Skaggs Community Hospital Association

Transcription

Community Health Needs Assessment
February 2013
February 2013
Contents
Consultants’ Report ............................................................................................................... 1
Introduction ....................................................................................................................................... 2
Summary of Community Health Needs Assessment .......................................................................... 3
General Description of Hospital ......................................................................................................... 3
Community Served by the Hospital ...................................................................................... 4
Defined Community ........................................................................................................................... 4
Community Details ................................................................................................................. 6
Identification and Description of Geographical Community ............................................................. 6
Community Population and Demographics ........................................................................................ 6
Socioeconomic Characteristics of the Community .......................................................... 12
Income and Employment .................................................................................................................. 12
Poverty.............................................................................................................................................. 14
Uninsured ........................................................................................................................................ 15
Education ......................................................................................................................................... 16
Health Status of the Community ......................................................................................... 16
Leading Causes of Death .................................................................................................................. 18
Health Outcomes and Factors ............................................................................................ 20
Taney County ................................................................................................................................... 22
Stone County .................................................................................................................................... 24
Health Care Resources ........................................................................................................ 26
Hospitals and Health Centers ........................................................................................................... 26
Hospital Market Share ...................................................................................................................... 27
Other Health Care Facilities and Providers ...................................................................................... 28
Estimated Demand for Physician Office Visits and Hospital Services ........................... 29
Estimated Demand for Physician Services........................................................................ 33
February 2013
Key Informant Interviews..................................................................................................... 37
Methodology..................................................................................................................................... 37
Key Informant Profiles ..................................................................................................................... 37
Key Informant Interview Results ..................................................................................................... 38
Key Findings .................................................................................................................................... 41
Community Health Input Questionnaire............................................................................. 42
Methodology..................................................................................................................................... 42
Community Health Input Questionnaire........................................................................................... 42
Community Health Input Results ..................................................................................................... 42
Prioritization of Identified Health Needs ............................................................................ 45
Considerations for Meeting Identified Health Needs ........................................................ 46
Access to Care .................................................................................................................................. 46
Diseases of the Heart ........................................................................................................................ 47
Tobacco Use ..................................................................................................................................... 49
Health Issues of Uninsured Persons, Low-Income Persons
and Minority Groups......................................................................................................... 50
Appendices
Acknowledgements .......................................................................................................................... 51
Key Informant Interview Protocol.................................................................................................... 53
Community Health Input Questionnaire Detail Results ................................................................... 56
Sources ............................................................................................................................................. 83
Consultant’s Report
Mr. David Strong
Chief Financial Officer
The Skaggs Community Hospital Association
d/b/a Skaggs Community Health Center
Branson, Missouri 65616
On behalf of Skaggs Community Hospital Association, d/b/a Skaggs Community Health Center, (Skaggs)
we have assisted in conducting a Community Health Needs Assessment (CHNA) consistent with the
scope of services outlined in our engagement letter dated August 9, 2012. The purpose of our
engagement was to assist the System in meeting the requirements of Internal Revenue Code §501(r)(3).
We relied on the guidance contained in IRS Notice 2011-52 when preparing your report. We also relied
on certain information provided by Skaggs, specifically certain utilization data and existing community
health care resources.
Based upon the assessment procedures performed, it appears Skaggs is in compliance with the provisions
of §501(r)(3). Please note that, we were not engaged to, and did not, conduct an examination, the
objective of which would be the expression of an opinion on compliance with the specified requirements.
Accordingly, we do not express such an opinion.
We used and relied upon information furnished by the Organization, its employees and representatives
and on information available from generally recognized public sources. We are not responsible for the
accuracy and completeness of the information and are not responsible to investigate or verify it.
These findings and recommendations are based on the facts as stated and existing laws and regulations as
of the date of this report. Our assessment could change as a result of changes in the applicable laws and
regulations. We are under no obligation to update this report if such changes occur. Regulatory
authorities may interpret circumstances differently than we do. Our services do not include interpretation
of legal matters.
February 28, 2013
Community Health Needs Assessment 2013
Introduction
IRC Section 501(r) requires health care organizations to assess the health needs of their communities and
adopt implementation strategies to address identified needs. Per IRC Section 501(r), a byproduct of the
Affordable Care Act, to comply with federal tax-exemption requirements, a tax-exempt hospital facility
must:
•
Conduct a community health needs assessment every three years.
•
Adopt an implementation strategy to meet the community health needs identified through the
assessment.
•
Report how it is addressing the needs identified in the community health needs assessment and a
description of needs that are not being addressed with the reasons why such needs are not being
addressed.
The community health needs assessment must take into account input from persons who represent the
broad interest of the community served by the hospital facility, including those with special knowledge of
or expertise in public health. The hospital facility must make the community health needs assessment
widely available to the public.
This community health needs assessment, which describes both a process and a document, is intended to
document The Skaggs Community Hospital Association, d/b/a Skaggs Regional Medical Center’s,
compliance with IRC Section 501(r). Health needs of the community have been identified and prioritized
so that The Skaggs Community Hospital Association, d/b/a Skaggs Regional Medical Center, (Hospital)
may adopt an implementation strategy to address specific needs of the community.
The process involved:
•
Collection and analysis of a large range of data, including demographic, socioeconomic and
health statistics, health care resources and patient use rates.
•
Interviews with key informants who represent a) broad interests of the community, b) populations
of need or c) persons with specialized knowledge in public health.
•
Circulation of a Community Health Input Questionnaire that gathered a wide range of
information which was widely distributed to members of the community.
This document is a summary of all the available evidence collected during the initial cycle of community
health needs assessments required by the IRS. It will serve as a compliance document as well as a
resource until the next assessment cycle.
Both the process and document serve as the basis for prioritizing the community’s health needs and will
aid in planning to meet those needs.
2
Summary of Community Health Needs Assessment
The Hospital engaged BKD, LLP to conduct a formal community health needs assessment. BKD, LLP is
one of the largest CPA and advisory firms in the United States, with approximately 2,000 partners and
employees in 30 offices. BKD serves more than 900 hospitals and health care systems across the country.
The community health needs assessment was conducted from October 2012 through December 2012.
Based on current literature and other guidance from the treasury and the IRS, the following steps were
conducted as part of Hospital’s community health needs assessment:
•
The “community” served by the Hospital was defined by utilizing inpatient and outpatient data
regarding patient origin. This process is further described in Community Served by the Hospital.
•
Population demographics and socioeconomic characteristics of the community were gathered and
reported utilizing various third parties (see references in Appendices). The health status of the
community was then reviewed. Information on the leading causes of death and morbidity
information was analyzed in conjunction with health outcomes and factors reported for the
community by CountyHealthrankings.org. Health factors with significant opportunity for
improvement were noted.
•
An inventory of health care facilities and resources was prepared and estimated a demand for
physician and hospital services was estimated. Both were evaluated for unmet needs.
•
Community input was provided through key informant interviews of 15 stakeholders and a
community health input questionnaire was widely distributed. The Community Health Input
Questionnaire was completed by 547 individuals. Results and findings are described in the Key
Informant and Community Health Input Questionnaire sections of this report.
•
Information gathered in the above steps was analyzed and reviewed to identify health issues of
uninsured persons, low-income persons and minority groups and the community as a whole.
Health needs were ranked utilizing a weighting method that considers 1) the ability of the
Hospital to impact change, 2) the size of the problem, 3) the seriousness of the problem and 4) the
prevalence of common themes.
Health needs were then prioritized taking into account the perceived degree of influence the
Hospital has to impact the need and the health needs impact on the overall health of the
community. Information gaps were identified during the prioritization process and are also
reported.
•
Recommendations based on this assessment have been communicated to Hospital management.
General Description of Hospital
The Hospital is a Missouri not-for-profit entity, which owns and operates an acute care hospital located in
Branson, Missouri, and provides inpatient, outpatient and emergency care services. The Hospital also
operates facilities providing physician and outpatient medical services in Branson, Forsyth, Kimberling
City, Hollister and Branson West, Missouri. A board of directors governs the Hospital and ensures that
medical services are available to the residents of Branson and the surrounding areas.
3
The Hospital has been serving southwestern Missouri residents for more than 62 years and offers over 25
major service areas to meet the needs of Missourians close to home. The Hospital’s average daily patient
census exceeds 90, with 165 hospital beds. A staff of over 1,000 personnel are required to operate the
hospital and its numerous clinics. Almost from the beginning and during each of the following five
decades, healthcare services and medical technology at the Hospital have continued to expand. All the
while, dedicated employees have maintained their sense of pride, caring and professionalism.
On June 28, 2012, the Hospital signed a nonbinding letter of intent with Lester E. Cox Medical Centers
(Cox) to exclusively negotiate a definitive agreement whereby it is anticipated that Cox will be
substituted as the sole member and owner of the Hospital. The letter of intent was the result of a four
month process which began in February 2012 with the Hospital issuing a Request for Proposal. Cox and
one other finalist were selected to undergo initial due diligence and negotiate a letter of intent. Cox was
selected by the Hospital’s Board from the two finalists. In January 2013, the Hospital became a part of
the CoxHealth network, doing business as Cox Medical Center Branson.
Community Served by the Hospital
The Hospital is located in the city of Branson, Missouri. Branson is approximately forty-five miles south
of Springfield, Missouri. Branson and the surrounding geographic area are not close to any major
metropolitan area. Branson is accessible by a state highway and other secondary roads.
Defined Community
A community is defined as the geographic area from which a significant number of the patients utilizing
hospital services reside. While the community health needs assessment considers other types of health
care providers, the utilization of Hospital services provides the clearest definition of the community. The
criteria established to define the community is as follows:
•
A zip code area must represent two percent or more of the Hospital’s total discharges and
outpatient visits.
•
The Hospital’s market share in the zip code area must be greater than or equal to 20 percent.
•
The area is contiguous to the geographical area encompassing the Hospital.
Based on the patient origin of acute care discharges from October 1, 2010, through September 30, 2011,
management has identified the community to include the zip codes listed in Exhibit 1. Exhibit 1 presents
the Hospital’s patient origin and charges for each of the top 10 zip code areas in its community.
Following is a detailed map of the Hospital’s geographical location and the footprint of the community
identified in Exhibit 1. The map displays the Hospital’s geographic relationship to surrounding counties,
significant roads and highways, and identifies the 10 zip codes that comprise the Hospital’s community.
4
When specific information is not available for zip codes, the community health needs assessment relies on
information for specific counties. The geographic area of the defined community based on the identified
zip codes for the community covers significant portions of Taney and Stone counties and excludes one zip
code in Boone County, Arkansas. The community health needs assessment utilizes the counties when
corresponding information is more readily available. Since zip code 72601 in Boone County is excluded
for the community, when using county data, this county is excluded.
Exhibit 1
Summary of Inpatient Discharges by Zip Code (Descending Order)
10/1/2010 - 9/30/2011
Percent
Zip Code
65616
65672
65653
65737
65686
65740
65739
65679
65611
65656
City
Discharges
of Total
Cumulative
Discharges
Percent
30.1%
40.0%
48.3%
55.1%
60.4%
65.3%
68.5%
71.2%
73.5%
75.7%
100.0%
Branson
Hollister
Forsyth
Reeds Spring
Kimberling City
Rockaway Beach
Ridgedale
Kirbyville
Blue Eye
Galena
All Other
2,167
714
593
490
383
349
233
193
165
156
1,751
30.1%
9.9%
8.2%
6.8%
5.3%
4.9%
3.2%
2.7%
2.3%
2.2%
24.3%
Total
7,194
100.0%
Source: Skaggs Community Hospital
5
Community Details
Identification and Description of Geographical Community
The following map geographically illustrates the Hospital’s location and community by showing the
community zip codes shaded. The bulk of the community’s population is concentrated in and around the
city of Branson, with portions of the nearby counties of Taney and Stone also having significant discharge
numbers.
Community Population and Demographics
The U.S. Bureau of Census has compiled population and demographic data based on the 2010 census.
The Nielsen Company, a firm specializing in the analysis of demographic data, has extrapolated this data
by zip code to estimate population trends from 2013 through 2018.
6
Exhibit 2 illustrates that the overall population is projected to increase slightly over the five-year period
from 68,512 to 71,493. In line with the overall numbers, the age category that utilizes health care services
the most, 65 years and over, is projected to increase from 14,833 to 17,042. The projected changes to the
composition of the total community, between male and female, are projected to remain approximately the
same over the five-year period.
Exhibit 2
The Skaggs Community Hospital Association Community Zip Codes
Estimated 2013 Population and Projected 2018 Population
Zip Code
65611
65616
65653
65656
65672
65679
65686
65737
65739
65740
City
Blue Eye
Branson
Forsyth
Galena
Hollister
Kirbyville
Kimberling City
Reeds Spring
Ridgedale
Rockaway Beach
PROVIDER SERVICE AREA
65611
65616
65653
65656
65672
65679
65686
65737
65739
65740
Blue Eye
Branson
Forsyth
Galena
Hollister
Kirbyville
Kimberling City
Reeds Spring
Ridgedale
Rockaway Beach
Under
18 years
249
5,747
1,155
950
1,703
751
724
1,513
230
894
13,916
257
6,180
1,240
911
1,789
764
709
1,482
224
938
14,494
18-44
years
45-64
years
65 years
and over
Estimated 2013 Population
372
624
8,521
6,828
1,558
1,543
1,292
3,602
889
968
2,064
323
1,165
20,754
1,529
2,158
717
1,605
2,506
504
995
19,009
Projected 2018 Population
373
561
8,955
6,938
1,645
1,457
1,293
1,438
3,645
2,091
868
657
986
1,459
2,179
2,353
343
513
1,206
997
21,493
18,464
Total
Male
Female
641
4,784
1,522
1,886
25,880
5,778
909
12,509
2,807
977
13,371
2,971
1,080
1,680
412
1,772
1,981
364
597
14,833
4,851
9,143
2,769
5,069
8,064
1,421
3,651
68,512
2,405
4,439
1,369
2,423
3,948
711
1,823
33,343
2,446
4,704
1,400
2,646
4,116
710
1,828
35,169
697
5,660
1,739
1,210
1,915
470
1,941
2,269
443
698
17,042
1,888
27,733
6,081
4,852
9,440
2,759
5,095
8,283
1,523
3,839
71,493
909
13,410
2,956
2,407
4,578
1,362
2,434
4,052
759
1,906
34,773
979
14,323
3,125
2,445
4,862
1,397
2,661
4,231
764
1,933
36,720
Source: The Nielsen Company
7
Exhibit 2.1 provides the percent difference for each zip code from estimated 2013 to projected 2018 as
well as the ability to compare the percent difference to the state of Missouri and the United States for
comparison purposes. Exhibit 2.1 illustrates that the overall population is projected to increase by 4.4
percent over the five-year period which is higher than both the projected increase for Missouri at 1.1
percent and the United States at 3.3 percent. Branson and Forsyth zip codes are projecting large increases
overall in comparison to Missouri and the United States, especially for age groups under 18 years as well
as 65 years and over. Note that the age category that utilizes health care services the most, 65 years and
over, is projected to increase overall by 14.9 percent. A major part of this increase is from Ridgedale zip
code, projecting an increase of 21.7%. This increase in the 65 year and over category will have a
dramatic impact on both the amount and type of services required by the community.
Exhibit 2.1
Estimated 2013 Population vs Projected 2018 Population Percent Difference
Zip Code
City
Under
18-44
45-64
65 years
18 years
years
years
and over
Total
Male
Female
0.2%
Percent Difference
65611
65616
65653
65656
65672
65679
65686
65737
65739
65740
Blue Eye
Branson
Forsyth
Galena
Hollister
Kirbyville
Kimberling City
Reeds Spring
Ridgedale
Rockaway Beach
3.2%
0.3%
-10.1%
8.7%
0.1%
0.0%
7.5%
5.1%
1.6%
18.3%
7.2%
7.2%
7.1%
7.4%
5.6%
-5.6%
14.3%
5.2%
5.3%
5.2%
0.0%
-4.1%
0.1%
-6.0%
12.0%
0.0%
0.1%
5.0%
1.2%
-3.1%
14.0%
3.2%
3.1%
3.4%
1.7%
-2.4%
-8.4%
14.1%
-0.4%
-0.5%
-0.2%
-2.1%
1.9%
-9.1%
9.5%
0.5%
0.5%
0.6%
-2.0%
5.6%
-6.1%
14.5%
2.7%
2.6%
2.8%
-2.6%
6.2%
1.8%
21.7%
7.2%
6.8%
7.6%
4.9%
3.5%
0.2%
16.9%
5.1%
4.6%
5.7%
4.2%
3.6%
-2.9%
14.9%
4.4%
4.3%
4.4%
Missouri 2013 Estimated (1,000s)
1,425
2,105
1,608
896
6,034
2,957
3,077
Missouri 2018 Projected (1,000s)
1,434
2,093
1,568
1,008
6,103
2,992
3,111
-0.6%
-2.5%
12.5%
PERCENT DIFFERENCE
0.6%
1.1%
1.2%
1.1%
U.S. 2013 Estimated (1,000s)
74,731
113,156
83,113
43,862
314,862
154,820
160,042
U.S. 2018 Projected (1,000s)
76,231
113,757
84,336
50,998
325,322
160,000
165,322
PERCENT DIFFERENCE
2.0%
0.5%
1.5%
16.3%
3.3%
3.3%
3.3%
8
The following is an analysis of the age distribution of the population for the community. The analysis is
provided by zip code and provides a comparison to Missouri and the United States.
Exhibit 2.2
Estimated 2013 Population vs Projected 2018 Population with Percent Totals
Zip Code
City
Under
18-44
45-64
65 years
18 years
years
years
and over
Total
Male
Female
51.8%
Estimated 2013 Population
65611
Blue Eye
13.2%
19.7%
33.1%
34.0%
100.0%
48.2%
65616
Branson
22.2%
32.9%
26.4%
18.5%
100.0%
48.3%
51.7%
65653
Forsyth
20.0%
27.0%
26.7%
26.3%
100.0%
48.6%
51.4%
65656
Galena
19.6%
26.6%
31.5%
22.3%
100.0%
49.6%
50.4%
65672
Hollister
18.6%
39.4%
23.6%
18.4%
100.0%
48.6%
51.4%
65679
Kirbyville
27.1%
32.1%
25.9%
14.9%
100.0%
49.4%
50.6%
65686
Kimberling City
14.3%
19.1%
31.7%
35.0%
100.0%
47.8%
52.2%
65737
Reeds Spring
18.8%
25.6%
31.1%
24.6%
100.0%
49.0%
51.0%
65739
Ridgedale
16.2%
22.7%
35.5%
25.6%
100.0%
50.0%
50.0%
65740
Rockaway Beach
24.5%
31.9%
27.3%
16.4%
100.0%
49.9%
50.1%
20.3%
30.3%
27.7%
21.7%
100.0%
48.7%
51.3%
TOTAL PROVIDER SERVICE AREA
Projected 2018 Population
65611
Blue Eye
13.6%
19.8%
29.7%
36.9%
100.0%
48.1%
51.9%
65616
Branson
22.3%
32.3%
25.0%
20.4%
100.0%
48.4%
51.6%
65653
Forsyth
20.4%
27.1%
24.0%
28.6%
100.0%
48.6%
51.4%
65656
Galena
18.8%
26.6%
29.6%
24.9%
100.0%
49.6%
50.4%
65672
Hollister
19.0%
38.6%
22.2%
20.3%
100.0%
48.5%
51.5%
65679
Kirbyville
27.7%
31.5%
23.8%
17.0%
100.0%
49.4%
50.6%
65686
Kimberling City
13.9%
19.4%
28.6%
38.1%
100.0%
47.8%
52.2%
65737
Reeds Spring
17.9%
26.3%
28.4%
27.4%
100.0%
48.9%
51.1%
65739
Ridgedale
14.7%
22.5%
33.7%
29.1%
100.0%
49.8%
50.2%
65740
Rockaway Beach
24.4%
31.4%
26.0%
18.2%
100.0%
49.6%
50.4%
TOTAL PROVIDER SERVICE AREA
20.3%
30.1%
25.8%
23.8%
100.0%
48.6%
51.4%
ESTIMATED 2013
20.3%
30.3%
27.7%
21.7%
100.0%
49.0%
51.0%
PROJECTED 2018 POPULATION
20.3%
30.1%
25.8%
23.8%
100.0%
49.0%
51.0%
4.2%
3.6%
