12months
2014H‐T2010SC
NA 51.9% 75.7% 52.0%
CHRViolentCrime:offensesthatinvolveface‐to‐faceconfrontationper100,000.
2010‐2012 464 123 196 177
CHR Homicides:deathsper100,000 2007‐2013 7 NA NA NA
CHRInjuryDeaths:intentionalandunintentionalinjuriesper100,000
2009‐2013 61 60 70 56
CHR InadequateSocialSupport‐adults 2005‐2010 20% 14% 20% 16%
CHRSocialassociations:numberofassociationsper10,000population
2013 10.2 23.3 13.2 14.6
CHR
ResidentialSegregationBlackWhite:degreetowhichliveseparatelyinageographicarea(0integrationto100segregation)
2010‐2014 74 NA 57 62
CHR
ResidentialSegregationnonwhite‐white:degreetowhichliveseparately(0integrationto100segregation)
2010‐2014 61 32 24 21
CHRPhysicalEnvironment(countyrank)
24 29 47
CHRAirPollutionParticulateMatter:averagedailydensity
2011 11.5 12 12.3 12
CHR Drinkingwaterviolations:Yes=presence FY2013‐14 No No No
CHR
SevereHousingProblems:atleast1of4problems‐overcrowding,highhousingcosts,orlackofkitchenorplumbing
2008‐2012 17% 13% 14% 14%
CHR
DrivingAloneToWork:percentageoftheworkforcethatusuallydrivesalonetowork.
2010‐2014 83% 81% 77% 83%
CHRLongCommuteDrivingAlone:Greaterthan30minutes 2010‐2014 32% 22% 37% 42%
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NOTE:TheThumbRuralHealthNetworkReportmaybebeneficialinRegionalconversationsaboutneedandalsocanshedsomelightasaregionastotrends.ThisreportdidnotincludecountyorMichigancomparisonsandthereforedidnotlendwelltoinclusioninthereportcardtable.
SourceKey CHR‐CountyHealthRanking 0‐8‐Birthto8Indicators PHY‐MichiganProfileforHealthyYouth HPSA‐HealthProviderShortageArea MDCH‐MichiganDepartmentofCommunityHealth AR‐AliceReport ALICE‐AssetLimitedIncomeConstrainedEmployed KC‐KidsCount
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IdentifiedNeeds&Priorities
PrioritizationProcessACHNAhelpstodirectresourcestotheissuesthathavethegreatestpotentialforimprovingthehealthofthecommunity.Successfullyaddressingpriorityissuesincreaseslifeexpectancy,improvesqualityoflife,andresultsinasavingstothehealthcaresystem.
ImplementationMeetingCaroCommunityHospitalbegantheprioritizationprocessbyreviewingthedatadescribedinthefindingssectionofthisreport.TheImplementationmeetingincluded8menand6women;frombothCaroCommunityHospital’sBoardofDirectorsandinternalhospitalleadership.Themeetingparticipantsalsoreviewedthefollowlistofconcernsrevealedinfocusgroups:
Table7TopconcernsoffocusgroupbytopicCaroCommunityHospital:
o Community/EnvironmentalConcerns Poverty (9)(*6) Notenoughjobswithlivablewages,notenoughtoliveon (7)(*5) Attractingandretainingyoungfamilies (6)(*4) Notenoughpublictransportation,costofpublictransportation(5)(*3) Childabuse (5) Physicalviolence,domesticviolence,sexualabuse (4)
o Physical,mentalhealth,andsubstanceabuseconcerns(adults)
Druguseandabuse(includingprescriptiondrugabuse) (9)(*5) Obesity/overweight (9)(*4) Poornutrition,pooreatinghabits (8)(*1) Alcoholuseandabuse (7)(*1) Cancer (6)(*2) Diabetes(3)(*2) Stress (3)(*2) Suicide(3) Smokingandtobaccouse/exposuretosecond‐handsmoke (3)
o Concernsabouthealthservices
Costofhealthinsurance (10)(*3) Costofprescriptiondrugs (7)(*1) Abilitytoretaindoctorsandnursesinthecommunity(5)(*2) Availabilityofmentalhealthservices (5)(*2) Costofhealthcareservices (5)(*1) Adequacyofhealthinsurance(concernsaboutout‐of‐pocketcosts) (5)(*1) Availabilityofspecialists (5) Extrahoursforappointments,suchaseveningsandweekends (4)(*2) Qualityofcare (3)
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o Concernsaboutyouthandchildren Youthobesity (5)(*1) Youthmentalhealth (5)(*1) Youthdruguseandabuse(includingprescriptiondrugabuse)(3)(*1) Notenoughactivitiesforchildren/youth (3) Youthhungerandpoornutrition (2)(*2)
o Concernsabouttheagingpopulation
Availabilityofresourcestohelptheelderlystayintheirhomes (5) Beingabletomeetneedsofolderpopulation (4) Assistedlivingoptions(4)
Keyinformationinterviewresultswereutilizedtoconfirmconcernsidentifiedinotherdataandtoidentifyotherpotentialareasofconcern.Themeetingparticipantsusedaprioritizationprocessthatincludedanalysisofissueslocatedinmultipledatasources.
