ST. VINCENT KOKOMO HOSPITAL COMMUNITY HEALTH NEEDS

Transcription

2016
COMMUNITY HEALTH
NEEDS ASSESSMENT
ST. VINCENT KOKOMO HOSPITAL
COMMUNITY HEALTH NEEDS ASSESSMENT REPORT
2016
COMMUNITY HEALTH NEEDS ASSESSMENT - 2
Contents
EXECUTIVE SUMMARY ........................................................................................................... 4
DEMOGRAPHICS .................................................................................................................................4
IDENTIFYING COMMUNITY HEALTH NEEDS – METHODOLOGY ........................................................................4
Secondary Data ...................................................................................................................................... 4
Primary Data – Community Input .......................................................................................................... 4
SIGNIFICANT COMMUNITY HEALTH NEEDS ................................................................................................4
PRIORITIZATION PROCESS & PRIORITY NEEDS ............................................................................................5
CONCLUSION .....................................................................................................................................5
NOTE TO THE READER ..........................................................................................................................5
INTRODUCTION ..................................................................................................................... 6
ABOUT ST. VINCENT HEALTH .................................................................................................................6
ABOUT ST. VINCENT KOKOMO HOSPITAL .................................................................................................6
ABOUT HEALTHY COMMUNITIES INSTITUTE ...............................................................................................6
SERVICE AREA ....................................................................................................................... 6
DEMOGRAPHICS .................................................................................................................... 6
POPULATION .....................................................................................................................................7
Race/ethnicity ........................................................................................................................................ 7
Age ......................................................................................................................................................... 7
ECONOMY.........................................................................................................................................7
Income ................................................................................................................................................... 7
Poverty ................................................................................................................................................... 8
Unemployment ...................................................................................................................................... 8
EDUCATION ....................................................................................................................................9
TRANSPORTATION............................................................................................................................. 10
PRECEDING CHNA EFFORTS & PROGRESS ............................................................................. 11
PRIORITY HEALTH TOPICS IN PRECEDING CHNA ....................................................................................... 11
COMMUNITY FEEDBACK ON PRECEDING CHNA & IMPLEMENTATION PLAN .................................................... 11
IDENTIFYING SIGNIFICANT COMMUNITY HEALTH NEEDS: METHODOLOGY ........................... 12
SECONDARY DATA ............................................................................................................................ 12
Overview .............................................................................................................................................. 12
Analyzing Disparities ............................................................................................................................ 13
Identifying Geographic Areas of Highest Need ................................................................................... 13
PRIMARY DATA: COMMUNITY INPUT ..................................................................................................... 14
SIGNIFICANT COMMUNITY HEALTH NEEDS ASSESSMENT FINDINGS ..................................... 15
GEOGRAPHICAL AREAS OF HIGHEST NEED ............................................................................................... 16
QUALITY OF LIFE FINDINGS .................................................................................................................. 16
HEALTH NEEDS FINDINGS ................................................................................................................... 17
SIGNIFICANT HEALTH NEEDS ................................................................................................................ 20
PRIORITIZATION OF TOP HEALTH NEEDS .............................................................................. 22
PRIORITIZATION SESSION PARTICIPANTS ................................................................................................. 22
PRIORITIZATION PROCESS ................................................................................................................... 22
Focus Group Discussion ....................................................................................................................... 23
HEALTH PRIORITIES FOR HOWARD COUNTY......................................................................... 25
SUBSTANCE ABUSE ............................................................................................................................ 25
ACCESS TO HEALTH SERVICES ............................................................................................................... 27
MENTAL HEALTH & MENTAL DISORDERS ................................................................................................ 29
EXERCISE, NUTRITION, & WEIGHT ........................................................................................................ 30
DIABETES ........................................................................................................................................ 33
OTHER SIGNIFICANT COMMUNITY HEALTH NEEDS .................................................................................... 35
CONCLUSION ....................................................................................................................... 37
APPENDIX A: EVALUATION OF PRECEDING CHNA PRIORITIES ............................................... 38
APPENDIX B: SECONDARY DATA ANALYSIS .......................................................................... 42
SCORING METHOD ............................................................................................................................ 42
Comparison to a Distribution of County Values: Within State and Nation ......................................... 42
Comparison to Values: State, National, and Targets ........................................................................... 42
Trend Over Time .................................................................................................................................. 42
Missing Values ..................................................................................................................................... 42
Indicator Scoring .................................................................................................................................. 43
Topic Scoring........................................................................................................................................ 43
DISPARITIES..................................................................................................................................... 43
SCORING RESULTS ........................................................................................................................ 44
DATA SOURCES................................................................................................................................. 50
APPENDIX C: COMMUNITY INPUT – KEY INFORMANT INTERVIEW QUESTIONS ..................... 51
APPENDIX D: PRIORITIZATION TOOLS .................................................................................. 52
APPENDIX E: AUTHORS ........................................................................................................ 63
APPENDIX F: COMMUNITY INPUT REPORT FOR HOWARD COUNTY ...................................... 64
For comments or questions about this report, please contact
St. Vincent Community Development & Health Improvement:
[email protected]
P ROD UCE D BY HEA LTH Y C OMMU NITIE S I NST ITUT E, OCT OBE R 2 01 5
WWW. HEA LTHY COMMU NIT I ES .C OM
Executive Summary
As part of St. Vincent Health’s 2016 Community Benefit efforts, St. Vincent Kokomo Hospital is pleased to present
the 2016 Community Health Needs Assessment (CHNA). As federally required by the Affordable Care Act, this
report provides an overview of the methods and process used to identify and prioritize significant health needs in
Howard County, Indiana. St. Vincent Health contracted Healthy Communities Institute (HCI) to help facilitate their
system-wide CHNA work and document all efforts into the 2016 reports for each hospital.