-2.9%
14.9%
4.4%
4.3%
4.4%
MISSOURI 2013
23.7%
35.9%
26.4%
13.9%
100.0%
49.2%
50.8%
UNITED STATES 2013
23.4%
35.0%
25.9%
15.7%
100.0%
49.2%
50.8%
PERCENT DIFFERENCE
9
Very similar to the 14.9 percent growth seen in the overall number of people in the 65 year and over
category in Exhibit 2.1, Exhibit 2.2 indicates that as a percent of total population for the community, the
65 year and over category will be 23.8 percent of the total population in 2018 compared to 21.7 percent
in 2013. Kimberling City zip code is showing the highest increase for ages 65 and over with an
increase of 3.1%.
While the relative age of the community population can impact community health needs, so can the
ethnicity and race of a population. The following Exhibit 3 shows the population of the community by
ethnicity by illustrating the Hispanic versus non-Hispanic residents. In total, the projected 2018
population breakdown shows the community has a slightly higher Hispanic population than the state of
Missouri, however, much lower than the United States. A review of the specific zip code areas shows a
relatively higher percentage of Hispanic residents in the Branson zip code than the rest of the community.
Exhibit 3
Estimated 2013 Population vs Projected 2018 Population with Percent Difference
Zip Code
65611
65616
65653
65656
65672
65679
65686
65737
65739
65740
City
Estimated 2013
NonHispanic Hispanic
Total
Projected 2018
Total
% Difference
% Total
Blue Eye
Branson
Forsyth
Galena
Hollister
Kirbyville
Kimberling City
Reeds Spring
Ridgedale
Rockaway Beach
55
1,960
162
82
429
85
71
217
22
133
1,831
23,920
5,616
4,769
8,714
2,684
4,998
7,847
1,399
3,518
1,886
25,880
5,778
4,851
9,143
2,769
5,069
8,064
1,421
3,651
68
2,403
206
92
508
92
76
251
22
161
1,820
25,330
5,875
4,760
8,932
2,563
5,019
8,032
1,501
3,678
1,888
27,733
6,081
4,852
9,440
2,655
5,095
8,283
1,523
3,839
23.6%
22.6%
27.2%
12.2%
18.4%
8.2%
7.0%
15.7%
0.0%
21.1%
-0.6%
5.9%
4.6%
-0.2%
2.5%
-4.5%
0.4%
2.4%
7.3%
4.5%
3.6%
8.7%
3.4%
1.9%
5.4%
3.5%
1.5%
3.0%
1.4%
4.2%
96.4%
91.3%
96.6%
98.1%
94.6%
96.5%
98.5%
97.0%
98.6%
95.8%
3,216
65,296
68,512
3,879
67,510
71,389
20.6%
3.4%
5.4%
94.6%
235
54,578
5,799
260,284
6,034
314,862
268
61,050
5,835
264,272
6,103
325,322
14.0%
11.9%
0.6%
1.5%
4.4%
18.8%
95.6%
81.2%
Missouri (1,000s)
U.S. (1,000s)
10
Exhibit 4 shows the population of the community by race by illustrating three different categories: white, black and other residents. In total, the population
breakdown for the community shows a higher concentration of white residents than the state of Missouri. A review of the specific zip code areas shows a
larger percentage of black residents in the Branson zip code compared to other zip codes in the community.
Exhibit 4
Estimated 2013 Population vs Projected 2018 Population with Percent Difference
Zip Code
65611
65616
65653
65656
65672
65679
65686
65737
65739
65740
City
White
Estimated 2013
Black
Other
Total
White
Projected 2018
Black
Other
Total
White
Percent Difference
Black
Other
Total
Percent Total
White
Black
Other
Blue Eye
Branson
Forsyth
Galena
Hollister
Kirbyville
Kimberling City
Reeds Spring
Ridgedale
Rockaway Beach
1,841
23,544
5,527
4,703
8,568
2,639
4,966
7,746
1,382
3,424
7
383
30
8
73
14
8
23
5
14
38
1,953
221
140
502
116
95
295
34
213
1,886
25,880
5,778
4,851
9,143
2,769
5,069
8,064
1,421
3,651
1,846
24,917
5,781
4,701
8,774
2,622
4,988
7,930
1,483
3,573
9
494
35
9
88
13
9
27
4
19
33
2,322
265
142
578
124
98
326
36
247
1,888
27,733
6,081
4,852
9,440
2,759
5,095
8,283
1,523
3,839
0.3%
5.8%
4.6%
0.0%
2.4%
-0.6%
0.4%
2.4%
7.3%
4.4%
28.6%
29.0%
16.7%
12.5%
20.5%
-7.1%
12.5%
17.4%
-20.0%
35.7%
-13.2%
18.9%
19.9%
1.4%
15.1%
6.9%
3.2%
10.5%
5.9%
16.0%
0.1%
7.2%
5.2%
0.0%
3.2%
-0.4%
0.5%
2.7%
7.2%
5.1%
97.8%
89.8%
95.1%
96.9%
92.9%
95.0%
97.9%
95.7%
97.4%
93.1%
0.5%
1.8%
0.6%
0.2%
0.9%
0.5%
0.2%
0.3%
0.3%
0.5%
1.7%
8.4%
4.4%
2.9%
6.1%
4.5%
1.9%
3.9%
2.4%
6.4%
64,340
565
3,607
68,512
66,615
707
4,171
71,493
3.5%
25.1%
15.6%
4.4%
93.2%
1.0%
5.8%
4,960
225,086
709
40,007
365
49,769
6,034
314,862
4,964
228,213
734
41,797
405
55,312
6,103
325,322
0.1%
1.4%
3.5%
4.5%
11.0%
11.1%
1.1%
3.3%
81.3%
70.1%
12.0%
12.8%
6.6%
17.0%
Missouri (1,000s)
U.S. (1,000s)
11
Socioeconomic Characteristics of the Community
The socioeconomic characteristics of a geographic area influence the way residents access health care
services and perceive the need for health care services within society. The economic status of an area
may be assessed by examining multiple variables within the community. The following exhibits are a
compilation of data that includes household income, labor force, employees by types of industry,
employment rates, educational attainment and poverty for the community. These measures will be used
to compare the socioeconomic status of the community to the state of Missouri and to the U.S.
Income and Employment
Exhibit 5 presents the average and median income for households in each zip code. Average income is
projected to decrease between 10.1% to 6.0% for some zip codes or increase between 1.4% to 1.8% for
other zip codes. The average change in median income is a projected decrease of 4.7%.
Exhibit 5
Estimated Family Income and Wealth for 2013 and 2018 with Percent Difference
Estimated 2013
Zip Code
City
Projected 2018
Percent Difference
Avg.
Median
Avg.
Median
Avg.
Median
Household
Household
Household
Household
Household
Household
Income
Income
Income
Income
Income
Income
65611
Blue Eye
$
56,452
$
41,684
$
58,231
$
42,855
3.2%
2.8%
65616
Branson
$
52,843
$
37,685
$
49,420
$
34,470
-6.5%
-8.5%
65653
Forsyth
$
39,227
$
30,521
$
36,862
$
28,016
-6.0%
-8.2%
65656
Galena
$
48,617
$
40,192
$
49,278
$
40,819
1.4%
1.6%
65672
Hollister
$
44,658
$
31,950
$
40,682
$
29,217
-8.9%
-8.6%
65679
Kirbyville
$
40,961
$
26,423
$
36,819
$
23,590
-10.1%
-10.7%
65686
Kimberling City
$
49,484
$
40,783
$
50,191
$
41,434
1.4%
1.6%
65737
Reeds Spring
$
56,414
$
42,925
$
57,443
$
43,691
1.8%
1.8%
65739
Ridgedale
$
45,029
$
35,545
$
41,364
$
32,000
-8.1%
-10.0%
65740
Rockaway Beach
$
31,800
$
27,026
$
29,816
$
24,545
-6.2%
-9.2%
Missouri
$
60,079
$
44,633
$
61,256
$
45,225
2.0%
1.3%
United States
$
69,637
$
49,297
$
71,917
$
49,815
3.3%
1.1%
Exhibit 6 presents the monthly resident unemployment rates for Taney and Stone counties. Annual averages are
shown for Missouri and the United States. Exhibit 6 illustrates unemployment rates are significantly higher in
the winter months than the summer months due the major industry in the area being leisure and hospitality.
12
Exhibit 6
The Skaggs Community Hospital Association Community
Monthly Unemployment Rates (%)
2012
2011
2011
Nov
Dec
County
Taney County
Stone County
Missouri
United States
8.4
9.9
7.6
8.2
9.8
11.5
7.8
8.3
Jan
Feb
19.2
17.6
7.6
8.8
Mar
20.4
19.3
8.4
8.7
14.9
13.4
7.9
8.4
Apr
10.6
9.6
6.8
7.7
May
June
9.6
8.7
7.0
7.9
July
7.8
8.1
7.0
8.4
7.8
8.9
7.6
8.6
Aug
Sept
7.3
8.3
7.1
8.2
Oct
6.9
7.3
6.3
7.6
7.4
8.2
6.6
7.5
Source: Missouri Economic Research and Information Center
Taney and Stone counties are supported by several major industries including leisure and hospitality, trade,
transportation and utilities, and education and health services. The leisure and hospitality industry accounts for
more than 40% of all employment in Taney County and approximately 37% of all employment in both
counties. Exhibit 7 summarizes employment by major industry for the two counties.
Exhibit 7
Employment by Major Industry
2010
Taney
Major Industries
Goods-producing
Natural resources and mining
Construction
Manufacturing
Service-providing
Trade, transportation and utilities
Information
Financial activities
Professional and business services
Education and health services
Leisure and hospitality
Other services
Federal Government
State Government
Local Government
Total employment
County
Stone
%
County
US
%
Total
%
%
1,301
59
659
583
24,116
5,766
361
1,348
2,267
2,456
11,157
761
164
161
2,012
4.7%
0.2%
2.4%
2.1%
86.9%
20.8%
1.3%
4.9%
8.2%
8.8%
40.2%
2.7%
0.6%
0.6%
7.2%
613
464
3,165
926
56
405
230
488
821
239
54
56
1,094
12.7%
0.0%
9.6%
0.0%
65.5%
19.2%
1.2%
8.4%
4.8%
10.1%
17.0%
4.9%
1.1%
1.2%
22.6%
1,914
59
1,123
583
27,281
6,692
417
1,753
2,497
2,944
11,978
1,000
218
217
3,106
5.9%
0.2%
3.4%
1.8%
83.7%
20.5%
1.3%
5.4%
7.7%
9.0%
36.8%
3.1%
0.7%
0.7%
9.5%
14.7%
1.4%
4.3%
9.0%
68.4%
19.1%
2.1%
5.8%
13.1%
14.6%
10.2%
3.4%
2.3%
3.6%
11.0%
27,754
100.0%
4,833
100.0%
32,587
100.0%
100.0%
Source: U.S. Department of Census
13
Major employers by county (more than 50 employees) include the following:
Exhibit 8
Employment by Top Employers
County
Year
Top Employers
Est.
Taney
Conservation Department District OFC
Kanakuk Kamps Inc.
Silver Dollar City
Kids Across America Kamps
Top of the Rock Golf Course
Skaggs Community Health Center
Devil's Pool Restaurant
Windham Vacation Ownership
Big Cedar Lodge
Kimberling Inn Resort & Conference
Reeds Spring Intermediate School
Wal-Mart Supercenter
Blue Eye High School
Tablerock Healthcare Center
Crane School Superintendent
Cox Medical Center
Crane High School
N/A
1926
1960
1991
1996
1950
1987
2005
1987
1981
N/A
N/A
N/A
1990
N/A
1906
N/A
X
X
X
X
X
X
X
X
X
Stone
X
X
X
X
X
X
X
X
Ozark Mountain Regional Health
1997
X
Summerfresh Market
1998
X
Source: http://www.missourieconomy.org/regional/location_one.html
Poverty
Exhibit 9 presents the percentage of total population in poverty (including under age 18) and median
household income for households in each county versus the state of Missouri and the United States.
Exhibit 9
Poverty Estimate: Percentage of Total Population in Poverty and Median Household Income
2008-2010 and 2009-2011 3-year Estimates
2010
County
Taney County
Stone County
Missouri
United States
All
Under
Persons
Age 18
16.5%
18.1%
14.5%
14.4%
26.2%
36.7%
20.2%
20.1%
Median
2011
Household
All
Under
Income
Persons
Age 18
19.1%
18.7%
15.2%
15.2%
30.7%
32.1%
21.3%
21.4%
$
$
$
$
39,405
41,546
45,829
51,222
Median
Household
Income
$
$
$
$
38,061
39,424
46,123
51,484
Source: U.S. Census Bureau, 2008-2010 & 2009-2011 American Community Surveys 3-year Estimates
14
Low-income residents often postpone seeking medical attention until health problems become aggravated,
creating a greater demand on a given community’s medical resources. This includes reliance upon
emergency room services for otherwise routine primary care. Often uninsured, the low-income
demographics’ inability to pay for services further strains the medical network. Low-income residents are
also less mobile, requiring medical services in localized population centers, placing additional pressure on
those providers already in high demand. Understanding the extent of poverty within the population,
therefore, helps determine an accurate picture of demand. The poverty rates for Taney and Stone counties
ranked unfavorably when compared to Missouri’s and national averages in 2010 and 2011. Stone
County’s rate did improve in 2011 for ages under 18, but still remained at a high rate in overall
comparisons.
Uninsured
Exhibit 10 presents health insurance coverage status by age (under 65 years) and income (at or below 400
percent) of poverty for each county versus the state of Missouri and the United States. It is clear that the
proportion of uninsured population increases when focusing on income levels at or below 400% of federal
poverty level versus all income levels. Taney and Stone counties show differences of 2.9% and 4.2%,
respectively.
Exhibit 10
Health Insurance Coverage Status by Age (under 65 years) and Income (at or below 400%) of Poverty
2009-2011 3-year Estimates
All Income Levels
County
Taney County
Stone County
Missouri
United States
At or Below 400% of FPL
Under 65
Percent
Under 65
Percent
Under 65
Percent
Under 65
Percent
Uninsured
Uninsured
Insured
Insured
Uninsured
Uninsured
Insured
Insured
12,105
6,077
771,174
45,640,406
29.4%
25.3%
15.4%
17.5%
29,060
17,909
4,223,302
215,786,240
70.6%
74.7%
84.6%
82.5%
10,644
5,486
697,310
40,138,822
32.3%
29.5%
20.6%
23.9%
22,284
13,118
2,688,522
127,905,808
67.7%
70.5%
79.4%
76.1%
Source: U.S. Census Bureau, 2009-2011 American Community Survey 3-year estimates
15
Education
Exhibit 11 presents educational attainment by age cohort for individuals in each county versus the State of
Missouri and the United States.
Exhibit 11
Educational Attainment by Age - Total Population
2009-2011 3-year Estimates
Age Cohort
State/ County
18-24
25-34
35-44
45-64
65+
Completing High School
Taney County
Stone County
Missouri
United States
83.6%
72.6%
83.9%
83.6%
89.1%
77.5%
89.5%
87.3%
86.9%
81.0%
89.7%
87.3%
84.9%
87.3%
89.5%
87.7%
78.2%
80.7%
78.1%
77.8%
Bachelor's Degree or More
Taney County
Stone County
Missouri
United States
3.1%
10.2%
9.2%
9.2%
19.0%
9.8%
30.8%
31.2%
18.7%
9.9%
29.5%
31.4%
17.8%
16.8%
25.7%
28.6%
18.3%
16.0%
17.2%
21.3%
Graduate or Professional Degree (Population 25 and over)
Taney County
5.0%
Stone County
5.0%
Missouri
9.6%
United States
10.5%
Source: U.S. Census Bureau, 2009-2011 American Community Survey 3-year estimates
Education levels obtained by community residents may impact the local economy. Higher levels of education
generally lead to higher wages, less unemployment and job stability. These factors may indirectly influence
community health. Both Taney and Stone counties compare unfavorably to Missouri and the United States for
persons aged 25 and older in obtaining a bachelor’s degree or higher. Persons obtaining a graduate or
professional degree are about 50 percent of the state and national average.
Health Status of the Community
This section of the assessment reviews the health status of Taney and Stone County residents, with
comparisons to the state of Missouri. This in-depth assessment of the mortality and morbidity data,
health outcomes, health factors and mental health indicators of the county residents that make up the
community will enable the Hospital to identify priority health issues related to the health status of its
residents.
16
Good health can be defined as a state of physical, mental, and social well-being, rather than the absence
of disease or infirmity. According to Healthy People 2010, the national health objectives released by the
U.S. Department of Health and Human Services, individual health is closely linked to community health.
Community health, which includes both the physical and social environment in which individuals live,
work and play, is profoundly affected by the collective behaviors, attitudes and beliefs of everyone who
lives in the community. Healthy people are among a community’s most essential resources.
Numerous factors have a significant impact on an individual’s health status: lifestyle and behavior,
human biology, environmental and socioeconomic conditions, as well as access to adequate and
appropriate health care and medical services. Studies by the American Society of Internal Medicine
conclude that up to 70 percent of an individual’s health status is directly attributable to personal lifestyle
decisions and attitudes. Persons who do not smoke, who drink in moderation (if at all), use automobile
seat belts (car seats for infants and small children), maintain a nutritious low-fat, high-fiber diet, reduce
excess stress in daily living and exercise regularly have a significantly greater potential of avoiding
debilitating diseases, infirmities and premature death.
The interrelationship among lifestyle/behavior, personal health attitude and poor health status is gaining
recognition and acceptance by both the general public and health care providers. Some examples of
lifestyle/behavior and related health care problems include the following:
Lifestyle
Primary Disease Factor
Smoking
Lung cancer
Cardiovascular disease
Emphysema
Chronic bronchitis
Alcohol/drug abuse
Cirrhosis of liver
Motor vehicle crashes
Unintentional injuries
Malnutrition
Suicide
Homicide
Mental illness
Poor nutrition
Obesity
Digestive disease
Depression
Driving at excessive speeds
Trauma
Motor vehicle crashes
Lack of exercise
Depression
Overstressed
Mental illness
Alcohol/drug abuse
17
Health problems should be examined in terms of morbidity as well as mortality. Morbidity is defined as
the incidence of illness or injury and mortality is defined as the incidence of death. However, law does
not require reporting the incidence of a particular disease, except when the public health is potentially
endangered. More than 50 infectious diseases in Missouri must be reported to county health departments.
Except for Acquired Immune Deficiency Syndrome (AIDS), most of these reportable diseases currently
result in comparatively few deaths.
Due to limited morbidity data, this health status report relies heavily on death and death rate statistics for
leading causes in death in Taney and Stone counties and the state of Missouri. Such information provides
useful indicators of health status trends and permits an assessment of the impact of changes in health
services on a resident population during an established period of time. Community attention and health
care resources may then be directed to those areas of greatest impact and concern.
Leading Causes of Death
Exhibit 12 reflects the leading causes of death for Taney and Stone County residents and compares the
rates, per hundred thousand, to the state of Missouri average rates, per hundred thousand.
Exhibit 12
Selected Causes of Resident Deaths: Number and Rate (2009 10 year trend) Rates per 100,000
Taney
Number
Rate
Stone
Number
Rate
Missouri
Number
Rate
Total Deaths, All Causes
4,740
841.1
3,428
788.4
602,631
871.5
Heart Disease
All Cancers (Malignant Neoplasms)
Smoking-Attributable
All Injuries and Poisonings
Stroke/Other Cerebrovascular Disease
Chronic Lower Respiratory Disease
Total Unintentional Injuries
Diabetes Mellitus
Pneumonia and Influenza
Alzheimer's Disease
1,346
1,176
936
353
261
263
253
79
148
108
237.9
199.2
159.4
72.8
45.5
44.5
52.1
14.2
26.3
19.6
965
893
676
232
187
192
171
74
54
103
216.9
184.8
141.8
73.5
43.8
41.2
54.6
16.2
12.8
25.9
172,202
135,732
105,354
43,403
38,628
33,585
29,386
16,393
16,373
15,722
245.6
197.7
152.2
67.0
54.9
48.7
45.0
23.8
23.1
21.9
Source: Missouri Department of Health & Senior Services
18
Exhibit 13 compares the number of deaths for Taney County residents, with U.S. Crude Rates and
identifies causes of death that statistically differ from U.S. rates.
Exhibit 13
Comparison of Rates for Selected Causes of Death: Rate per 100,000 Residents: Taney County
2009 10-year Trend
Number
of Deaths
Selected Cause of Death
County
Rate
Percent
County
Difference
from US
2009
US
Rate
MO
Rate
4,740
841.1
871.5
794.5
5.9%
Heart Disease
Diabetes Mellitus
Alzheimer's Disease
1,346
1,176
936
353
261
263
253
79
148
108
237.9
199.2
159.4
72.8
45.5
44.5
52.1
14.2
26.3
19.6
245.6
197.7
152.2
67.0
54.9
48.7
45.0
23.8
23.1
21.9
195.4
185.0
N/A
N/A
42.0
44.8
38.5
22.4
17.5
25.8
21.8%
7.7%
N/A
N/A
8.3%
-0.7%
35.3%
-36.6%
50.3%
-24.0%
Exhibit 13.1 compares the number of deaths for Stone County residents, with U.S. Crude Rates and
identifies causes of death that statistically differ from U.S. rates.
Exhibit 13.1
Skaggs Community Hospital Association Community
Comparison of Rates for Selected Causes of Death: Rate per 100,000 Residents: Stone County
2009 10-year Trend
Selected Cause of Death
Number
of Deaths
Heart Disease
Diabetes Mellitus
Alzheimer's Disease
County
Rate
MO
Rate
2009
US
Rate
Percent
County
Difference
from US
3,428
788.4
871.5
794.5
-0.8%
965
893
676
232
187
192
171
74
54
103
216.9
184.8
141.8
73.5
43.8
41.2
54.6
16.2
12.8
25.9
245.6
197.7
152.2
67.0
54.9
48.7
45.0
23.8
23.1
21.9
195.4
185.0
N/A
N/A
42.0
44.8
38.5
22.4
17.5
25.8
11.0%
-0.1%
N/A
N/A
4.3%
-8.0%
41.8%
-27.7%
-26.9%
0.4%
19
Health Outcomes and Factors
An analysis of various health outcomes and factors for a particular community can, if improved, help
make that community a healthier place to live, learn, work and play. A better understanding of the factors
that affect the health of the community will assist with how to improve the community’s habits, culture
and environment. This portion of the community health needs assessment utilizes information from
County Health Rankings, a key component of the Mobilizing Action Toward Community Health
(MATCH) project, a collaboration between the Robert Wood Johnson Foundation and the University of
Wisconsin Population Health Institute.
The County Health Rankings model is grounded in the belief that programs and policies implemented at
the local, state and federal levels have an impact on the variety of factors that, in turn, determine the
health outcomes for communities across the nation. The model provides a ranking method that ranks all
50 states and the counties within each state, based on the measurement of two types of health outcomes
for each county: how long people live (mortality) and how healthy people feel (morbidity). These
outcomes are the result of a collection of health factors and are influenced by programs and policies at the
local, state and federal levels.
20
Counties in each of the 50 states are ranked according to summaries of a variety of health measures.
Those having high ranks, e.g. 1 or 2, are considered to be the “healthiest.” Counties are ranked relative to
the health of other counties in the same state on the following summary measures:
•
Health Outcomes - rankings are based on an equal weighting of one length of life (mortality)
measure and four quality of life (morbidity) measures.
•
Health Factors - rankings are based on weighted scores of four types of factors:
o
Health behaviors (six measures)
o
Clinical care (five measures)
o
Social and economic (seven measures)
o
Physical environment (four measures)
A more detailed discussion about the ranking system, data sources and measures, data quality and
calculating scores and ranks can be found at the website for County Health Rankings
(www.countyhealthrankings.org).
As part of the analysis of the needs assessment for the community, the two counties that comprise the
majority of the community will be used to compare the relative health status of each county to the state of
Missouri as well as to a national benchmark. A better understanding of the factors that affect the health of
the community will assist with how to improve the community’s habits, culture and environment.
The following tables, from County Health Rankings, summarize the 2012 health outcomes for the two
counties that comprise the majority of the community for Skaggs Regional Medical Center. Each
measure is described and includes a confidence interval or error margin surrounding it – if a measure is
above the state average and the state average is beyond the error margin for the county, then further
investigation is recommended.
Health Outcomes - rankings are based on an equal weighting of one length of life (mortality) measure and
four quality of life (morbidity) measures. Exhibit 14 shows Taney County health outcomes were
significantly higher than national benchmarks. Mortality outcomes were comparable to the state, ranking
49th, but unfavorable for morbidity, ranking 82nd. Exhibit 15 shows Stone County health outcomes were
comparable to the state of Missouri (ranking 39 on mortality and 59 on morbidity out of 115 counties).
Each measure for all counties was at or above national benchmarks showing many opportunities for
improvement.
21
Taney County
Exhibit 14
Taney County Health Rankings - Health Outcomes (2012)
Taney
Error
National
County
Margin
Benchmark
Mortality
Premature death - Years of potential life lost before age
75 per 100,000 population (age-adjusted)
Morbidity
Poor or fair health - Percent of adults reporting fair or
poor health (age-adjusted)
Poor physical health days - Average number of
physically unhealthy days reported in past 30 days (ageadjusted)
Poor mental health days - Average number of mentally
unhealthy days reported in past 30 days
(age-adjusted)
Low birth weight - Percent of live births with low birth
weight (<2500 grams)
Rank
(of 115)
MO
49
8,305
7,388-9,223
5,466
7,981
82
16.0%
12.0-22.0%
10.0%
16.0%
4.0
2.8-5.2
2.6
3.6
5.7
4.0-7.5
2.3
3.7
7.5%
6.7-8.3%
6.0%
8.1%
Source: Countyhealthrankings.org
A number of different health factors shape a community’s health outcomes. The County Health Rankings
model includes four types of health factors: health behaviors, clinical care, social and economic and the
physical environment.
Exhibit 14.1 summarizes the health factors for Taney County. Areas for improvement include:

Health Behavior/Adult Smoking

Health Behavior/Adult Obesity

Health Behavior/Motor Vehicle Crash Death Rate

Health Behavior/Teen Birth Rate

Clinical Care/Uninsured Adults

Clinical Care/Primary Care Physicians

Social & Economic Factors/Children in Poverty

Social & Economic Factors/Violent Crime Rate
22
Exhibit 14.1
Taney County Health Rankings - Health Factors (2012)
Taney
Error
National
County
Margin
Benchmark
Health Behaviors
Adult smoking - Percent of adults that report smoking at least 100
cigarettes and that they currently smoke
Adult obesity - Percent of adults that report a BMI >= 30
Excessive drinking - Percent of adults that report excessive
drinking in the past 30 days
Motor vehicle crash death rate - Motor vehicle deaths per 100K
population
Sexually transmitted infections - Chlamydia rate per 100K
population
Teen birth rate - Per 1,000 female population, ages 15-19
Clinical Care
Uninsured adults - Percent of population under age 65 without
health insurance
Primary care physicians - Ratio of population to primary care
physicians
Preventable hospital stays - Hospitalization rate for ambulatorycare sensitive conditions per 1,000 Medicare enrollees
Diabetic screening - Percent of diabetic Medicare enrollees that
receive HbA1c screening
Mammography screening - Percent of female Medicare enrollees
that receive mammography screening
Social & Economic Factors
High school graduation - Percent of ninth grade cohort that
graduates in 4 years
Some college - Percent of adults aged 25-44 years with some postsecondary education
Children in poverty - Percent of children under age 18 in
poverty
Inadequate social support - Percent of adults without
social/emotional support
Rank
(of 115)
MO
80
26.0%
32.0%
20.0-35.0%
26.0-39.0%
14.0%
25.0%
24.0%
31.0%
13.0%
24.0-38.0%
8.0%
17.0%
26.0
20.0-31.0
12.0
19.0
238.0
58.0
53.0-63.0
84.0
22.0
438.0
44.0
43
22.0%
20.0-24.0%
1,433:1
11.0%
15.0%
631:1
1,274:1
52.0
47.0-57.0
49.0
75.0
83.0%
77.0-89.0%
89.0%
84.0%
59.0%
53.0-64.0%
74.0%
65.0%
99
91.0%
86.0%
57.0%
51.0-62.0%
68.0%
61.0%
31.0%
24.0-38.0%
13.0%
21.0%
20.0%
14.0-29.0%
14.0%
19.0%
Children in single-parent households - Percent of children that
live in household headed by single parent
30.0%
24.0-37.0%
20.0%
32.0%
Violent Crime rate - Violent crimes per 100,000 population (ageadjusted)
628.0
73.0
518.0
Physical Environment
Air pollution-particulate matter days - Annual number of
unhealthy air quality days due to fine particulate matter
Air pollution-ozone days - Annual number of unhealthy air quality
days due to ozone
Access to healthy foods - Healthy food outlets include grocery
stores and produce stands/farmers' markets
Limited access to recreational facilities - Rate of recreational
facilities per 100,000 population
Fast food restaurants - Percent of all restaurants that are fastfood establishments
19
0.0
0.0
0.0
0.0
0.0
7.0
1.0%
0.0%
8.0%
12.0
16.0
10.0
38.0%
25.0%
47.0%
23
Stone County
Exhibit 15
County Health Rankings - Health Outcomes (2012)
Stone
Error
National
County
Margin
Benchmark
Mortality
Premature death - Years of potential life lost before age
75 per 100,000 population (age-adjusted)
MO
39
8,061
6,881-9,241
5,466
7,981
Morbidity
Poor or fair health - Percent of adults reporting fair or
poor health (age-adjusted)
Poor physical health days - Average number of
physically unhealthy days reported in past 30 days (ageadjusted)
Poor mental health days - Average number of mentally
unhealthy days reported in past 30 days
(age-adjusted)
Low birth weight - Percent of live births with low birth
weight (<2500 grams)
Rank
(of 115)
59
10.0%
16.0%
4.3
2.3-6.3
2.6
3.6
3.9
2.1-5.6
2.3
3.7
7.3%
6.2-8.5%
6.0%
8.1%
A number of different health factors shape a community’s health outcomes. The County Health Rankings
model includes four types of health factors: health behaviors, clinical care, social and economic and the
physical environment.
Exhibit 15.1 summarizes the health factors for Stone County. Areas for improvement include:

Health Behavior/Adult Smoking

Health Behavior/Adult Obesity

Health Behavior/Motor Vehicle Crash Death Rate

Health Behavior/Teen Birth Rate

Clinical Care/Uninsured Adults

Clinical Care/Primary Care Physicians

Social & Economic Factors/Children in Poverty

Social & Economic Factors/Violent Crime Rate
24
Exhibit 15.1
Stone County Health Rankings - Health Factors (2012)
Stone
Error
County
Margin
Health Behaviors
Adult smoking - Percent of adults that report smoking at least 100
cigarettes and that they currently smoke
Adult obesity - Percent of adults that report a BMI >= 30
Excessive drinking - Percent of adults that report excessive drinking
in the past 30 days
Motor vehicle crash death rate - Motor vehicle deaths per 100K
population
Sexually transmitted infections - Chlamydia rate per 100K
population
Teen birth rate - Per 1,000 female population, ages 15-19
Clinical Care
Uninsured adults - Percent of population under age 65 without health
insurance
Primary care physicians - Ratio of population to primary care
physicians
Preventable hospital stays - Hospitalization rate for ambulatory-care
sensitive conditions per 1,000 Medicare enrollees
Diabetic screening - Percent of diabetic Medicare enrollees that
receive HbA1c screening
Mammography screening - Percent of female Medicare enrollees that
receive mammography screening
Social & Economic Factors
High school graduation - Percent of ninth grade cohort that graduates
in 4 years
Some college - Percent of adults aged 25-44 years with some postsecondary education
Children in poverty - Percent of children under age 18 in
poverty
Inadequate social support - Percent of adults without social/emotional
support
Children in single-parent households - Percent of children that live in
household headed by single parent
Violent Crime rate - Violent crimes per 100,000 population (ageadjusted)
Physical Environment
Air pollution-particulate matter days - Annual number of unhealthy
air quality days due to fine particulate matter
Air pollution-ozone days - Annual number of unhealthy air quality
days due to ozone
Limited access to healthy foods - Healthy food outlets include
grocery stores and produce stands/farmers' markets
Access to recreational facilities - Rate of recreational facilities per
100,000 population
Fast food restaurants - Percent of all restaurants that are fast-food
establishments
National
Benchmark
Rank
(of 115)
MO
24
22.0%
30.0%
15.0-32.0%
24.0-37.0%
14.0%
25.0%
24.0%
31.0%
11.0%
6.0-19.0%
8.0%
17.0%
34.0
27.0-42.0
12.0
19.0
111.0
54.0
48.0-60.0
84.0
22.0
438.0
44.0
33
19.0%
17.0-21.0%
3,499:1
11.0%
15.0%
631:1
1,1274:1
49.0
42.0-55.0
49.0
75.0
84.0%
77.0-91.0%
89.0%
84.0%
67.0%
60.0-74.0%
74.0%
65.0%
103
91.0%
86.0%
38.0%
32.0-44.0%
68.0%
61.0%
31.0%
22.0-39.0%
13.0%
21.0%
17.0%
11.0-26.0%
14.0%
19.0%
33.0%
25.0-41.0%
20.0%
32.0%
73.0
518.0
415.0
18
0.0
0.0
0.0
0.0
0.0
7.0
0.0%
0.0%
8.0%
6.0
16.0
10.0
25.0%
47.0%
27.0%
25
Taney County Health Synopsis: Taney County has low rates of excessive drinking, sexually transmitted
infections and preventable hospital stays in comparison to the state. The county is challenged by higherthan desirable rates of smoking, motor vehicle crash death rates, teen birth rates, uninsured residents,
children in poverty and violent crimes in comparison to the state. Overall morbidity factors are higher
when compared to national benchmarks. Excessive drinking, obesity, and sexually transmitted infections
while lower or comparable to the state, are still significantly higher than the national rates. The ratio of
population to primary care is higher than both the state and national benchmarks. Overall physical
environment for the county ranks highest for the categories of health factors (19 out of 115 counties) with
social and economic factors and health behaviors ranking among the lowest (99 and 80, respectively, out
of 115 counties).
Stone County Health Synopsis: Stone County has low rates of excessive drinking, sexually transmitted
infections and preventable hospital stays in comparison to the state. The county is challenged by higherthan desirable motor vehicle crash death rates, teen birth rates, uninsured residents and children in
poverty. Overall morbidity factors are higher when compared to national benchmarks. Smoking, obesity,
excessive drinking and violent crime rates, while lower or comparable to the state are still significantly
higher than the national rates. The ratio of population to primary care is higher than both the state and
national benchmarks. Overall physical environment and health behaviors for the county ranks highest for
the categories of health factors (18 and 24, respectively, out of 115 counties) with social and economic
factors ranking among the lowest (103 of 115 counties).
Health Care Resources
The availability of health resources is a critical component to the health of a community and a measure of
the soundness of the area’s health care delivery system. An adequate number of health care facilities and
health care providers are vital for sustaining a community’s health status. Fewer health care facilities and
health care providers can impact the timely delivery of services. A limited supply of health resources,
especially providers, results in the limited capacity of the health care delivery system to absorb charity
and indigent care as there are fewer providers upon which to distribute the burden of indigent care. This
section will address the availability of health care resources to the residents of Taney and Stone counties.
Hospitals and Health Centers
The Hospital has 152 acute beds and is the only hospital located in Taney county. Residents of the
community also take advantage of services provided by hospitals in neighboring counties. Exhibit 16
summarizes hospital services located in Missouri available to the residents of Taney and Stone Counties:
Exhibit 16
Summary of Acute Care Hospitals
Miles
Annual
Annual
Facility
from
Bed
Annual
Patient
Type
Skaggs
Size
Discharges
Revenue
Cahill Road, Branson, MO 65616
Acute Care
0
152
6,406
$
394,568,600
Mercy Hospital Springfield
1235 East Cherokee Street, Springfield, MO 65804
Acute Care
39
716
34,336
$
2,066,794,926
CoxHealth
1423 N. Jefferson, Springfield, MO 65802
Acute Care
44
602
29,873
$
2,015,407,055
Source: Costreportdata.com
26
The following is a brief description of the health care services available at each of these facilities:
Mercy Hospital Springfield (formerly St. John’s Hospital) – Mercy Hospital - Springfield is located in
Springfield, Missouri, approximately forty-five minutes north of Branson. Mercy Hospital - Springfield
provides a full range of acute care, psychiatric inpatient, outpatient and ancillary services. Mercy
Hospital - Springfield has a Level I Emergency Trauma Center and Burn Unit.
CoxHealth – CoxHealth is located in Springfield, Missouri, approximately forty-five minutes north of
Branson. CoxHealth provides a full range of acute care, psychiatric inpatient, outpatient and ancillary
services. CoxHealth has a Level I Emergency Trauma Center. Skaggs Regional Medical Center and
CoxHealth have formed a strategic partnership.
Hospital Market Share
The market share of a hospital relative to that of its competitors may be based largely on the services
required by patients and the availability of those services at each facility. For this study, the market share
of the Hospital was considered based on the type of services required by those patients in the community.
The ability to attain a certain relative market share (percentage) of the community varies based on a
number of factors, including the services provided, geographical location and accessibility of each
competing facility. Exhibits 17 and 17.1 present the relative market share of each hospital that had
discharges of residents from the community (Taney and Stone Counties). These tables present an analysis
of data for the three most currently available years, showing the percentage of total discharges from each
hospital. This information provides an excellent idea of summary market share as well as the
outmigration of patients from the community. For Taney County residents in 2010, the Hospital
maintained approximately 64 percent of all discharges with CoxHealth capturing about 14 percent and
Mercy Hospital-Springfield capturing about 12 percent. For Stone County in 2010, the Hospital
maintained approximately 37 percent of all discharges with CoxHealth capturing about 25 percent and
Mercy Hospital-Springfield capturing about 24 percent.
Exhibit 17
Patient Origin Analysis: Taney County Acute Care Discharges by Hospital (2008 through 2010)
2008
2009
Total
2010
Total
Discharges
%
Total
Discharges
%
Discharges
%
4,573
65.0%
4,324
62.9%
4,723
64.0%
CoxHealth
1,031
14.5%
1,008
14.7%
1,031
14.0%
784
11.1%
880
12.8%
897
12.2%
All other
652
9.4%
659
9.6%
727
9.8%
7,040
100.0%
6,871
100.0%
7,378
100.0%
Total
Source: Missouri Hospital Association; Hospital Industry Data Institute (HIDI)
27
Exhibit 17.1
Skaggs Community Hospital Association Community
Patient Origin Analysis: Stone County Acute Care Discharges by Hospital (2008 through 2010)
2008
2009
Total
Discharges
2010
Total
%
Total
Discharges
%
Discharges
%
1,476
37.7%
1,390
37.1%
1,440
CoxHealth
985
25.2%
923
24.6%
967
25.0%
904
23.1%
951
25.4%
934
24.1%
All other
548
14.0%
484
12.9%
533
13.7%
3,913
100.0%
3,748
100.0%
3,874
100.0%
Total
37.2%
Source: Missouri Hospital Association; Hospital Industry Data Institute (HIDI)
Other Health Care Facilities and Providers
Skaggs Clinics - With several locations in Branson and surrounding area, these clinics provide various
primary and specialty care services.
Cox Health Center Branson - Located in Branson, Missouri, this clinic is staffed by three family
medicine physicians and provides various primary care services.
Mercy Clinics and Urgent Care - With several locations in Branson and surrounding area, these clinics
provide various primary care and urgent care.
Branson Walk-In Clinic - Located in Branson, Missouri, this family medicine clinic is staffed by one
physician. It provides various primary care services.
Branson Clinic - Located in Branson, Missouri, this clinic is staffed by one physician and provides
various family medicine and women’s health care services.
VA Branson Clinic - Located in Branson, Missouri, this outpatient clinic provides primary care and
behavioral health services for veterans.
Taney County Health Department - Located in Branson and Forsyth, the purpose of the Health
Department is to protect the health of the public by preventing the occurrence and spread of disease and to
promote healthy practices and lifestyles. The department also provides a WIC (Women, Infants and
Children) Support Program for families who meet certain nutritional and financial guidelines. Other
services include family planning, adult health, child health, immunizations, and screenings for blood
pressure, hepatitis, sexually transmitted diseases, HIV and tuberculosis.
Stone County Health Department - Located in Galena and Branson West, the purpose of the Health
Department is to prevent, promote and protect the public’s health. The department provides a WIC
(Women, Infants and Children) Support Program for families who meet certain nutritional and financial
guidelines. Other services include family planning, health education, immunizations, and screenings for
blood pressure, hepatitis, sexually transmitted diseases, HIV and tuberculosis.
Jordan Valley Community Health Center - Located in Springfield, Missouri, this federally qualified
health center provides medical, dental, vision, behavioral health and pharmacy services. It also provides a
WIC (Women, Infants, and Children) Support Program for families who meet certain nutritional and
financial guidelines.
28
Access Family Care - Cassville - Located in Cassville, Missouri, this federally qualified health center
provides medical, dental and pharmacy services.
Estimated Demand for Physician Office Visits and Hospital Services
In order to define existing services and develop future plans that may affect the operations of the Hospital,
this study includes an analysis of estimated demand for physician office visits, hospital emergency room
visits and hospital discharges using national averages and population estimates. Current and future unmet
need can be evaluated based on the changes in the size of the market for certain services as determined by
applying these national average use rates to the population of the community. Exhibit 18 summarizes
estimated 2013 and projected 2018 physician office visits, emergency department visits and hospital
discharges using 2009 national average use rates from the National Center for Health Statistics.
Age
Exhibit 18
Physician Office Visits, Emergency Department Visits, and Discharges
Estimated 2013
Estimated
Emergency
Hospital
2013
Physician
Estimated
Department
Emergency
Office Visits
Physician
Visits
Department
Discharges
Community
Population
per Person
Office Visits
per Person
Visits
per Person
0-17
18-44
45-64
65+
13,916
20,754
19,009
14,833
Total
68,512
Primary Care Visits
Specialty Care Visits
Total
2.47
2.34
4.01
7.37
55.9%
44.1%
Physician
Office Visits
per Person
0-17
18-44
45-64
65+
14,494
21,493
18,464
17,042
2.47
2.34
4.01
7.37
Total
71,493
Primary Care Visits
Specialty Care Visits
Total
0.45
0.49
0.39
0.52
268,482
2018
Community
Population
Age
34,373
48,564
76,226
109,319
0.0342
0.0886
0.1210
0.3549
476
1,838
2,299
5,264
31,558
9,877
150,082
118,401
268,482
Projected 2018
Emergency
Projected
Department
Physician
Visits
Office Visits
per Person
35,800
50,294
74,041
125,600
285,734
55.9%
44.1%
6,262
10,169
7,414
7,713
Estimated
Hospital
Discharges
0.45
0.49
0.39
0.52
Projected
Emergency
Department
Visits
6,522
10,532
7,201
8,862
Hospital
Discharges
per Person
Projected
Hospital
Discharges
0.0342
0.0886
0.1210
0.3549
495
1,904
2,233
6,048
33,117
10,680
159,725
126,009
285,734
Source: www.cdc.gov, community populations from The Nielsen Company
29
Examination of the population demographics suggests that the aging of the “baby boom” population will
actually slightly increase the overall utilization of hospital and primary care services within the
community. For example, the projected change in the age category 65+ shows a significant increase.
While the age category 65+ is projected to increase 14.9 percent from 2013 to 2018, the overall
population of the community is projected to increase by only 4.4 percent.
Exhibit 19 illustrates the percentage change in the calculated utilization from Exhibit 18 as an estimated
percentage increase in utilization from 2013 to 2018.
Exhibit 19
Estimated Difference in Utilization: Physician Office Visits,
Emergency Room Visits and Hospital Discharges
Estimated 2013 and Projected 2018
Estimated
Projected
2013
2018
Primary Care Physician Office Visits
Specialty Care Physician Office Visits
Total Estimated Physician Office Visits
Emergency Department Visits
Hospital Discharges
150,082
118,401
268,482
31,558
9,877
159,725
126,009
285,734
33,117
10,680
Percent
Difference
6.4%
6.4%
6.4%
4.9%
8.1%
Exhibits 20 and 21 provide detailed analysis of estimated acute care discharges, ambulatory procedures,
hospital outpatient department visits and physician office visits. These exhibits categorize the utilization
for estimated 2013 and projected 2018 by different age categories to assess possible growth areas. A
review of each of the charts indicates that there is potential market growth in all of the acute care areas.
The categories with highest percentage increase are operations on the miscellaneous diagnostic and
Therapeutic procedures, respiratory system and cardiovascular system.
30
Exhibit 20
Estimated and Projected Number of Ambulatory Surgery Procedures by Procedure Category and Age: Provider Service Area
Estimated 2013
Projected 2018
Under
15-44
45-64
65 years
Under
15-44
45-64
65 years
Procedure Category
Total
15 years
years
years
and over
Total
15 years
years
years
and over
Total Provider Service Area Population
All procedures
Operations on the nervous system
Operations on the endocrine system
Operations on the eye
Operations on the ear
Operations on the nose, mouth, and pharynx
Operations on the respiratory system
Operations on the cardiovascular system
Operations on the hemic and lymphatic system
Operations on the digestive system
Operations on the urinary system
Operations on the male genital organs