POTENTIALNEEDSInAlphabeticalorder
(Combinedindicatorsfromsurveys,focusgroups,andsecondarydata)
=Notmeeting
stateaverage
=CountyNeedbasedondata
=CountyNeedbasedoninterview
Focusgroup
=Survey
VOTEforyourtop5(1topchoice,5lowest)
1. AbuseandViolenceincludingBullying
o
2. AccesstoDentalHealthcareandProviders
o
4
3. AccesstoEmergencyCare o 4. Accesstoinhomehealthcare
andsupports o
5. Accesstolongtermhealthcareservices
o
6. AccesstoPrenatalCare o 7. AccesstoPrimaryHealthcare
andProviders o
10
8. AccesstoPublicHealthServicesandProviders
o
9. Accesstospecializedhealthcareservices
o
10. AccesstoVisionHealthcareandProviders
o
11. AlcoholUse/Abuse o 4
12. Cancer o
13. Diabetes o
14. Education o
15. EnvironmentalHealth o
16. FamiliesServicesandSupports o 17. HealthEducationand
Awareness o
Caro Community Hospital Community Health Needs Assessment
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18. HealthInsuranceandHealthcareCosts
o
4
19. HealthcareWorkforce o 4
20. HeartDisease
21. LocalEconomicConditions o
22. LungDiseaseandAsthma o
23. MentalHealth o 8
24. Nutrition o
25. Obesity o 26. PersonalAttitudestoHealth
andHealthcare o
27. PhysicalActivity o
28. QualityofHealthcare o
29. ReproductiveHealth o
30. SafetyandViolence o
31. SeniorSupportServices o
32. SocialConditions o
33. SocialEmotionalSupport o
34. SubstanceAbuse o
35. TeenBirths o
36. TobaccoUse (prenatal) (prenatal) o
37. TrafficSafety o
38. Transportation o
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Assessexistingresourcesthatareaddressingpriorities
IdentifiedNeeds&AvailableResourcesThenextstepintheresourceassessmentwastogroupneedsintocategories.ThecategoriesarelistedonTable4alongwiththeresourcesthatareprovidedbythehospitalandthecommunity.