DEMOGRAPHICS
st
According to the 2015 County Health Rankings, Howard County ranks 61 out of 92 Indiana counties in health
outcomes. Howard County demographics are slightly more homogenous than the overall Indiana state population.
According to Nielsen Claritas 2015, 87.5% the county’s population is White, 7.1% is Black/African American, 1.1%
is Asian, 2.% is of two or more races, and 3.2% is Hispanic/Latino. The median household income is lower than the
state at about $38,922 annually, and roughly 13.1% of Howard County families are living in poverty, which is
®
slightly higher than the state. HCI’s SocioNeeds Index identified the zip code of 46901 as having the greatest
socioeconomic need.
IDENTIFYING COMMUNIT Y HEALTH NEEDS – METHODOLOGY
SECONDARY DATA
The secondary data used in this assessment was obtained and analyzed from the St. Vincent Health Community
Dashboard (http://www.stvincent.org/chna), which includes a comprehensive dashboard of over 100 community
health and quality of life indicators covering over 20 topic areas. Indicator values for Howard County were
compared to other counties in Indiana and nationwide to score health topics and compare relative areas of need.
Other considerations for health areas of need included trends over time, Healthy People 2020 targets, and
disparities by gender and race/ethnicity.
PRIMARY DATA – COMMUNITY INPUT
The needs assessment was further informed by interviews with community members who have a fundamental
understanding of Howard County’s health needs and represent the broad interests of the community. Eight key
informants provided valuable input on the county’s health challenges, the sub-populations most in need, and
existing resources for county residents.
SIGNIFICANT COMMUNIT Y HEALTH NEEDS
Primary and secondary data were evaluated and synthesized to identify the significant community health needs in
Howard County. These needs span the following topic areas and are often inter-related:
Wellness & Lifestyle
Diabetes
Substance Abuse
Children’s Health
Respiratory
Diseases
Social Environment
Transportation
Exercise, Nutrition,
& Weight
Mental Health &
Mental Disorders
Access to Health
Services
PRIORITIZATION PROCESS & PRIORITY NEEDS
Kokomo Hospital called together hospital decision makers and community leaders to prioritize the significant
community health needs of Howard County considering several criteria: alignment with Ascension Health
strategies of healthcare that leaves no one behind and care for the poor and vulnerable; opportunities for
partnership; availability of existing programs and resources; opportunities for partnership; addressing disparities of
subgroups; availability of evidence-based practices; and community input. The following five health and/or quality
of life topics were selected as the top priorities:
Substance Abuse
Access to Health
Services
Mental Health &
Mental Disorders
Exercise, Nutrition,
& Weight
Diabetes
CONCLUSION
This report describes the process and findings of a comprehensive health needs assessment for the residents of
Howard County, Indiana. The prioritization of the identified significant health needs will guide the community
health improvement efforts of St. Vincent Kokomo Hospital. From this process, St. Vincent Kokomo will outline
how they will address the top five prioritized health needs in their Implementation Strategy.
NOTE TO THE READER
Your feedback is welcomed and encouraged. Please send any feedback and/or comments about this report to:
[email protected].
Introduction
ABOUT ST. VINCENT HEALTH
St. Vincent Health has been serving their Indiana community members for over 130 years. As a member of
Ascension Health, the largest Catholic health care system in the country, the St. Vincent mission is to care for the
body, mind and spirit of those in need, regardless of personal means or religious affiliation.
St. Vincent is dedicated to providing spiritually centered, holistic care, that sustains and furthers both individual
and community health - with 22 health ministries serving 47 counties in Central and Southern Indiana.
ABOUT ST. VINCENT KOKOMO HOSPITAL
St. Vincent Kokomo, formerly St. Joseph Hospital, is a 138-bed acute care facility that has been serving Howard
County for over 100 years. As a nonprofit hospital, and part of St. Vincent Health, Kokomo Hospital is dedicated to
improving the health of Howard County residents, with special attention to the poor and vulnerable. St. Vincent
Kokomo Hospital is located in Kokomo, Indiana, and serves Howard County.
ABOUT HEALTHY COMMUNITIES INSTITUTE
Healthy Communities Institute, now part of Midas+, a Xerox Company, was retained by St. Vincent Health to
conduct the 2016 Community Health Needs Assessment (CHNA) for 11 of their service areas, and to author the
subsequent CHNA reports for each service area.
Based in Berkeley, California, HCI provides customizable, web-based information systems that offer a full range of
tools and content to improve community health, and developed the St. Vincent Community Health Needs
Assessment Platform. The organization is comprised of public health professionals and health IT experts
committed to meeting clients’ health improvement goals.
To learn more about Healthy Communities Institute please visit www.HealthyCommunitiesInstitute.com.
Service Area
St. Vincent Kokomo Hospital is located in Kokomo, Indiana. St. Vincent Kokomo serves Howard County, which
includes the city of Kokomo and the towns of Russiaville and Greentown. Howard County has an estimated
population of 82,660 and, according to the 2015 County Health Rankings, ranks 61st out of 92 Indiana counties for
overall health. Howard County is a manufacturing center, and has many workers who commute into the county
from other communities.