Operations on the female genital organs
Obstetrical procedures
Operations on the musculoskeletal system
Operations on the integumentary system
Miscellaneous diagnostic and therapeutic procedures
68,512
11,434
23,236
19,009
14,833
71,493
12,032
23,955
18,464
17,042
12,434
315
31
22
8
63
329
2,141
108
1,593
291
69
406
1,301
1,242
384
4,053
354
36
0
2
4
10
0
0
3
42
5
4
2
2
27
0
146
2,726
62
6
3
2
17
29
135
10
231
40
3
190
1,295
171
87
445
3,080
80
13
5
0
15
90
625
39
433
86
22
137
3
385
127
1,017
6,275
137
12
12
3
20
210
1,381
57
887
161
40
77
0
659
170
2,445
13,383
337
32
24
9
66
358
2,332
116
1,722
314
75
420
1,341
1,336
408
4,409
372
38
0
2
4
11
0
0
3
44
5
4
2
2
29
0
154
2,810
64
6
4
2
17
30
139
10
238
41
3
196
1,335
177
90
459
2,991
78
12
5
0
15
88
607
37
421
84
22
133
3
374
123
988
7,210
157
14
14
3
24
241
1,586
66
1,020
185
46
88
0
757
196
2,809
Source: CDC - National Health Statistic Report #29, October 26, 2010
31
Market
Difference
Percent
7.6%
7.0%
5.2%
8.4%
7.7%
5.9%
9.0%
9.0%
7.3%
8.1%
7.9%
8.1%
3.3%
3.1%
7.6%
6.4%
8.8%
Exhibit 21
Estimated and Projected Number of Acute Care Discharges by Medical Diagnostic Category and Age: Provider Service Area
Estimated 2013
Projected 2018
Under
15-44
45-64
65 years
Under
15-44
45-64
Procedure Category
Total
15 years
years
years
and over
Total
15 years
years
years
Total Provider Service Area Population
Market
Difference
Percent
65 years
and over
68,512
11,434
23,236
19,009
14,833
71,493
12,032
23,955
18,464
17,042
All Conditions
9,582
410
1,963
2,174
5,036
10,352
431
2,023
2,112
5,786
8.0%
Infectious and patristic diseases
Neoplasms
Endocrine, nutritional and metabolic diseases and immunity disorders
Diseases of the blood and blood-forming organs
Mental Disorders
Diseases of the nervous system and sense organs
Diseases of the circulatory system
Diseases of the respiratory system
Diseases of the digestive system
Diseases of the genitourinary system
Complications of pregnancy, childbirth and puerperium
Diseases of the skin and subcutaneous tissue
Diseases of the musculoskeletal system and connective tissue
Congenital anomalies
Certain conditions originating in the perinatal period
Symptoms, signs and ill defined conditions
Injury and poisoning
Supplementary classifications
360
475
527
141
540
222
1,951
1,001
929
618
91
203
574
18
32
48
806
1,011
24
7
29
0
28
19
6
103
38
13
0
16
5
0
32
8
36
12
42
45
68
24
232
32
81
62
152
97
91
36
50
5
0
10
148
789
73
161
136
29
185
56
449
194
258
136
0
60
174
7
0
11
191
54
221
262
295
89
96
116
1,415
643
481
371
0
92
345
6
0
18
431
157
394
512
570
154
558
240
2,152
1,098
1,000
673
94
217
623
19
33
51
871
1,058
26
7
30
0
29
20
6
108
40
14
0
16
6
0
33
9
38
13
43
46
70
24
240
33
83
63
157
100
94
37
52
6
0
10
152
813
71
157
132
28
179
54
436
188
251
133
0
58
169
7
0
11
185
52
254
301
339
102
110
133
1,626
738
553
426
0
106
396
6
0
21
496
180
9.3%
7.6%
8.3%
9.3%
3.3%
7.9%
10.3%
9.7%
7.6%
8.9%
3.1%
6.9%
8.4%
4.4%
5.2%
6.5%
8.1%
4.6%
Source: CDC - National Health Statistic Report #29, October 26, 2010
32
Estimated Demand for Physician Services
Physician needs assessment data has become increasingly important to hospitals developing strategic
physician recruitment plans and seeking to comply with federal recruiting regulations. There are several
methodologies for estimating physician needs within a community using physician-to-population ratios.
These methodologies have been applied to the population of the community to assist with the
determination of future need for additional primary care and/or specialty care physicians.
Exhibit 22 provides four different need methodologies widely recognized in the health care industry.
These rates serve as a useful starting point in assessing community need for physicians, but alone they
should not constitute the basis for a comprehensive medical staff plan. While the rates of the four
methodologies offer a general range of physicians needed per 100,000 population, they reflect national
numbers. GMENAC (Graduate Medical Education National Advisory Committee) was a one-time, ad
hoc committee of health care experts convened by Congress to assess U.S. health care manpower needs.
In 1980, GMENAC issued estimates of the number of physicians needed per 100,000 population. The
GMENAC numbers are over 30 years old and are considered dated by many. Writing in the
December 11, 1996, issue of JAMA, David Goodman, MD, et al, projected needs based on three different
types of service populations: the patient panel of a large HMO, the population of a community with a high
level of managed care and the population of a mostly fee-for-service community. The numbers in this
group of rates reflect a mostly fee-for- service community. Writing in an 1989 edition of the Journal of
Health Care Management, Hicks and Glenn, projected needs based on the current rate of patient visits
generated to particular specialists as determined by the Department of Health and Human Services’
National Ambulatory Healthcare Administration report divided by the number of patient visits physicians
typically handle, as determined by the Medical Group Management Association. Solucient is a health
care consulting firm. Its numbers are based on a 2003 study and are, therefore, the most current of the
figures provided. Solucient employed a methodology similar to Hicks & Glenn, which analyzed National
Ambulatory Health Care Administration patient/physician visits data, Medical Group Management
Association physician productivity data and private and public claims data showing patient/physician visit
rates by age.
An average of all four methodologies was calculated and applied to the Hospital’s estimated 2013 and
projected 2018 overall zip code to estimate the specific physician needs for the area. Aiding in
calculating the estimated need populations, recommendations were taken from the Healthcare Strategy
Group (HGS) Advanced Manpower Planning guide. The rates do not consider technological
advancements over time nor do they consider the differing healthcare needs of the local populations.
Medicated stents and new imaging procedures are examples of advancements that have greatly impacted
the demand for physician services, but are unaccounted for under the four existing models. HGS
recommended making technology adjustments to the following specialties: cardiology, cardiac surgery,
neurology, neurosurgery and orthopedics. These recommendations are built into the calculations that
went into generating the numbers shown in Exhibit 22. HGS also recommended making adjustments to
models based on mortality rate variances by contrasting national and local mortality rates. Refer to the
contrasts for Skaggs Community Hospital Association Community at Exhibit 13. HGS recommended
adjusting for 80% of the variance after the first 10% that recognizes the needs of the local community and
can be supported by the medical staff and legal counsel. These recommendations were included in
calculations based on the variance of all causes of death. The calculated estimated need was then
compared to calculations of estimated physician supply and an incremental difference was derived.
33
Exhibit 22
Summary of Physician Need by Specialty
Estimated Supply
Based on Health
Resources & Svcs
Admin. Average &
National Supply of Total
Active Physicians
4 Studies Physician Need per 100,000 Population
Physician Group
GMENAC
Goodman
Hicks &
Glenn
Solucient
Average
2013
2018
Estimated Need Based on
Average Physician Need,
Mortality, and
Technological Advances
2013
2018
Physician Shortage
(Excess)
2013
2018
Physician Full Time Equivalents
General and family practice
25.2
-
16.2
22.5
21.3
29.3
30.5
13.8
14.4
(15.5)
(16.1)
Internal medicine
28.8
-
11.3
19.0
19.7
9.2
9.7
12.8
13.3
3.6
3.6
Pediatrics
12.8
-
7.6
13.9
11.4
2.6
2.7
7.4
7.7
4.8
5.0
OB/GYN
9.9
8.4
8.0
10.2
9.1
1.5
1.6
5.9
6.2
4.4
4.6
Psychiatry
15.9
7.2
3.9
5.7
8.2
-
-
5.3
5.5
5.3
5.5
Primary care
92.6
15.6
47.0
71.3
69.7
42.6
44.5
45.2
47.1
2.6
2.6
Allergy/Immunology
0.8
1.3
-
1.7
1.3
0.3
0.3
0.8
0.9
0.5
0.6
Cardiology
3.2
3.6
2.6
4.2
3.4
1.8
1.9
2.6
2.7
0.8
0.8
Dermatology
2.9
1.4
2.1
3.1
2.4
0.9
0.9
1.5
1.6
0.6
0.7
Endocrinology
0.8
-
-
-
0.8
-
-
0.5
0.5
0.5
0.5
Gastroenterology
2.7
1.3
-
3.5
2.5
0.9
1.0
1.6
1.7
0.7
0.7
Hematology/Oncology
3.7
1.2
-
1.1
2.0
0.4
0.4
1.3
1.3
0.9
0.9
Infectious Disease
0.9
-
-
-
0.9
-
-
0.6
0.6
0.6
0.6
Nephrology
1.1
-
-
0.7
0.9
-
-
0.6
0.6
0.6
0.6
Neurology
2.3
2.1
1.4
1.8
1.9
1.3
1.3
1.4
1.4
0.1
0.1
Pulmonology
1.5
1.4
-
1.3
1.4
0.7
0.8
0.9
0.9
0.2
0.1
Rheumatology
0.7
0.4
-
1.3
0.8
-
-
0.5
0.5
0.5
0.5
-
-
-
2.0
2.0
4.9
5.1
1.3
1.4
(3.6)
(3.7)
20.6
12.7
6.1
20.8
20.3
11.2
11.7
13.6
14.1
2.4
2.4
Medical Specialties
Other Medical Specialties
Medical Specialties
34
Exhibit 22 (Continue)
Summary of Physician Need by Specialty
Estimated Supply
Based on Health
Resources & Svcs
Admin. Average &
National Supply of Total
Active Physicians
4 Studies Physician Need per 100,000 Population
Physician Group
Hicks &
Glenn
Solucient
Average
2013
2018
Estimated Need Based on
Average Physician Need,
Mortality, and
Technological Advances
2013
2018
Physician Shortage
(Excess)
GMENAC
Goodman
2013
2018
General Surgery
9.7
9.7
4.1
6.0
7.4
3.4
3.5
4.8
5.0
1.4
1.5
Neurosurgery
1.1
0.7
-
-
0.9
0.4
0.4
0.6
0.7
0.2
0.3
Ophthalmology
4.8
3.5
3.2
4.7
4.1
1.5
1.5
2.6
2.7
1.1
1.2
Orthopedic Surgery
6.2
5.9
4.2
6.1
5.6
1.9
2.0
3.8
4.0
1.9
2.0
Plastic Surgery
1.1
1.1
2.3
2.2
1.7
0.5
0.5
1.1
1.1
0.6
0.6
Urology
3.2
2.6
1.9
2.9
2.6
0.8
0.8
1.7
1.8
0.9
1.0
-
-
-
2.2
2.2
1.7
1.7
1.2
1.3
(0.5)
(0.4)
26.1
23.5
15.7
24.1
24.5
10.2
10.4
15.8
16.6
5.6
6.2
Emergency
8.5
2.7
-
12.4
7.9
2.5
2.6
5.1
5.3
2.6
2.7
Anesthesiology
8.3
7.0
-
-
7.7
3.5
3.7
5.0
5.2
1.5
1.5
Radiology
8.9
8.0
-
-
8.5
2.8
2.9
5.5
5.7
2.7
2.8
Pathology
5.6
4.1
-
-
4.9
1.6
1.6
3.1
3.3
1.5
1.7
31.3
21.8
-
12.4
28.8
10.4
10.8
18.7
19.5
8.3
8.7
-
Surgical Specialties
Other Surgical Specialties
Surgical Specialties
Hospital-Based
Hospital-Based
Pediatric Subspecialties
Pediatric Cardiology
-
-
-
0.2
0.2
0.2
0.2
0.2
0.2
-
Pediatric Neurology
-
-
-
0.1
0.1
-
-
0.1
0.1
0.1
0.1
Pediatric Psychiatry
-
-
-
0.5
0.5
0.6
0.7
0.3
0.3
(0.3)
(0.4)
Other Pediatric Subspecialties
-
-
-
0.9
0.9
1.2
1.2
0.6
0.6
(0.6)
(0.6)
Pediatric Subspecialties
-
-
-
1.7
1.7
2.0
2.1
1.2
1.2
(0.8)
(0.9)
73.6
68.8
130.3
145.0
76.4
79.5
94.5
98.5
18.1
19.0
Total physicians
170.6
35
Conclusion
Exhibit 22 is organized among physician groups, defined by the four physician studies. Primary care
includes: general and family practice, internal medicine, pediatrics, OB/GYN and psychiatry. Medical
specialties include: allergy/immunology, cardiology, dermatology, endocrinology, gastroenterology,
hematology/oncology, infectious disease, nephrology, neurology, pulmonology, rheumatology and other
medical specialties. Surgical specialties include: general surgery, neurosurgery, ophthalmology,
orthopedic surgery, plastic surgery, urology and other surgical specialties. Hospital-based includes:
emergency, anesthesiology, radiology and pathology. Pediatric subspecialties include: pediatric
cardiology, pediatric neurology, pediatric psychiatry and other pediatric subspecialties. The estimates are
based on national averages and conclude that a physician shortage does exist. Exhibits 14.1 and 15.1
show a physician shortage for their respective counties as well with physician-to-population ratios of
1,433:1 for Taney County and 3,499:1 for Stone County. The above exhibit is based on the zip code
populations as defined in Exhibit 1. The national study averages have been applied to the zip code
population to calculate the estimated need.
36
Key Informant Interviews
Interviewing key informants (community stakeholders) is a technique employed to assess public
perceptions of the county’s health status and unmet needs that represent the broad interests of the
Community with knowledge of or expertise in public health. These interviews are intended to ascertain
opinions among individuals likely to be knowledgeable about the community and influential over the
opinions of others about health concerns in the community.
Methodology
Interviews with 15 key informants were conducted over nine dates in September/October 2012.
Informants were determined based on their a) specialized knowledge or expertise in public health, b) their
affiliation with local government, schools and industry or c) their involvement with underserved and
minority populations.
A representative from Skaggs contacted all individuals nominated for interviews. If the respective key
informant agreed to an interview, an interview time and place was scheduled. All interviews were
conducted by Skaggs Regional Medical Center employees.
All interviews were conducted using a standard questionnaire. A copy of the interview instrument is
included in the Appendices. A summary of their opinions is reported without judging the truthfulness or
accuracy of their remarks. Community leaders provided comments on the following issues:
•
Health and quality of life for residents of the community
•
Barriers to improving health and quality of life for residents of the community
•
Opinions regarding the important health issues that affect Taney and Stone County residents and
the types of services that are important for addressing these issues
•
Delineation of the most important health care issues or services discussed and actions necessary
for addressing those issues
Interview data was initially recorded in narrative form. Themes in the data were identified and
representative quotes have been drawn from the data to illustrate the themes. Informants were assured
that personal identifiers such as name or organizational affiliations would not be connected in any way to
the information presented in this report. Therefore, quotes included in the report may have been altered
slightly to preserve confidentiality.
This technique does not provide a quantitative analysis of the leaders’ opinions, but reveals community
input for some of the factors affecting the views and sentiments about overall health and quality of life
within the community.
Key Informant Profiles
Key informants from the community (see the Appendices for a list of key informants) worked for the
following types of organizations and agencies:
•
Social service agencies
•
Local school system and community college
•
Local city and county government
•
Public health agencies
37
•
Industry
•
Faith community
•
Medical providers
Key Informant Interview Results
The interview questions for each key informant were identical. The questions on the interview instrument
are grouped into four major categories for discussion:
1. General opinions regarding health and quality of life in the community
2. Underserved populations and communities of need
3. Barriers
4. Most important health and quality of life issues
A summary of the leaders’ responses by each of these categories follows. Paraphrased quotes are
included to reflect some commonly held opinions and direct quotes are employed to emphasize strong
feelings associated with the statements. This section of the report summarizes what the key informants
said without assessing the credibility of their comments.
1. General Opinions Regarding Health and Quality of Life in the Community
The key informants were asked to rate the health and quality of life in their respective county. They
were also asked to provide their opinion whether the health and quality of life had improved, declined
or stayed the same over the past few years. Lastly, key informants were asked to provide support for
their answers.
Most of the key informants rated the health and quality of life in their county in the
average/fair/moderate category. There were a few responses on either end of this average rating.
Most of the informants ranked quality of life higher than health. Interviewees repeatedly noted that
there were extreme diversities in health and quality of life for certain residents within the community.
Economic circumstances are seen to contribute largely to the dichotomy between the two groups.
When asked whether the health and quality of life had improved, declined, or stayed the same, the
responses were split evenly across the board with five saying it had improved, five staying the same
and five saying it had declined. One informant stated access to care improved, but quality life has
stayed the same. Another informant reported quality of life had improved, but health has declined.