Table4:CommunityHealthNeeds&Resources
Category Need5 and Related Data Current Caro Community
Hospital Efforts Current Community Efforts
Access to Care
Need
Access to primary healthcare and providers
Access to dental health
Related Data
Not meeting state average
County need based on data
County need based on stakeholder interviews
Hospital need based on focus group
Hospital need based on survey
1. Specialty clinic offering various specialty medical providers: a. Dermatology b. Nephrology c. Cardiology d. Pulmonology e. Orthopedics f. Neurology g. Gynecology h. Endocrinology i. Oncology j. Neurosurgery k. And more
2. Primary care clinic in Caro. 3. After Hours Clinic with
evening and weekend hours opening soon
4. Students from CMU College of Medicine
5. Use of mid‐level practitioners 6. Ongoing advertising of
physicians to increase consumer awareness
County Programs 1. Adult day services and Foster Care Homes 2. Human Development Commission 3. Subsidized Housing Assistance, Independent
and Assisted Living, long term care homes 4. Region VII Area Agency on Aging and Huron
County Council on Aging 5. Legal services for seniors‐ Port Huron Office 6. A&D Home Care and BWCIL provides Nursing
Home Transition services 7. BWCIL is the Housing Assistance Resource
Agency (HARA) for the Thumb Area Continuum of Care. Provides homeless prevention and rapid re‐housing
8. Homeless Coalition‐ Emergency Shelter, security deposits rental arrearages
9. Lakeshore Legal Aid Local Programs 1. HDC‐Home delivered meals
Specialty Services
Need
Mental Health
Alcohol use/abuse Related Data
Not meeting state average
County need based on data
County need based on stakeholder interviews
Hospital need based on focus group
1. Referrals to local Mental Health providers through hospital and primary care
2. Invite mental health providers to Health Fairs
3. Invite Mental Health providers to host community training onsite
4. Referrals for patients to substance abuse treatment and community support groups such as AA
1. Thumb Area Unity Council: conglomeration of local Alcoholics Anonymous groups.
2. List Psychological, Thumb Area Psychological Services and Thumb Behavioral Health offer substance abuse counseling.
3. Thumb Area Psychological Services based in Cass City.
4. Thumb Behavioral Health, List Psychological and other mental health providers.
5 *indicates issue related to top community health priori es ** indicates issue related to top health system priori es
Caro Community Hospital Community Health Needs Assessment
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Hospital need based on survey
5. Substance Abuse screening and treatment referral in primary care clinics
Health Insurance & Healthcare
Costs .
Need
Health insurance and healthcare costs
Related Data
Not meeting state average
County need based on data
County need based on stakeholder interviews
Hospital need based on focus group
1. Financial Assistance Program 2. Working with new insurance
companies to be in their network
3. Financial Counselor 4. Payment Plans 5. Online Bill Pay 6. Annual Community Health
Fair 7. Low‐cost sports physicals for
local students 8. Program for uninsured or
those with high deductibles to get cost‐effective lab work
County Programs 10. Adult day services and Foster Care Homes 11. Human Development Commission 12. Subsidized Housing Assistance, Independent
and Assisted Living, long term care homes 13. Region VII Area Agency on Aging and Huron
County Council on Aging 14. Legal services for seniors‐ Port Huron Office 15. A&D Home Care and BWCIL provides Nursing
Home Transition services 16. BWCIL is the Housing Assistance Resource
Agency (HARA) for the Thumb Area Continuum of Care. Provides homeless prevention and rapid re‐housing
17. Homeless Coalition‐ Emergency Shelter, security deposits rental arrearages
18. Lakeshore Legal Aid Local Programs HDC‐Home delivered meals
Recruitment and
Retention
Need
Healthcare Workforce
Related Data
Not meeting state average
County need based on data
County need based on stakeholder interviews
Hospital need based on focus group
1. Ongoing, active recruiting efforts of medical staff
2. Competitive wage/benefit packages
3. Continually updating employee benefits package
4. Internationals 5. Medical Opportunities of MI
(MCRH)
WrittenCHNAReportandImplementationPlan TheCHNAreportwascompletedindraftforminNovember,2016.Thefinalreportwasreviewedand
postedtothehospitalwebsiteatwww.cch‐mi.orginDecember,2016. TheImplementationPlaniscurrentlyindevelopmentandwillalsobepostedtothehospitalwebsitewith
finalapprovalbytheHospitalBoardofDirectorsinDecember,2016.
Caro Community Hospital Community Health Needs Assessment
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AdditionalDocuments(AvailableUponRequest) SurveyInstrument ImplementationPlan FocusGroupDesign InterviewOutline
Survey,Stakeholder,FocusGroupReport ThumbAreaHealthStatusDataReports