Demographics
The demographics of a community significantly affect its health profile. Different race/ethnic, age and
socioeconomic groups may have unique needs and require varied approaches to health improvement efforts. All
estimates are sourced from the 2015 Nielsen Claritas data unless otherwise indicated.
POPULATION
Howard County has a population of 82,660.
Figure 1 shows the population count by zip
code, with St. Vincent Kokomo Hospital being
located in Howard County’s zip code with the
highest population count (46901).
Figure 1.
RACE/ETHNICITY
Howard County’s population is slightly more
homogenous than that of the statewide
population, with 87.5 percent of the
population being white. The remaining
population primarily consists of Black/African
American, those of 2 or more races, and
Asian. At 3.2 percent, the Hispanic/Latino
population is less than the state.
Figure 2.
St. Vincent
Kokomo
AGE
5-17
As shown in Figure 2, the age distribution of
Howard County is quite similar to the rest of
Indiana with the exception of some minor
differences. Proportionally, there are slightly less
young adults aged 18-24 years old and there are
more adults who are 65 and older when
compared to Indiana state. The proportion of
children aged 0-7 and adults aged 25-64 are
approximately the same between the county and
state.
ECONOMY
INCOME
The median household income of Howard County is $38,922, which is approximately $10,000 less than Indiana as a
state overall. At a more granular level, there are variations in income levels among Howard County zip codes. In
Figure 3, Zip Code 46901 is shown as having the lowest median household income when compared to other zip
codes, the county value, and the state value. The zip code in gray has the highest income level.
Figure 3.
POVERTY
Figure 4.
As shown in Figure 4, the family poverty rates in
Howard County are higher compared to the rest of
the state. Families and families with children living
below the poverty line in the county are higher by
about 2 percent.
Figure 5.
UNEMPLOYMENT
The overall unemployment rate in Howard
County is slightly higher than Indiana, and is
highest among males by a small margin. The
unemployment rate in Howard County ranges
from 6.5% to 11.5% among the county’s zip
codes, with an overall county value of 10.6%.
The map in Figure 5 shows zip code 46901 as
having the highest unemployment rate in the
county. At 11.1%, Howard County males have
a higher unemployment rate than the county
overall, state, and females in both the county
and state (see Figure 6).
Figure 6.
EDUCATION
In the chart under Figure 7, high school degree
attainment in the adult population among Howard
County residents is about even with the state, but
bachelor degree attainment is about 5 percent lower
in Howard.
Figures 8 and 9 show maps of High School Degree or
Higher and Bachelor’s Degree or higher by zip code for
the 25 years and older population of Howard County.
Zip code 46901 has the lowest high school degree
attainment and lowest bachelor’s degree attainment
within the county.
Figure 8.
Figure 7.
Figure 9.
TRANSPORTATION
The area covered by Zip Code 46901 has the
highest percentage of households without a
vehicle when compared to other Howard
County zip codes.
Figure 10.
Preceding CHNA Efforts & Progress
The CHNA process should be viewed as a
three-year cycle (Figure 11). An important
piece of that cycle is revisiting the progress
made on priority health topics set forth in the
preceding CHNA. By reviewing the actions
taken to address a priority health issue and
evaluating the impact those actions have
made in the community, it is possible to
better target your resources and efforts
during your next round of the CHNA cycle.
Figure 11. 3-Year CHNA Cycle
3-Year Cycle
PRIORITY HEALTH TOPI CS IN
PRECEDING CHNA
St. Vincent Kokomo’s priority health topics for
FY 14-16 were:






Obesity
Food/Access to Food
Jobs/Economic Opportunity
Addiction
Mental Health
Teen Births/Family Disintegration
A detailed table describing the strategies/action steps and indicators of success for each of the preceding priority
health topics that were included in the Implementation Strategy (Obesity, Hunger, and Jobs/Economic
Opportunity) can be found in Appendix A.
COMMUNITY FEEDBACK ON PRECEDING CHNA & I MPLEMENTATION PLAN
St. Vincent Kokomo’s preceding CHNA was made available to the public via the website: stvincent.org. To collect
comments or feedback on the report, a special email address was created:
[email protected]. No comments had been received on the preceding CHNA at the time this
report was being written.
Identifying Significant Community Health
Needs: Methodology
Significant community health needs for Howard County were determined using a combination of secondary and
primary data (community input).
SECONDARY DATA
OVERVIEW
Secondary data used for this assessment were collected and analyzed with the St. Vincent Community Dashboard
(http://stvincent.org/chna/), a web-based community health data platform developed by Healthy Communities
Institute and sponsored by St. Vincent. The community dashboard brings non-biased data, local resources and a
wealth of information to one accessible, user-friendly location. It includes a comprehensive dashboard of over 100
community indicators covering over 20 topics in the areas of health, determinants of health, and quality of life. The
data are primarily derived from state and national public secondary data sources. The value for each of these
indicators is compared to other communities, nationally or locally set targets, and to previous time periods.