Another informant stated that Taney County has seen an overall decline, and Stone County has stayed
the same.
Key informants noted that services at Skaggs Regional Medical Center and other medical providers
contributed to the overall improvement of health and quality of life in the community. Seasonal
employment, lack of options for healthy living, geography of the counties, low wages and lack of
affordability of insurance were the highlighted reasons for a decline in health and quality of life.
Informants noted Skaggs Regional Medical Center, health departments and free clinics/education as
the biggest assets to the community. The public schools, the lakes and overall beauty of the area
drawing in the tourism industry were also noted as assets.
38
Overall, key informants value the Hospital’s impact on community health and recognize the Hospital
as an asset to the community. Lack of health education as well as motivation and affordability of care
were generally seen as the reasons behind poor health and poor quality of life. Poor economic
conditions and lack of “year around” jobs are seen as detriments to community health.
“There is more accessible healthcare. Skaggs has done so much within the community and has
expanded the scope of care.”
“There is a growing element of homelessness and core groups of chronically homeless,
unemployed and/or addicted. It is estimated that 30% of people utilizing community agencies
and services fall into these categories.”
“Many can’t pay for rent or buy food. Unhealthy foods are cheaper and taste good, so there is
no incentive to purchase healthier options. Accountability is not there yet, as there is no
connection between food and health. The community is still slow to change.”
“Services are available and the community agencies do a good job getting the word out.”
2. Underserved Populations and Communities of Need
Key informants were asked to provide their opinions regarding specific populations or groups of
people whose health or quality of life may not be as good as others. They were also asked to provide
their opinions as to why they thought these populations were underserved or in need. Each key
informant was asked to consider the specific populations they serve or those with which they usually
work. They identified primarily the seasonally unemployed and the lower income populations as
having the largest needs.
Respondents identified three main areas of need: health and healthy living education, access
to/affordability of care and motivating the community to improve their health. A high concentration in
a population of elderly people contributes to the rise in health care costs. This in turn causes economic
strain for the community, and especially the elderly that need the increased care. When the elderly and
others like those in seasonal employment have to choose between eating and paying for their care, this
puts more demand on local charities and community centers. These people in rural areas have another
layer of complexity with a transportation need to get the medical care they need. With limited
resources, and the high demand of needs from the elderly, it increases the difficulty of providing
quality care to the population as a whole. Those that avoid their health problems because of these
issues and only seek care in emergent situations increase the strain on medical facilities.
Uninsured/underinsured are considered to have issues accessing care. Although services are available,
some of the uninsured/underinsured do not have necessary knowledge regarding how to access care.
Additionally, there are those that would qualify for Medicaid, but refuse to use a government program.
The key informants were asked what could improve the health and quality of life in the area. The
main responses were based on ideas for education and providing the community with ways to improve
their health habits. The following were included:
• Improving means of affordable public transportation.
• Educating the population on the importance of eating well, seeing a physician regularly and diet
and exercise.
• Somehow make obtaining insurance more affordable.
39
• Reach out to kids at an early age to provide education regarding health and the value of
education or skill sets.
• A travelling clinic would be wonderful to provide education and outreach.
• Develop a well thought out plan that includes many agencies, health departments, cities and
counties to implement a consistently accessible wellness and medical program, including parks
and recreation or a health and wellness facility without to travel far for these services.
“Lower income level can’t afford medical insurance, healthcare, gym membership, healthy
foods, etc. Affordability and accessibility are both an issue. Stone and Taney counties are
technically considered underserved areas on most government websites. Stone County is
medically disenfranchised as there is no hospital in the county and few medical clinics.”
“People who live in motels do not have access to a kitchen or proper refrigeration. In many
cases, there is a mom and her boyfriend and their four kids sharing a small hotel room. There is
no consistency in their lives which adds to stress levels and poor mental health.”
“Not many students go to college in Stone County. 2% of Galena students go to college.”
“The way of thinking is passed down from generation to generation.”
3. Barriers
The key informants were asked what barriers or problems keep community residents from obtaining
necessary health services in their community. Responses from key informants included transportation
issues, affordability of care, lack of education, good jobs w/benefits, mentality and geography of the
area.
Lack of education and communication surrounding health issues and the availability of health
resources is seen as a primary barrier to health services. Education surrounding access to health
services for the newly uninsured or underinsured persons is also identified as a community need.
People do not understand how to access services and there is limited media access for the local
community to receive information regarding education and screenings offered. There is also a sense
that health agencies do not cooperate and work together in offering such services.
Being a rural community with no public transportation system is viewed as a barrier to accessing
regular health care for those without personal transportation. Those interviewed believe it is difficult
to reach out to isolated or marginalized people in the community. There is a lack of transportation for
low-income residents to receive services and a lack of personal “know-how” of the medically indigent
for accessing needed services.
Lack of education and communication surrounding health issues and the availability of health
resources is seen as a primary barrier to health services. Education surrounding access to health
services for the uninsured or underinsured persons is also identified as a community need. The overall
perception is that people are not motivated to make the necessary changes to improve their lives.
There is also a sense that health agencies need is to improve services. Several respondents feel another
community need is to provide more outlets for exercise and healthy activities.
As previously noted, people’s attitudes and culture, surrounding health and lifestyle choices, are seen
as a barrier. Bad habits are passed down from generation to generation and there are not enough
resources to bring about a change.
40
“Inability to reach people. Parents with second grade children and younger don’t read
newspapers or watch the news. Instead they receive information via blogs, Twitter, Facebook,
etc., which are not always reliable sources. The traditional institution may not reach this at risk
population.”
“Roads are not conducive to get from one side of the county to the other. The county is very
spread out, and you have to go around the lake.”
“The county is not set up to provide healthy lifestyles. It is all about tourists and not the locals.
The area is more expensive due to tourism. A paradigm shift needs to happen, but it is hard to
change behaviors.”
4. Most Important Health and Quality of Life Issues
Key informants were asked to provide their opinion as to the most critical health and quality of life
issues facing the community.
The issues identified most frequently were:
1. Access/affordability of care
2. Obesity and lack of physical activities
3. Public transportation
Other issues that were reported are overuse of the emergency room due to lack of preventative care,
dental health, tobacco use, diabetes, seasonal employment and substance abuse.
“It is not reasonable to expect people to come to Taney County for treatment.”
“Those who are not seeing doctors need to be educated and need to see some sort of provider.
People eat terribly and need dental work. Educating children would be the biggest thing we
could do to improve the health and quality of life.”
“Good paying jobs that help people support their families, get insurance and buy better foods is
what is needed. People with food stamps are not always buying healthy foods. ”
Key Findings
A summary of themes and key findings provided by the key informants follows:
•
Information and education on health issues is a problem. There is a significant need to
inform, educate and counsel specific categories of the community.
•
Drug and alcohol abuse are seen as a health and quality of life issue.
•
Transportation is an issue for rural residents, low income households and people living in
Stone County.
41
•
The Hospital should work toward being the trusted leader in the community regarding
innovative health education, screenings and initiatives. The Hospital should also take the
lead role in bringing agencies and organizations together in addressing community health
needs.
•
There is a significant need for better employment options along with more affordable
benefits.
•
Specific populations lack general knowledge regarding health services and/or how to access
those health services as well as motivation to seek out answers regarding healthcare.
Community Health Input Questionnaire
The Hospital circulated community health input questionnaires, in order to gather broad community input
regarding health issues. The input process was launched on October 2, 2012, and was closed on
December 11, 2012.
The Community Health Questionnaire broad survey was intended to gather information regarding the
overall health of the community. The results are intended to provide information on different health and
community factors. Requested community input included demographics and socioeconomic
characteristics, behavioral risk factors, health conditions and access to health resources
Methodology
A web-based tool, Question Pro, was utilized to conduct the community input process. Paper
questionnaires, which were identical to the electronic questionnaire, were also distributed to populations
who may not have access to the internet or generationally are more likely to complete a paper
questionnaire. Electronic and paper questionnaires were circulated to the residents of the community.
Scheduled below is the survey distribution report.
There were 547 questionnaires completed and returned which comprised of 405 electronic questionnaires
and 142 paper questionnaires. Sociodemographic characteristics such as age, education, income and
employment status were fairly comparable to the most recent census data. Over 68 percent of the
questionnaire respondents were female which is more than the 51 percent of the population of the
community. Additionally, representation of those individuals 65 and older is less than that reported in the
latest census data.
The instrument used for this input process was based largely on the Centers for Disease Control and
Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS), as well as various other public
health surveys and customized questions. The final instrument was developed by the Hospital
representatives in conjunction with BKD.
Community Health Input Results
The questionnaire was quite detailed in nature, including many specific questions regarding general
health, satisfaction with specific and general providers and demographic information. A compilation of
the actual results are included in the Appendices to allow for a detailed analysis. Health needs indicated
include:
42
•
Assessment of Personal Health
When asked to assess their personal health status, 28 percent of the respondents described their
health as being “excellent,” while 56 percent stated that their overall health was “good.”
When asked to rate their community as a “healthy community,” approximately 9 percent of the
respondents indicated their community was healthy or very healthy. More than 30 percent of the
respondents indicated their community was unhealthy.
•
Health Care Access Issues
Over 43 percent of the respondents reported having health insurance with over 48 percent of
health insurance being provided by private insurance companies. Health care access issues are
primarily related to costs. Respondents noted the following reasons for not receiving medical
care:
1. Cannot afford it
2. Have never applied for Medical Assistance
3. Employer does not offer it
The other respondents either did not qualify for employer plans or Medical Assistance, or felt
they did not need insurance.
•
Lifestyle Behavioral Risk Factors
Proper diet and nutrition seem to be a challenge as only 13 percent of the respondents report
eating the daily recommended servings of fruits and vegetables and 24 percent of the respondents
report that they never exercise. Of the respondents, 32 percent report exercising at least three
times per week. When asked about exercising at least five times per week, nearly 38 percent of
the respondents answered “never.” Nearly 13 percent of the respondents always smoke
cigarettes. Use of seat belts is high (over 84 percent) and when applicable, respondents’ children
use seat belts and/or child safety seats.
•
Social and Mental Health
Over 13 percent of the respondents reported always being stressed out with over 67 percent
responding that they were sometimes stressed out. Almost 20 percent of the respondents rated
their stress level as High or Very High. Over 17 percent of the respondents reported that they did
less than they would like because of mental health or emotional issues.
Approximately 17 percent of respondents who reported that their current employment is stressful,
while almost 29 percent reported that finances are stressful. Nearly 45 percent of the respondents
worry about losing their job.
43
What do Citizens say about the Health of their Community?
The five most important “health problems:”
1. Obesity (adult)
2. Aging problems and heart disease and stroke
3. Obesity (child)
4. Child abuse/neglect
5. Dental problems
The three most “risky behaviors:”
1. Drug abuse
2. Alcohol abuse
3. Tobacco use/second hand smoke
The five most important factors for a “healthy community:”
1. Affordable and available health care
2. Affordable housing
3. Emergency response services
4. Job security
5. Healthy behaviors and lifestyles
44
Prioritization of Identified Health Needs
The Hospital has accomplished much over the past several years and continues to work on the
development and implementation of programs and initiatives that work toward the improvement of
community health and wellness. Primary and secondary data from this assessment process will be a
valuable resource for future planning. The community input findings obtained through interviews and the
community input questionnaire should be especially useful in understanding residents’ health needs. The
findings provide the Hospital a lot of information to act on. In order to facilitate prioritization of
identified health needs, a ranking and prioritization process was used and is described in the section
below.
Analysis of community health information, key informant interviews and the community health input
questionnaire were all used to assess the health needs of the community in Exhibit 23:
Exhibit 23
Ranking of Community Health Needs
Health Problem
Affordable Healthcare
Uninsured Residents
Diseases of the Heart
Access to Specialists
Shortage of Physicians
Access to Recreational Facilities/Limited
Adult Smoking
Transportation
Adult Obesity