HCI’s Data Scoring Tool was used to systematically summarize multiple comparisons across the Community
Dashboard to rank indicators based on highest need. For each indicator, the community value was compared to a
distribution of Indiana and US counties, state and national values, Healthy People 2020 and significant trends were
noted. These comparison scores range from 0-3, where 0 indicates the best outcome and 3 the worst. Availability
of each type of comparison varies by indicator and is dependent upon the data source, comparability with data
collected for other communities, and changes in methodology over time. These indicators were grouped into topic
areas for a higher level ranking of community health needs. More detailed methodology used by the Data Scoring
Tool is described in Appendix B: Secondary Data Analysis.
Figure 12. HCI Data Scoring
Overview
Score range:
Good
0
1
Bad
2
3
Table 1. Quality of Life and Health Topics
Areas
Quality of Life
Economy
Education
Environment
Public Safety
Social Environment
Transportation
Health
Access to Health Services
Cancer
Children’s Health
Diabetes
Exercise, Nutrition, & Weight
Heart Disease & Stroke
Immunization & Infectious
Diseases
Kidney & Urinary Tract Diseases
Maternal, Fetal & Infant Health
Men’s Health
Mental Health & Mental Disorders
Older Adults & Aging
Prevention & Safety
Respiratory Diseases
Substance Abuse
Women’s Health
Indicators were categorized into 23 topic areas, which were further classified as a quality of life or
health topic.
Please note that the most recent period of measure was used for all secondary data presented in this report (as
publicly available on January 20, 2015).
ANALYZING DISPARITIES
Outside of topic area scoring, a separate analysis was conducted to determine if disparities exist among subpopulations within Howard County. If age, gender, or race/ethnicity specific values were available, the indicator
was evaluated for the presence of substantial disparities. For details on the methods used to analyze disparities,
please see Appendix B: Secondary Data Analysis.
IDENTIFYING GEOGRAPHI C AREAS OF HIGHEST N EED
®
The SocioNeeds Index —developed by
Healthy Communities Institute and available
on the St. Vincent health data platform—is a
tool used to help determine which
communities of Howard County are in most
need of services and interventions. The Index
summarizes multiple socioeconomic
indicators, ranging from poverty to
education, which may affect health or access
to care. All zip codes in the United States are
given an Index value from 0 (low need) to 100
(high need). Within Howard County, zip codes
are ranked based on their Index value. These
ranks are used to identify the relative level of
need within the county.
Figure 13. The SocioNeeds Index
®
PRIMARY DATA: COMMUNITY INPUT
To expand upon the information gathered from the secondary data, Healthy Communities Institute conducted key
informant interviews to collect community input. Interviewees who were asked to participate were recognized as
having expertise in public health, special knowledge of community health needs and/or represented the broad
interest of the community served by the hospital, and/or could speak to the needs of medically underserved or
vulnerable populations. Fourteen individuals were contacted for the service area, and eight agreed to participate
and scheduled an interview. The following organizations were contacted to provide community input through key
informant interviews with HCI. Those in bold were able to provide an interview:
 211 of Howard County – United Way
 Kokomo Police Department
 4Community of Howard County
 Kokomo Urban Outreach
 Bridges Outreach
 Project Access
 Headstart
 Rescue Mission
 Howard County Commissioner
 St. Vincent Kokomo Hospital Behavioral
Health
 Howard County Public Health
 Western High School
 Indiana Health Center
 Kokomo Economic Development Alliance
Interviews were conducted during the months of February to April 2015 by telephone and ranged from 11-33
minutes in length. During the interview, questions were asked to learn about the interviewee’s background and
organization, biggest health needs and barriers of concern in the community, as well as the impact of health issues
on vulnerable populations. A list of the questions asked during the interviews can be found in Appendix C.
Each interview included both an interviewer and a note taker from HCI, so much of the conversation was captured
verbatim. Notes taken during the interviews were uploaded to a summary qualitative data analysis tool,
TagCrowd.com, to create a word cloud. Word clouds help to identify the words or phrases mentioned most often
in the interviews, and appear in the largest and darkest font in Figure 14 below.
Figure 14. Primary Data Word Cloud
The word cloud was used to get an initial sense of the major issues in the community. The interview notes were
also uploaded to the web application Dedoose, a qualitative data analysis software. Using the major issues from
the word cloud, themes from the interview questions (such as needs, barriers and advice), and secondary data
health and quality of life topics, a code list was created. Interview notes were coded using this list, which allows for
comparison and inclusion of the primary data with the secondary data throughout the report. Input from key
informants is included in each relevant topic area. The code cloud below, Figure 15, was created from the key
informant interview transcripts, where the size and darkness of the words reflect the relative number of times the
word appeared. The figure provides an overall picture of the themes that were most prominent in the community
input.
Figure 15. Primary Data Code Cloud
Significant Community Health Needs
Assessment Findings
The secondary data summary and key informant interview findings are presented together to capture a more
holistic assessment of health needs in Howard County. Quality of life topics are presented first, as they are key to
understanding the barriers to health in the community. Furthermore, the availability of socioeconomic data for
specific sub-populations and sub-county geographies provides a framework for identifying the populations most
vulnerable to the poor health outcomes identified.
®
Figure 16. HCI SocioNeeds Index by Zip Code, Howard County
®
Table 2. HCI SocioNeeds Index
Values & Rankings by Zip Code,
Zip Code
Rank
Howard
County Index
46901
46902
46936
46979
75.2
66.6
33.8
24.9
4
3
2
1
GEOGRAPHICAL AREAS O F HIGHEST NEED
Social and economic factors are well known to be strong determinants of health outcomes. The HCI SocioNeeds
®
Index summarizes multiple socioeconomic indicators, ranging from poverty to education, which may affect health
or access to care. All zip codes in the United States are given an Index value from 0 (low need) to 100 (high
need). Within Howard County, zip codes are ranked based on their Index value (see Table 2). These ranks are used
to identify the relative level of need within the county.
Geographically, there are parts of Howard County for which quality of life issues are of greater concern (Figure 16).
The Index shows that zip codes 46901 and 46902 are the communities with the highest socioeconomic need within
Howard County and are more likely to be affected by poor health outcomes.
QUALITY OF LIFE FINDINGS
Socioeconomic indicators across the
quality of life topic areas point to
multiple barriers to health, and the
effect of these drivers was noted in
both the secondary data and key
informant interviews – specifically
around social environment, economy
and transportation (Table 3). Outside of
Kokomo, Howard County is rural and
one key informant stated that the lowincome population is “more spread out
than it used to be.” Public
transportation has improved in
Kokomo with a free trolley, but
transportation is still a barrier in the
county to accessing services.
Table 3. Quality of Life Topics
Topic
Score
Social Environment
1.92
Economy
1.81
Environment
1.67
Education
1.53
Transportation
1.42
Public Safety
1.29
Key Informant Total:
Community Input
HEALTH NEEDS FINDINGS
The outcomes of the primary and secondary data analysis were combined to identify the significant community
needs in Howard County. The analysis revealed that there were significant needs across the majority of the topic
areas considered.
Table 4 briefly summarizes the findings by topic area, where topics are sorted by secondary data summary score
range; areas are identified with a high disparity score by category; and the number of times the area was identified
as a top need by a key informant. Some topic areas which did not score high or did not have a score in the
secondary data summary were identified as a top need by key informants, underlining the importance of
considering both quantitative data and community input when assessing health issues.
Table 4. Health Topics
Disparities
R
Score
Community Input
2.03
Diabetes
2.02
G
Substance Abuse
1.88
G
Children's Health
1.81
G
1.78
1.77
1.71
1.68
1.68
G
1.60
G
Immunizations & Infectious Diseases
1.36
Prevention & Safety
1.29
R
R
Topic
G
Disparity
Health Topic
R
G
Topic Score
Women's Health
1.22
1.22
1.08
Cancer
0.88
Men's Health
0.63
Community Input
R indicates Disparity by Race
Key Informant Total:
G indicates Disparity by Gender
The graph in Figure 17 below provides an overall synthesis of the primary and secondary data for all quality of life
and health topics available for Howard County analysis. The X-axis demonstrates the evidence of need based on
secondary data scores, and the Y-axis displays evidence of need based on the percentage of key informants
indicating the topic as a health concern. The size of the circles provides another level of evidence—larger circles
indicate more indicators were available for that secondary data topic.
Figure 17. Secondary and Primary Data Synthesis
High Community
Input & Low
Secondary Data
Scoring
Low Community
Input & Low
Secondary Data
Scoring
High Community
Input & High
Secondary Data
Scoring
Low Community
Input & High
Secondary Data
Scoring
Taking the information displayed in the above graph to a broader view of the health needs of Howard County
based on the rigorous secondary data analysis and rich community input that was synthesized, the Venn diagram
below
Figure 18. Venn Diagram of Topic Areas and Data Support
Strong Evidence of Need in
Primary Data
 Transportation
 Access to Health Services
Strong Evidence of Need in
Secondary Data
 Diabetes
 Social Environment
 Children’s Health
 Substance Abuse
 Economy
 Exercise,
 Wellness & Lifestyle
Nutrition, &
Weight
 Respiratory Diseases
 Mental Health &
 Environmental & Occupational
Mental Disorders
Health
 Older Adults & Aging
 Heart Disease and Stroke
 Kidney & Urinary Tract
Infections
 Environment
 Education
Weak Evidence of Need in Primary and Secondary Data:
Immunizations & Infectious Diseases, Maternal, Fetal & Infant Health, Public Safety, Prevention
& Safety, Women’s Health, Cancer, Men’s Health
SIGNIFICANT HEALTH N EEDS
The list of health needs in Table 5 below highlights the most significant health needs based on the analysis and
synthesis of the primary and secondary data. This list represents 10 of the most pressing health and quality of life
topics to be considered for the prioritization process.
Table 5. Significant Health and Quality of Life Topics for Prioritization
Secondary Data
Topic
Score
Health Topic
Disparities in
Data
Primary Data
Community Input
(Total N=8)
Key Themes from Community
Top 5 Health Needs/Concerns from Secondary Data
2.03
Wellness &
Lifestyle
N/a, not mentioned as a top health
need/concern during community
input process
2.02
Diabetes
African-Americans
have  ER Rate
for diabetes and
long-term
diabetes
complications
Diabetes frequently mentioned as an
issue; lack of preventive services or
programs for pre-diabetics.
1.88
Substance
Abuse
Men have 
hospitalization
and ER rates due
to alcohol abuse
Drug and alcohol abuse perceived as
high; heroin and meth use on rise;
smoking a big issue.
1.81
Children’s
Health
Boys have 
hospitalization
rates for pediatric
asthma
Parenting issues and family stability;
nutrition and food allergies; smoking
in the home and childhood asthma.