Diabetic Screenings
Cancer
Access to Healthy Foods
Diabetes
Drug Abuse
Respiratory
Physical Activity
Low Birth Weight
Children in Poverty
Alcohol abuse
Mental Health
Infant Mortality
Dental Health
Teen birth rate
Motor Vehicle Crashes
STDs
Ability of the
Hospital to
Impact
Change
3
3
4
3
3
4
3
3
2
4
2
1
3
2
3
1
2
1
1
2
2
1
1
1
1
How many
What are the
people are
consequences of
affected by the not addressing
issue?
this problem?
4
4
3
4
4
3
3
3
3
2
3
4
2
2
2
4
2
2
3
2
2
2
1
2
1
4
4
4
3
3
3
3
3
4
3
4
3
3
3
3
3
2
2
2
2
2
2
2
2
2
Prevalence of
common
themes
Total Score
4
4
3
4
4
3
4
4
4
2
3
4
2
3
1
2
2
3
2
1
1
2
2
1
1
Weighted
Score
15
15
14
14
14
13
13
13
13
11
12
12
10
10
9
10
8
8
8
7
7
7
6
6
5
18
18
18
17
17
17
16
16
15
15
14
13
13
12
12
11
10
9
9
9
9
8
7
7
6
45
Health needs were ranked based on four factors:
1. The ability of the Hospital to impact long-term change.
2. How many people are affected by the issue or size of the issue?
3. What are the consequences of not addressing this problem?
4. Prevalence of common themes.
The weighted score was determined by giving a double weight to the first column for the Hospital’s
ability to impact long-term change. The total score possible is 16 points, making the total weighted score
possible 20 points. The leadership of the Hospital has decided to define a need as an item with a
weighted score of 16 or higher. Exhibit 23 shows that there are many health needs for the community.
The health issues with a weighted score of 16 or higher, shows in the first column that the Hospital has a
greater ability to impact long-term changes. It is that ability combined with the other three factors that
have driven the score up for some health issues more than others.
Considerations for Meeting Identified Health Needs
After compiling and analyzing all of the data in this assessment, we recommend that management
consider the following benchmarking, targets, ideas and strategies in its implementation strategy plans.
Some of the strategies will address multiple needs. These lists are not intended to be exhaustive and do
not imply there is only one way to address the identified health needs.
Access to Care
Access to care (including transportation), uninsured residents, affordable health care, access to physicians
and access to specialists were some of the health needs with the highest priority. Increasing access to
both routine medical care and medical insurance are vital steps in improving the health of the community.
Exhibit 24.1
Access to Care
Leading Health Indicators
County Health Rankings
County
Healthy
Skaggs
US
People
Community
Benchmark
2020 Targets
Insured adults
Increase the proportion of persons
with medical insurance
Taney County
78.00%
89.00%
100.0%
Stone County
81.00%
89.00%
100.0%
Ratio of population to primary care
physicians
Increase the proportion of persons
with a usual primary care provider
Taney County
1,433:1
631:1
83.9%
Stone County
3,499:1
631:1
83.9%
Benchmark Sources: County Health Rankings
46
Recommendations to improve community health related to access to care include the following:
•
Extended services and increased hours of operation at community health clinics for the working
poor.
•
Recruitment of additional specialists to the community as well as increased collaboration among
specialists and other agencies such as school programs, clinics, etc.
•
The implementation of a community health resource center to be located within the Hospital
which would provide assistance to those needed to access health resources. Additionally, routine
screening and education sessions could be provided at the resource center.
•
The compilation of a health resource directory providing the listing of available health resources
in the community with primary contact information for each resource.
•
Education sessions for the newly unemployed and underemployed regarding how to access health
services including clear information as to what agencies provide which services.
•
Strive to be the “thought leader” and convener of agencies serving the health needs of the
community.
Diseases of the heart, access to recreational facilities, adult obesity and access to healthy foods are some
of the highest ranked health needs in the community. Additionally, changes in these areas can have a
high impact to the overall health of the community.
Hypertension prevention includes following a healthy eating pattern, reducing salt and sodium in the diet,
maintaining a healthy weight, being physically active, limiting alcohol intake and quitting smoking if a
smoker. Research has shown that following a healthy eating plan can both reduce the risk of developing
high blood pressure and lower an already elevated blood pressure. To reduce salt and sodium in the diet,
it is best to reduce intake to the recommendation of less than 2.4 grams (2,400 milligrams) of sodium a
day. Being overweight increases the risk of developing high blood pressure. Blood pressure rises as
body weight increases. Taney county, representing half the community for the Hospital, has a ranking in
the bottom quartile of the state for adult obesity. Nearly one in three adults in that county are obese.
Lack of physical activity, poor dietary choices and obesity are linked with the increased risk of several
medical conditions in addition to diseases of the heart. Physical activity can help reduce blood pressure
as well as reduce the risk of other types of heart disease.
47
Exhibit 24.2
County
Healthy
Skaggs
US
People
Community
Benchmark
2020 Targets
Cause of Death Rates
Reduce coronary heart disease deaths per 100,000
persons
Taney County
237.9
195.4
100.8
Stone County
216.9
195.4
100.8
Reduce the proportion of adults who are obese
Adult Obesity
County
Taney County
32.00%
25.00%
30.5%
Stone County
30.00%
25.00%
30.5%
Excessive Drinking
County
Reduce the proportion of adults engaging in binge
drinking during the past 30 days
Taney County
13.00%
8.00%
24.4%
Stone County
11.00%
8.00%
24.4%
Rate of recreational facilities per
100,000 population
County
Taney County
12
16
N/A
Stone County
6
16
N/A
Increase the proportion of adults with hypertension
whose blood pressure is under control
County
N/A
N/A
61.2%
Increase proportion of adults who have had their blood
cholesterol checked within the preceding 5 years
County
N/A
N/A
82.1%
Community and US Benchmark Source: County Health Rankings
Recommendations to improve diseases of the heart rate include:
•
A community-wide fitness initiative led by the Hospital focusing on fitness, nutrition and
physical activity.
•
Community education about the available options for outdoor physical fitness.
•
Education on nutrition and cooking for healthy hearts.
48
Tobacco Use
The Healthy People 2020 goal for tobacco use is to reduce illness, disability and death related to the use
as well as secondhand smoke exposure. Tobacco use causes cancer, heart disease, lung diseases,
premature birth, low birth weight, stillbirth and infant death. There is no risk-free level of exposure to
secondhand smoke. It can cause the same health issues listed as smoking, but in addition can cause
severe asthma attacks, respiratory infections, ear infections and Sudden Infant Death Syndrome. Tobacco
use is the single most preventable cause of death and disease in the United States.
Key informant interviews reflected drug and alcohol abuse as a health and quality of life issue impacting
the community. The community health input questionnaire indicated that drug abuse was one of the five
most important health problems impacting the community.
Exhibit 24.3
Tobacco Use
Healthy
Skaggs
US
People
Community
Benchmark
2020 Targets
Reduce cigarette smoking by adults
Adult Smoking
County
Taney County
26.00%
14.00%
12.0%
Stone County
22.00%
14.00%
12.0%
Reduce use of cigarettes by
adolescents in past 30 days
County
N/A
N/A
16.0%
Reduce proportion of children aged 311 exposed to secondhand smoke
County
N/A
N/A
47.0%
Community and US Benchmark Source: County Health Rankings
Recommendations to reduce tobacco use include:
•
Adopt policies and strategies to increase access, affordability, and use of smoking cessation
services and treatments.
•
Establish policies to reduce exposure to secondhand smoke.
49
Health Issues of Uninsured Persons, Low-Income Persons and Minority Groups
Certain key informants were selected due to their positions working with low-income and uninsured
populations. Several key informants were selected due to their work with minority populations. Based
on information obtained through key informant interviews and the community health survey, the
following chronic diseases and health issues were identified:
•
Uninsured/low income population
 Access to healthy foods
 Dental care
 Mental and emotional health
 Education on access to health services
 Obesity
•
Hispanic population
 Dental care
 Prenatal care
 Access to care due to not having legal status
 Preventative care
 Obesity
50
APPENDICES
Acknowledgements
The project Steering Committee was the convening body for this project. Many other individuals
including community residents, key informants and community-based organizations contributed to this
community health needs assessment.
Project Steering Committee
Special thanks to all of the following committee members for their time and commitment to this project:
Lisa Marshall, Wellness Coordinator
Leigh Patterson, Controller
Adriana Iacob, Accounting Manager
Heather Zoromski, Pharmacy Program Coordinator & Grant Writer
Neil Frost, Marketing Director
Key Informants
Thank you to the following individuals who participated in our key informant interview process:
Erica Hunt, Faith Community Health Clinic
Dawn Erickson, Associate Director and Grants Director, Sigma House of Springfield/Larry Simmering
Recovery Center
Leon Combs, Retired
William Mahoney, CEO, Skaggs Community Hospital Association
Donna Huck, School Nurse, Reeds Spring Middle School
Pam Burnette, Clinical Services, Stone County Health Department
Debbie Redford, Communications Director & Grants Writer, Hollister School District
Jeff Hawkins, Deputy Chief, Taney County Ambulance District
Dr. Rick Blubaugh, Managing Partner, 360 Medicine
Meghan Connell, Director, Gift of Hope
Kim King, Health Educator, Stone County Health Department
Bethany Thomas, Senior VP, Tri-Lakes Area Chamber of Commerce
Nellie Lamers, Family Financial Education Specialist, Taney County Extension Office-MU
Pat Davis, Executive Director, CAM Food Pantry
Mindy Honey, Managing Editor, Branson Tri-Lakes News
Lori Brown, Executive Director of Accountable Care
Margaret Gregg, Director of Revenue Integrity
51
Thank you to the following businesses and entities that assisted with distributing the community health
input questionnaire:
Skaggs Insider
Intranet
Skaggs.net
CAM Food Pantry
Stone County Health Department
MU Extension
Faith Community Health Clinic
Church Army
Stone County OACAC
Branson Parents as Teachers
Love, Inc.
The Caring People
1st Christian Church
Lakes Area Child Advocacy Center
Stone County Family Services Division
52
KEY INFORMANT INTERVIEW PROTOCOL
53
54
55
COMMUNITY HEALTH INPUT QUESTIONNAIRE
DETAIL RESULTS
(540 Responses)
1. Select the county in which you live:
60.00%
49.44%
45.93%
40.00%
20.00%
4.63%
0.00%
Taney
Stone
Other
2. Length of time you have been a resident in
your current municipality:
60.00%
(539 Responses)
50.09%
40.00%
20.00%
18.00%
18.92%
1 to 5 Years
6 to 10 Years
12.99%
0.00%
Less Than 1 Year
More Than 10 Years
(537 Responses)
3. Your 5 digit zip code:
40.00%
25.51%
20.00%
13.04%
11.17% 11.36%
8.75%
2.98%
2.79%
8.01%
4.66%
3.17%
1.86%
0.93%
65679
65680
0.74%
2.61%
0.19%
2.23%
0.00%
65611
65616
65624
65653
65656
65672
65681
65686
65737
65739
65740
65759
65771
Other
56
(528 Responses)
4. County in which you work:
80.00%
60.00%
57.58%
40.00%
22.73%
17.61%
20.00%
2.08%
0.00%
Taney
Stone
Other
N/A
(537 Responses)
5. Your current age:
60.00%
48.23%
40.00%
20.00%
17.88%
18.06%
18 to 35
36 to 45
15.83%
0.00%
46 to 65
66 and older
(533 Responses)
6. Your sex:
80.00%
68.48%
60.00%
40.00%
31.52%
20.00%
0.00%
Female
Male
57
(540 Responses)
7. Your racial/ethnic identification
(check all that apply):
94.26%
100.00%
80.00%
60.00%
40.00%
20.00%
0.00%
0.37%
0.93%
1.67%
1.67%
Asian or Pacific
Islander
Black or African
American
Latino or Hispanic
Native American
1.11%
White or Caucasian
8. Your highest level of education completed
(check one):
Other
(537 Responses)
40.00%
29.98%
29.05%
21.60%
20.00%
14.90%
4.47%
0.00%
Less than 12 Years
High School Graduate/GED
Some College
College Graduate
Post Graduate Degree
(560 Responses)
9. Your employment status
80.00%
60.00%
60.54%
40.00%
Full-Time Student
Part-Time Student
Full-Time
Homemaker
1.61%
0.89%
0.54%
2.50%
Unemployed Due
to Disability of
Illness
2.32%
Unemployed Less
Than 1 Year
0.54%
Unemployed More
Than 1 Year
0.54%
Unemployed
17.86%
12.68%
20.00%
Retired
Employed PartTime
Employed FullTime
0.00%
58
(493 Responses)
10. Your employer's industry sector:
60.00%
38.74%
40.00%
20.00%
5.48%
5.07% 2.23%
3.65%
0.41% 0.41% 0.81%
0.20% 0.41% 0.00%
12.78%
11.36%
5.68% 3.25% 3.85%
5.07%
0.61%
Other
Unemployed
Agriculture
Government
Other services
Leisure and
hospitality
Health care and
social assistance
Educational services
Professional and
business services
Financial activities
Information
Transportation and
warehousing
Retail trade
Wholesale trade
Utilities
Mining
Manufacturing
Construction
0.00%
(521 Responses)
11. Your yearly income:
40.00%
29.94%
21.88%
20.00%
17.47%
17.66%
6.14%
6.91%
$100,000 or Higher
Not Applicable
0.00%
Less than $14,999
$15,000 - $34,999
$35,000 - $54,999
$55,000 - $99,999
12. Number of people (including yourself)
living in your household:
(537 Responses)
60.00%
40.97%
40.00%
20.86%
20.00%
13.04%
13.04%
5.59%
6.52%
5
6 or higher
0.00%
1
2
3
4
59
13. Select the type(s) of insurance you currently
have (check all that apply):
(976 Responses)
60.00%
43.85%
40.00%
26.13%
19.77%
20.00%
9.53%
0.72%
0.00%
Health
Dental
Vision
Do Not Have Insurance
Do Not Know
14. Select your current source of health insurance: (523 Responses)
60.00%
48.37%
40.00%
17.59%
16.83%
20.00%
8.41%
2.68%
2.68%
2.49%
Medicaid
Government
Health Savings
Account
0.96%
0.00%
Private
Medicare
Other
Do Not Know
15. If you do not have health insurance, why not?
Do Not Have
Health Insurance
(111 Responses)
100.00%
80.00%
76.58%
60.00%
40.00%
20.00%
5.41%
3.60%
3.60%
7.21%
3.60%
0.00%
Cannot afford it
My employer does not Not qualified for the
offer it
plan where I work
Not qualified for
Medical Assistance
I have never applied I feel I do not need it
for Medical Assistance
60
16. In general, how would you rate your
current health status?
(535 Responses)
55.51%
60.00%
40.00%
28.04%
20.00%
13.08%
3.36%
0.00%
Excellent
Good
Fair
Poor
17. Number of days you have been too sick
to work or carry out your usual activities
during the past 30 days:
80.00%
(502 Responses)
65.74%
60.00%
40.00%
26.69%
20.00%
3.59%
1.00%
2.99%
3-5
6-10
More Than 10
0.00%
0
1-2
18. Your last routine doctor's visit was:
(532 Responses)
100.00%
80.00%
76.88%
60.00%
40.00%
20.00%
7.33%
3.95%
4.89%
4.51%
2.44%
Within Last 19 - 24
Months
Between 2 - 5 Years
Over 5 Years Ago
Have Never Had A
Routine Doctor's Visit
0.00%
Within Last 12 Months Within Last 13 - 18
Months
61
19. Select any of the following preventive
procedures you have had in the last year
20.00%
(2587 Responses)
15.35%
Cholesterol
screen
Prostate cancer
PSA screening
Prostate cancer
digital screening
Skin cancer
screening
Blood sugar
check
Blood pressure
check
Colon/Rectal
examination
Flu shot
Glaucoma test
Pap smear
0.00%
Mammogram
1.62% 2.47% 1.78%
1.01%
20. Where you go for routine health care
Bone density
test
0.62% 1.55%
Cardiovascular
screening
2.82%
2.74%
11.13%
9.74%
Dental
cleaning/x-rays
10.17%
Hearing
screening
3.67%
10.32%
Vision screening
7.42% 6.03%
STD (Sexually
Transmitted…
11.56%
(1049 Responses)
60.00%
41.75%
40.00%
1.05%
3.72%
4.77%
0.76%
0.67%
Hospital
Emergency
Room
Health
Department
Clinic
Care
Center/Urgent
Care
Chiropractor
Nurse or Clinic
at My Place of
Employment
Community
Free Clinic
4.10%
2.00%
Other
2.19%
20.88%
Do Not Have a
Health Care
Provider
18.11%
20.00%
Dentist
Eye doctor
Physician's
Office
0.00%
21. Are you able to visit a doctor/health care
provider when needed?
(534 Responses)
80.00%
62.73%
60.00%
40.00%
28.09%
20.00%
5.43%
3.75%
Seldom
Never
0.00%
Always
Sometimes
62
22. The following have stopped you from getting