1.78
Respiratory
Diseases
Women and
African-Americans
have  ER rates
due to adult
asthma
Concern with child asthma rates;
smoking rates and smoking during
pregnancy.
Top Quality of Life
1.92
Social
Environment
Lifestyle and family stability; cycle of
non-traditional family structure;
domestic violence. “Many
grandparents are raising
preschoolers, the parents are out of
the picture for whatever reason.”
1.42
Transportation
Free trolley improved things in city,
but not in county; trolley
schedule/stops may not be
convenient; only one cab company
takes Medicaid, specialists far away.
Top 3 Needs/Concerns from Community Input
1.77
Exercise,
Nutrition &
Weight
Obesity; unhealthy habits overeating, lack of exercise; lack of
nutrition availability and education.
1.71
Mental health
& Mental
Disorders
Lack of mental and behavioral health
services, not enough therapists and
psychiatrists; long wait time for
appointments.
1.08
Access to
Health
Services
Difficulties with health system
navigation; lack of transportation;
issues with understanding new
coverage; provider retention; long
wait times.
Prioritization of Top Health Needs
To better target community resources on Howard County’s most pressing health needs, St. Vincent Kokomo
participated in a group discussion facilitated by HCI to hone in on up to five health needs. Those health needs will
be under consideration for the development of an implementation plan that will address some of the community’s
most pressing health issues.
PRIORITIZATION SESSI ON PARTICIPANTS
o
o
o
o
o
o
o
o
o
o
o
Abbie Smith, United Way of Howard County, President
Dennis Ressler, St. Vincent Kokomo, Executive Director – Finances
Diana H. Lowery, Clinic of Hope, Social Worker
Jeana O’Haver, St. Vincent Kokomo, Solutions Development Analyst
John Rudy, St. Vincent Kokomo, Executive Director of Diagnostic & Treatment Services
Karam Abbasi, MD, St. Vincent Kokomo, General Surgeon
Kathy Peoples, St. Vincent Kokomo, VP Nursing/CNO
Margie Johnson, St. Vincent Kokomo, Interim Regional President
Mark D. Deckinger, St. Vincent Kokomo, Manager Pastoral Care
Robert A. Lee, Township Trustee/Board, Trustee/Board Member
Rolando Fuertes, St. Vincent Kokomo, Health Access Coordinator
PRIORITIZATION PROCESS
On July 15, 2015, the above participants convened at St. Vincent Kokomo to review and discuss the results of HCI’s
primary and secondary data analysis leading to the preliminary top 10 significant health needs highlighted in Table
5 above. From there, participants utilized a prioritization toolkit (Appendix D) to examine how well each of the 10
significant health needs met the criteria set forth by St. Vincent. The criteria for prioritization can be seen in Figure
19 below:
Figure 19: St. Vincent System-Wide Criteria for Prioritization
• Alignment with Ascension Health Strategies –
Healthcare that Leaves No One Behind &
Care for the Poor & Vulnerable
• Community Input
• Opportunity for Partnership
• Availability of Existing Resources or Programs
• Availability of Evidence-Based Practices
• Addresses Disparities of Sub-Groups
FOCUS GROUP DISCUSSION
Additional community input was presented from the Howard County Focus Group, to be taken into account during
the prioritization process. Kelly Peisker, St. Vincent/St. Joseph Hospital, Ann Yeakle, Community Health Network,
Lisa Holaday, Howard Community Hospital, and Whitney Albrecht, student from IUPUI, School of Public Health
facilitated the focus group which was held at the Kokomo Public Library on March 25, 2015, from 11am to 2pm
with key community leaders. In attendance were representatives from:
 Acacia Academy, Indiana University
 Kokomo Housing Authority
 American Cancer Society
 Kokomo Public Library
 Bona Vista
 Kokomo Rescue Mission
 Center Township
 Mental Health Association
 City of Kokomo
 Project Access
 Clinic of Hope
 Samaritan Caregivers
 Community Foundation
 St. Vincent Kokomo Hospital
 Early Headstart
 UAW/Partners for a Healthier Community
 Excel Center
 United Way
 Indiana Health Center
 YMC
 Ivy Tech
The six main topics brought up during the Focus Group were Behavioral & Mental Health, Lifestyle, Access to
Healthcare, Tobacco, Unemployment/Underemployment, and Food Security. In Figure 20 below, these topics were
matched up to HCI secondary data topic definitions, the poorest performing indicators for that topic from the
secondary data analysis, and how the topic fared in the key informant interviews. There was overall agreement
between the main issues mentioned in the focus group and the key informant interviews, though more emphasis
was placed on unemployment/underemployment in the focus group than by key informants.
Figure 20. Howard County Focus Group Findings
Focus Group Health
Topic
HCI Health Topics
Behavioral Health &
Mental Health
Mental Health & Mental
Disorders
Lifestyle
- Wellness & Lifestyle
- Exercise, Nutrition & Weight
Access to Healthcare
Tobacco
Substance Abuse
Unemployment/
Underemployment
Economy
Food Security
Exercise, Nutrition & Weight
Warning Indicators
Secondary Data
 Poor Mental Health Days
 Death Rate to Suicide
 Depression: Medicare Pop.




Adults who are Obese
Adults who are Sedentary
Low-Income Preschool Obesity
Non-Physician Primary Care
Provider Rate
 Adults who Smoke
 Mothers who Smoke during
Pregnancy
 Unemployed Workers in Civilian
Labor Force




Grocery Store Density
Food Environment Index
Food Insecurity Rate
Low Income & Low Access to a
Grocery Store
Community Input
6 out of 8 Key Informants
Completion of the prioritization toolkit in Appendix D allowed participants to arrive at numerical scores for each
health need that correlated to how well each health need met the St. Vincent system-wide criteria for
prioritization. Participants then ranked the top 10 health needs according to their topic scores, with the highest
scoring health needs receiving the highest priority ranking. Participants were encouraged to use their own
judgment and knowledge of their community in the event of a tie score. After completing their individual ranking
of the 10 health needs, participants submitted their ranking into an online polling platform that collates the
submissions and results in an aggregate ranking of the health needs. The aggregate ranking can be seen below in
Figure 21.
Figure 21. Group Ranking of Howard County’s Most Pressing Health Needs
As seen in the group ranking above, the top five health priorities for Howard County to consider for subsequent
implementation planning are:





Substance Abuse
Diabetes
These five health needs will be broken down in further detail below to understand how findings in the secondary
data and community input led to each issue becoming a high priority health need for Howard County.
Health Priorities for Howard County
SUBSTANCE ABUSE
SECONDARY DATA FINDINGS
Substance Abuse’s Poorest Performing Indicators and Rankings

Howard County ranks in the worst quartile in the US, Indiana state, and Indiana Counties for Liquor Store
Density, and ranks in the worst quartile for Indiana state and counties and the Age-Adjusted Hospitalization
Rate due to Alcohol Abuse. According to the CDC, excessive alcohol use, either in the form of heavy drinking
(drinking more than two drinks per day on average for men or more than one drink per day on average for
women), or binge drinking (drinking more than four drinks during a single occasion for men or more than
three drinks during a single occasion for women), can lead to increased risk of health problems such as liver
disease or unintentional injuries.
Health Disparities for Substance Abuse

Males have higher hospitalization and ER rates due to alcohol abuse than females.
Substance Abuse was frequently cited during the key informant interviews. The secondary data analysis illustrates
poor performance across indicators, with the exception of a self-reported indicator of adults who drink excessively.
Table 6 below shows the Substance Abuse indicators that contributed to the topic receiving an overall topic score
of 1.88. The gauges illustrate how Howard County is faring compared to the following six comparisons: the Indiana
State Value, Indiana County Value, US Value, US Counties Value, HP2020 if a target is available, and the time trend
score. A gauge in the green received a score of 0-1 (good), yellow a score of 1-2 (fair), and red a score of 3 (poor).
Table 6. Comparison Scores for Substance Abuse Indicators
Substance Abuse
Topic Score 1.88
Howard
County
Value
Indiana
State
Value
Liquor Store
c
Density
16.9
12.1
2.45
Death Rate due
to Drug
b
Poisoning
25.1
11.9
2.33
Age-Adjusted
Hospitalization
Rate due to
d
Alcohol Abuse
28.3
9.9
2.03
Indicator:
Indiana
State
Indiana
Counties
US
Value
US
Counties
HP2020
Benchmark
Time
Trend
Score
Total
Indicator
Score
Howard
County
Value
Indiana
State
Value
Age-Adjusted
ER Rate due to
e
Alcohol Abuse
32
29.4
Health
Behaviors
a
Ranking
80
Indicator:
AlcoholImpaired
Driving Deaths
Adults who
Smoke
Mothers who
Smoked During
Pregnancy
Adults who
Drink
Excessively
Indiana
State
Indiana
Counties
US
Value
US
Counties
HP2020
Benchmark
Time
Trend
Score
Total
Indicator
Score
1.88
1.80
29.7%
26.2
1.73
24%
22.8
1.73
20.6%
16.5
1.70
13.6
25.4
1.23
a
Value represents Howard County’s rank out of 92 Indiana Counties
b
Value represents the number of deaths per 100,000 population
c
Value represents the number of stores per 100,000 population
d
Value represents the number of hospitalizations per 10,000 population ages 18+
e
Value represents the number of ER visits per 10,000 population ages 18+
COMMUNITY INPUT
Seven out of eight Key Informants cited Substance Abuse as
a need for Howard County.
Key themes from the informants indicate that drug and
alcohol abuse rates are high in the community, heroin and
meth use appears to be on the rise, and smoking continues
to be an issue.
Key informants spoke to substance abuse and the connection
to mental health, and even nutrition. Infectious diseases,
such as hepatitis C, related to drug use are of concern.
Progress has not yet been made around tobacco use despite
“trying to be a smoke free city” and smoking rates during
pregnancy are still too high.
Quotes from Key Informants





“Smoking is a problem – there is an ordinance
where you have to stand outside commercial
buildings – Breathe Easy Committee that was sadly
declined by city government. Smoking is still ok in a
lot of bars and clubs.
“Another health issue- drug use and infectious
diseases relating from drug use. Our police
department just has jurisdiction within city limits,
but a lot of meth/ drug use in rural areas now.”
“Drug and alcohol abuse is a huge issue. It’s the
bulk of what we see, as the chemical dependency
unit in the whole regional area. Sometimes I have an
’all heroin day‘ with appointments.”
“Teen pregnancy, smoking rates during pregnancy –
those are also big issues.”