the health care you need (check all that apply):
(477 Responses)
40.00%
20.75%
16.56%
6.71%
23. You travel outside of area for medical care:
1.26%
Other
0.63%
No childcare
2.31%
Doctor is too far away
Couldn't pay for
needed prescription
medicine
I speak a different
language or am from
a different culture
8.60%
3.98%
Lack of transportation
7.34%
0.00%
Health care provider
will not take my
insurance
My deductible or copayment was too high
The health care
provider's hours did
not fit my schedule
No Insurance
0.00%
My health insurance
did not cover,
approve or pay for…
2.73%
Could not get an
appointment
8.39%
8.18%
Could not get time off
from work to go
12.58%
Too expensive/can
not afford insurance
premiums
20.00%
(535 Responses)
60.00%
40.00%
40.00%
35.33%
20.00%
14.95%
9.72%
0.00%
Always
Sometimes
Seldom
Never
24. If you travel outside of area for medical care,
select the service you seek (check all that apply):
(784 Responses)
40.00%
26.28%
20.00%
9.31%
13.14%
14.16%
15.56%
9.82%
7.14%
4.59%
0.00%
Medical - Doctor
Appointments
Outpatient
Treatment
Hospitalization
Dental
Appointments
Laboratory or
Other Tests
X-Rays
Other
Not Applicable
(Do Not Travel
Outside Area for
Medical Care)
63
(406 Responses)
25. If you travel outside of the area for
medical care, why?
40.00%
26.11%
22.91%
21.43%
16.75%
20.00%
3.69%
5.91%
Recently Moved
to Area
Local Doctors
Not On My
Insurance Plan
2.46%
0.74%
0.00%
Services Not
Quality Better
Available In My
Elsewhere
Own Community
Closer to My Too Hard to Get
Place of Work Appointment for
Local Doctor
Other
26. The last time you have seen a dentist was:
Not Applicable
(Do Not Travel
Outside Area for
Medical Care)
(526 Responses)
80.00%
63.50%
60.00%
40.00%
20.91%
20.00%
13.12%
2.47%
0.00%
Within the past year
Within the past 2 years
Within the past 3-5 years
27. Your employer provides you dental
health insurance:
I have never seen a dentist
(513 Responses)
60.00%
43.08%
40.00%
20.00%
33.14%
13.06%
10.72%
0.00%
Yes
Yes, but I pay a portion of it
No
I am currently unemployed
64
28. Sources where you obtain most healthrelated information (check all that apply):
34.71%
40.00%
23.80%
19.94%
2.16%
3.01%
1.60%
1.13%
Health
Department
Church
School
10.44%
Health Help
Line
(Telephone)
20.00%
(1063 Responses)
0.38%
2.82%
Other
Public Library
Internet
Newspaper/Ma
gazine/Televisio
n/Radio
Doctor/Nurse/P
harmacist
Family/Friends
0.00%
(504 Responses)
29. What is the source where you obtain
information concerning LOCAL health events such
as health and wellness, education events, screenings,
health and dental services, and support groups?
40.00%
26.79%
26.79%
18.45%
20.00%
12.90%
7.54%
1.19%
3.17%
3.17%
School
Church
0.00%
Newspaper
Magazines
Television
Radio
Internet
30. Person or entity you feel is most responsible
for providing health information (check one):
Other
(503 Responses)
60.00%
45.73%
40.00%
20.00%
4.17%
1.19%
8.15%
11.13%
14.71%
0.00%
4.57%
4.37%
5.96%
Employer
Internet
Other
0.00%
Church/Faith
Doctors
Nurses
Hospitals
Health
Department
Yourself
Public Library
65
31. Your employer offers health promotion/
wellness programs:
(531 Responses)
60.00%
43.31%
40.00%
29.57%
21.66%
20.00%
5.46%
0.00%
Yes
No
I do not know the answer
Not Applicable (Unemployed or
Retired)
32. If your employer offers health promotion/
wellness programs, you participate:
(454 Responses)
60.00%
40.97%
40.00%
27.53%
20.00%
16.96%
8.81%
5.73%
0.00%
Always
Sometimes
Seldom
Never
Not Applicable, No
programs offered
(449 Responses)
33. If your employer does not currently offer
health promotion/wellness programs, but will offer
them in the future, will you participate?
60.00%
40.00%
49.44%
26.95%
18.49%
20.00%
5.12%
0.00%
Yes
No
Maybe
Not Applicable, No programs
offered
66
Memory loss
Family violence
0.79%
0.20% 0.00%0.00%
Hepatitis
3.14%
Migraine headaches
4.81%
Drug abuse/addiction
34. Please check if you have been diagnosed
by a doctor with any of the following
Obesity/weight problems
2.06%
Dental health problems
4.71%
Lung or respiratory disease
8.00%
Stress
Arthritis
9.42%
HIV/AIDS
Gonorrhea
Liver disease
1.18%
Infant death
0.20%
Asthma
Cancer
0.00%
Lupus
0.88%
Glaucoma
2.45%
Hearing disorders
3.34%
Mental disorders
4.22%
Kidney Disease
1.08%
Sickle cell anemia
0.00%
Heart Disease
16.00%
High blood pressure
2.00%
TB
0.39%
Eye disorders
4.22%
Alcohol abuse
4.00%
Epilepsy
0.69%
Sinus problems
10.00%
Stroke
Diabetes
(1019 Responses)
18.00%
15.41%
14.00%
12.00%
9.81%
7.26%
8.15%
6.00%
3.73%
4.51%
2.45%
3.14%
1.28%
0.49%
0.00%
67
0.19% 0.26%
Other (please specify)
Public transportation
Pedestrian/bicycle safety
2.45% 2.60%
2.19%
0.83%
Low infant death rate
Prenatal health care (affordable, available)
Parks and recreation facilities
0.53%
Nursing home care/assisted living/senior
housing (safe, affordable, available)
1.51%
Low level of child abuse
6.00%
Low crime/safe neighborhoods
Low adult death and disease rates
Job availability
2.23%
Healthy behaviors and lifestyles
6.68%
Good schools
2.00%
Emergency preparedness
7.36% 7.51%
Clean and safe environment
Childcare (safe, affordable, available)
8.26%
Job security
8.00%
Healthy food sources (affordable, accessible)
8.79%
Health care (affordable, available)
16.00%
Emergency response services
(ambulance/fire/police)
4.00%
Disability services (safe, affordable, available)
10.00%
Affordable housing
35. In the following list, please mark what you (2651 Responses)
think are the FIVE MOST IMPORTANT FACTORS
FOR A "HEALTHY COMMUNITY". (Those factors that
most improve the quality of life in a community).
CHECK ONLY FIVE:
18.00%
15.92%
14.00%
12.00%
7.47% 7.39%
6.87%
3.70%
4.75%
1.96%
0.00%
0.57%
68
0.00%
2.30%
1.82%
1.39%
0.79%
0.32%
0.51%
Other (please specify)
4.00%
Underage drinking
4.55%
Teenage pregnancy
Suicide
Sexually transmitted diseases
School violence/ bullying
0.08%
Respiratory/lung disease
1.43%
Rape/sexual assault
2.30%
Poor birth outcomes (prematurity, low birth…
Obesity (child)
Obesity (adult)
12.00%
Motor vehicle crash injuries
4.63%
Mental health problems
0.08%
Lead poisoned children
Infectious diseases (Hepatitis, TB, etc.)
1.27%
0.32%
Industrial/farming injuries
6.26%
6.10%
High blood pressure
8.24%
Heart disease and stroke
0.83%
Firearm related injuries
1.86%
Elder abuse/neglect
6.00%
Domestic abuse
Diabetes
6.46%
6.18%
Dental problems
Dementia/Alzheimer's
Child abuse/neglect
8.00%
Cancer
2.00%
Availability of ambulance service
Aging problems (e.g. arthritis,…
think are the FIVE MOST IMPORTANT "HEALTH
PROBLEMS" in our community. (Those problems which
have the greatest impact on overall community health).
CHECK ONLY FIVE:
14.00%
11.72%
10.00%
8.24%
7.33%
5.39%
4.20%
2.93%
2.50%
69
think are the THREE MOST IMPORTANT "RISKY
BEHAVIORS" in our community. (Those behaviors which
have the greatest impact on overall community health).
CHECK ONLY THREE (3):
40.00%
25.51%
5.82%
1.85%
Not using
birth
control/unsa…
Tobacco
use/second
hand smoke
Not getting
"shots" to
prevent…
Poor eating
habits
Lack of
exercise
Drug abuse
Dropping out
of school
Alcohol abuse
0.00%
38. Please mark how you would rate your
community as a "Healthy Community":
60.00%
3.01%
1.09%
Other (please
specify)
1.34%
14.00%
11.96%
Not using seat
belts/child
safety…
0.38%
Gang activity
10.55%
6.01%
Gambling
20.00%
18.48%
(532 Responses)
55.08%
40.00%
30.08%
20.00%
8.83%
5.64%
0.38%
0.00%
Very unhealthy
Unhealthy
Somewhat healthy
Healthy
Very healthy
39. Please think about your daily activities during (534 Responses)
the past 4 weeks. You did less than you would have
liked to due to mental or emotional problems:
100.00%
82.58%
80.00%
60.00%
40.00%
20.00%
17.42%
0.00%
Yes
No
70
40. The following aspects of my life are really
stressful right now(check all that apply):
(389 Responses)
40.00%
31.16%
28.64%
17.09%
20.00%
11.56%
5.03%
3.27%
Relationship with
spouse
Relationship with
family
3.27%
0.00%
Employment
Personal Health
Child/parent care
Finances
41. Please mark how you cope with stress
20.00%
(1786 Responses)
15.96%
16.00%
12.00%
Other
13.16%
9.07%
10.02%
8.00%
3.19%
2.97%
4.00%
10.02%
9.18%
7.56%
2.80%
9.85%
1.90%
0.39%
0.11%
1.12%
2.69%
42. On a typical day, you would rate your level
of stress as:
Other
N/A
Consume illegal
drugs
Exercise
Talk to family
Hurt self
Drink alcohol
Meditate
Listen to music
Smoke
Pray
Read
Take prescription
medications
Eat
Talk to friends
Watch TV
0.00%
(535 Responses)
60.00%
45.98%
40.00%
24.86%
15.70%
20.00%
9.35%
4.11%
0.00%
Very high
High
Moderate
Low
Very low
71
43. On average, how many times per week
do you exercise?
(532 Responses)
40.00%
32.52%
34.77%
23.50%
20.00%
9.21%
0.00%
Every day
3-5 times
1-2 times
44. You wear a seat belt:
None
(521 Responses)
100.00%
84.26%
80.00%
60.00%
40.00%
20.00%
11.13%
3.07%
1.54%
Never
N/A
0.00%
Always
Sometimes
45. Your child/children (under age 4)
use a child seat:
80.00%
(481 Responses)
70.27%
60.00%
40.00%
29.52%
20.00%
0.21%
0.00%
Sometimes
Never
0.00%
Always
N/A
72
46. Your child/children (age 4 or older)
use a seat belt:
60.00%
(490 Responses)
54.49%
44.49%
40.00%
20.00%
0.82%
0.20%
Sometimes
Never
0.00%
Always
47. You wear a helmet when riding a bicycle,
rollerblading or skateboarding:
N/A
(495 Responses)
80.00%
63.23%
60.00%
40.00%
20.00%
15.76%
14.95%
6.06%
0.00%
Always
Sometimes
Never
48. You wear a helmet when riding a motor
scooter, ATV or motorcycle:
N/A
(496 Responses)
80.00%
64.31%
60.00%
40.00%
23.99%
20.00%
4.84%
6.85%
Sometimes
Never
0.00%
Always
N/A
73
49. You drive the posted speed limit:
60.00%
(516 Responses)
52.71%
40.70%
40.00%
20.00%
2.71%
3.88%
Never
N/A
0.00%
Always
Sometimes
50. You eat at least 5 servings of fruits and
vegetables each day:
(512 Responses)
80.00%
66.02%
60.00%
40.00%
20.00%
17.19%
13.28%
3.52%
0.00%
Always
Sometimes
Never
51. You eat fast food more than once a week:
60.00%
N/A
(519 Responses)
52.60%
40.00%
31.21%
20.00%
12.33%
3.85%
0.00%
Always
Sometimes
Never
N/A
74
52. You exercise at a moderate pace at least
30 minutes per day, 5 days per week:
(517 Responses)
60.00%
40.43%
40.00%
20.00%
37.52%
17.41%
4.64%
0.00%
Always
Sometimes
Never
53. You consume more than 3 alcoholic drinks
per day (female) or more than 5 per day (male):
80.00%
N/A
(507 Responses)
68.05%
60.00%
40.00%
15.78%
14.40%
20.00%
1.78%
0.00%
Always
Sometimes
Never
54. You smoke cigarettes:
80.00%
N/A
(505 Responses)
69.50%
60.00%
40.00%
20.00%
13.47%
13.27%
3.76%
0.00%
Always
Sometimes
Never
N/A
75
55. You use chewing tobacco:
(497 Responses)
100.00%
77.87%
80.00%
60.00%
40.00%
16.90%
20.00%
2.01%
3.22%
Always
Sometimes
0.00%
Never
56. You text while driving a motor vehicle:
N/A
(498 Responses)
80.00%
61.45%
60.00%
40.00%
24.70%
20.00%
10.84%
3.01%
0.00%
Always
Sometimes
Never
57. You are exposed to secondhand smoke
in your home or at work:
N/A
(502 Responses)
80.00%
62.75%
60.00%
40.00%
20.00%
13.94%
10.56%
12.75%
0.00%
Always
Sometimes
Never
N/A
76
58. You use illegal drugs (marijuana, cocaine,
methamphetamine, etc.):
(501 Responses)
100.00%
80.64%
80.00%
60.00%
40.00%
17.37%
20.00%
0.00%
0.40%
1.60%
Always
Sometimes
Never
59. You perform self-exams for cancer
(breast or testicular):
60.00%
N/A
(510 Responses)
50.20%
40.00%
24.71%
20.00%
16.08%
9.02%
0.00%
Always
Sometimes
Never
60. You wash your hands with soap and water
after using the restroom:
N/A
(515 Responses)
100.00%
81.36%
80.00%
60.00%
40.00%
14.95%
20.00%
2.33%
1.36%
Never
N/A
0.00%
Always
Sometimes
77
61. You wash your hands with soap and water
before preparing and eating meals:
(512 Responses)
100.00%
82.03%
80.00%
60.00%
40.00%
14.06%
20.00%
1.56%
2.34%
Never
N/A
0.00%
Always
Sometimes
62. You apply sunscreen before planned
time outside:
(506 Responses)
80.00%
57.51%
60.00%
40.00%
24.11%
14.62%
20.00%
3.75%
0.00%
Always
Sometimes
Never
63. You get a flu shot each year:
60.00%
N/A
(512 Responses)
54.30%
40.00%
25.39%
20.00%
15.43%
4.88%
0.00%
Always
Sometimes
Never
N/A
78
64. You get enough sleep each night (7-9 hours):
(510 Responses)
80.00%
60.20%
60.00%
40.00%
26.86%
20.00%
11.18%
1.76%
0.00%
Always
Sometimes
Never
65. You feel stressed out:
N/A
(503 Responses)
80.00%
67.40%
60.00%
40.00%
20.00%
16.70%
13.32%
2.58%
0.00%
Always
Sometimes
Never
66. You feel happy about your life:
60.00%
N/A
(497 Responses)
51.91%
43.26%
40.00%
20.00%
2.62%
2.21%
Never
N/A
0.00%
Always
Sometimes
79
67. You feel lonely:
(504 Responses)
60.00%
42.86%
46.03%
40.00%
20.00%
6.15%
4.96%
0.00%
Always
Sometimes
Never
68. You worry about losing your job:
N/A
(496 Responses)
37.90%
40.00%
35.89%
19.56%
20.00%
6.65%
0.00%
Always
Sometimes
Never
69. You feel safe in your community:
60.00%
N/A
(503 Responses)
52.88%
42.15%
40.00%
20.00%
3.38%
1.59%
Never
N/A
0.00%
Always
Sometimes
80
(493 Responses)
70. You practice safe sex (condom, abstinence
or other barrier method, etc.):
60.00%
44.22%
40.00%
37.73%
20.00%
8.11%
9.94%
Sometimes
Never
0.00%
Always
N/A
(518 Responses)
71. Do you keep firearms in your home?
60.00%
53.09%
39.19%
40.00%
20.00%
7.72%
0.00%
Yes
No
N/A
72. If firearms are kept in your home, are they
stored unloaded and separate from ammunition?
(491 Responses)
60.00%
43.38%
40.12%
40.00%
16.50%
20.00%
0.00%
Yes
No
N/A
81
(516 Responses)
73. Does domestic violence impact your life?
100.00%
88.37%
80.00%
60.00%
40.00%
20.00%
9.11%
2.52%
0.00%
Yes
No
N/A
74. If you have children, what is your primary (481 Responses)
resource for obtaining childhood immunizations?
80.00%
58.63%
60.00%
40.00%
26.82%
20.00%
12.68%
1.04%
0.83%
Free clinic
Other
0.00%
Doctor's office
County Health Department
N/A
82
SOURCES
Sources
2011.1 Nielsen Demographic Update, the Nielsen Company, April 2011
Regional Economic Conditions (RECON). 2006-2010, Federal Deposit Insurance Corporation, 8 Dec.
2011 < http://www2.fdic.gov/recon/index.asp>
United States Department of Labor: Bureau of Labor Statistics. 2010. U.S. Department of Census. 8
Nov. 2011 <http://www.bls.gov/cew/>.
2010 Poverty and Median Income Estimates – Counties, U.S. Census Bureau, Small Areas Estimate
Branch, November 2011.
Branch, December 2010.
Branch, November 2009.
Branch, December 2008.
2009 Health Insurance Coverage Status for Counties and States: Interactive Tables. U.S. Census
Bureau, Small Area Health Insurance Estimates. 13 Jan. 2012
<http://www.census.gov/did/www/sahie/data/2009/tables.html>.
County Health Rankings: Mobilizing Action Toward Community Health. 2011. Robert Wood Johnson
Foundation and the University of Wisconsin Population Health Institute. 30 Nov. 2011
<http://www.countyhealthrankings.org>.
Community Health Status Indicators: CHSI 2009. U.S. Department of Health & Human Services. 8
Nov. 2011 <http://communityhealth.hhs.gov/>.
HealthyPeople.gov. 2011. U.S. Department of Health and Human Services. 30 Nov. 2011
<http://www.healthypeople.gov/>.
Missouri Economic Research and Information Center. Missouri Department of Economic Development.
http://www.missourieconomy.org/indicators/laus/default.aspx
Missouri Department of Economic Development. Missouri Division of Business and Community
Service. http://www.missourieconomy.org/regional.location_one.html
Missouri Department of Health & Senior Services. Leading Cause of Death Profile.
http://health.mo.gov/data/mica/ASPsDeath/header.php?cnty=213#
Cost Report Data. Single Cost Reports. http://www.costreportdata.com/search.php
Missouri Hospital Association. Hospital Industry Data Institute (HIDI). Taney County & Stone County
PO103E – 2008 Annual. Discharges by Hospital, Age, and Major Service.
Health, United States, 2011 with Special Feature on Socioeconomic Status and Health. Table 96. Visits
to Physician Offices, Hospital Outpatient Departments, and Hospital Emergency Departments, by Age,
83
Sex, and Race: United States, selected years 1995-2009.
http://www.cdc.gov/nchs/data/hus/hus11.pdf#096
Healthcare Strategy Group. Physician Strategy News: June 2008.
http://www.healthcarestragetygroup.com/newsletters/articl.php?show=advanced_manpower. October
18, 2012.
Merritt Hawkins, an AMN Healthcare Company. A Review of Physician-To-Populations Ratios.
http://www.merritthawkins.com/pdf/a-review-of-physician-to-population-ratios.pdf. October 18, 2012.
Physician Supply and Demand: Projections to 2020. U.S. Department of Health and Human Services
Health Resources and Services Administration Bureau of Health Professions October 2006. Exhibit 11.
http://ftp.hrsa.gov/migrated/bhpr/workforce/PhysicianSupplyDemand.pdf. October 18, 2012.
84

Skaggs Community Hospital Association

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