ACCESS TO HEALTH SER VICES
Access to Health Service’s Poorest Performing Indicators and Rankings

Howard County ranks in the worst quartile in the Indiana state for the Non-Physician Primary Care Provider
Rate. Access to primary care providers increases the likelihood that community members will have routine
checkups and screenings. Moreover, those with access to primary care are more likely to know where to go for
treatment in acute situations.
Since Access to Health Services made the initial shortlist for pressing health needs in Howard County due to
community input evidence, the indicators available in the secondary data for this topic aren’t quite as poor
performing compared to some other topics that were presented for consideration. Table 7 below shows all Access
to Health Services indicators that contributed to the topic receiving an overall topic score of 1.08. The gauges
illustrate how Howard County is faring compared to the following six comparisons: the Indiana State Value, Indiana
County Value, US Value, US Counties Value, HP2020 if a target is available, and the time trend score. A gauge in the
green received a score of 0-1 (good), yellow a score of 1-2 (fair), and red a score of 3 (poor).
Table 7. Comparison Scores for Access to Health Services Indicators
Topic Score 1.08
Howard
County
Value
Indiana
State
Value
39
49
1.73
Adults with
Health
Insurance
81.5%
80.1%
1.40
Clinical Care
c
Ranking
7
Primary Care
a
Provider Rate
59
65
1.18
92.8%
91.3%
0.98
77
48
0.68
57
76
0.38
Indicator:
Non-Physician
Primary Care
a
Provider Rate
Children with
Health
Insurance
Dentist Rate
Indiana
State
Indiana
Counties
US
Value
US
Counties
HP2020
Benchmark
Time
Trend
Score
Total
Indicator
Score
1.20
a
Preventable
b
Hospital Stays
a
Rates are expressed as the number of providers per 100,000 population
b
Indicates the hospital discharge rate for ambulatory care-sensitive conditions (ACSC) per 1,000 Medicare enrollees
c
From the County Health Rankings, this value is the Howard County Ranking out of 92 total Indiana Counties
COMMUNITY INPUT
Seven out of eight Key Informants cited Access to Health Services as a need for
Howard County.
The most pressing issues in regard to access to health services, as cited by key informants were a lack of general
practitioners in the community, the need for more education and outreach around navigating the healthcare
system, and barriers to specialist care.
Key informants also provided
insight to the experiences of poor
and vulnerable populations
pertaining to accessing health
services. The figure to the right
includes some direct quotes from
key informants regarding accessing
health services in their community
and the populations most affected.






“
There’s difficulty in keeping providers and long wait times for patients.
Access to specialist services is difficult for Medicaid patients or those with
no insurance, so wait time is again a big barrier. Lots of patients can’t travel
to the capital for services because it is too far.”
“Once people are on Medicaid or HIP, they are not eligible for any kind of
dental resources in the community. No one can get serious dental
procedures, which can have serious medical consequences.”
“People have issues understanding their new insurance coverage.”
“General public doesn’t even know what a health navigator is or how to deal
with their insurance.”
“I don’t think it’s necessarily the lowest income who are struggling most
because they are covered by Medicaid. It’s the groups that don’t really
qualify, that are working 2 or 3 part-time jobs that don’t offer benefits. Or
maybe they are working full time but can’t afford the benefits. They aren’t
going to see a specialist.”
MENTAL HEALTH & MENT AL DISORDERS
Mental Health & Mental Disorder’s Poorest Performing Indicators and Rankings


Howard County ranks in the worst quartile for Indiana state and counties and US counties for Poor Mental
Health Days – Adults reported that their mental health was not good approximately 4.9 days of the past 30.
Howard County ranks in the worst quartile for Indiana state and the US for the Age-Adjusted Death Rate due
to Suicide. An estimated 25 attempted suicides occur per every suicide death, and those who survive suicide
may have serious injuries, in addition to having depression and other mental problems. Other repercussions of
suicide include the combined medical and lost work costs on the community, totaling to over $30 billion for all
suicides in a year, and the emotional toll on family and friends. Men are about four times more likely than
women to die of suicide, but three times more women than men report attempting suicide. Suicide occurs at a
disproportionately higher rate among adults 75 years and older.
Mental Health & Mental Disorders was a commonly cited issue during our key informant interviews. The topic
made the initial shortlist for pressing health needs in Howard County due to community input evidence more so
than the secondary data, as this topic was not as poor performing compared to some others that were presented
for consideration. Table 8 below shows the poorest performing Mental Health & Mental Disorders indicators that
contributed to the topic receiving an overall topic score of 1.71. The gauges illustrate how Howard County is faring
compared to the following six comparisons: the Indiana State Value, Indiana County Value, US Value, US Counties
Value, HP2020 if a target is available, and the time trend score. A gauge in the green received a score of 0-1
(good), yellow a score of 1-2 (fair), and red a score of 3 (poor).
Table 8. Comparison Scores for Mental Health & Mental Disorders Indicators
Topic Score 1.71
Howard
County
Value
Indiana
State
Value
Poor Mental
Health Days
4.9
3.7
2.43
Age-Adjusted
Death Rate due
to Suicide a
15
13.6
2.30
Depression:
Medicare
Population
16.3%
16.6
2.00
Alzheimer’s
Disease or
Dementia:
Medicare
Population
9.5%
9.7
1.45
Indicator:
Indiana
State
Indiana
Counties
US
Value
US
Counties
HP2020
Benchmark
Time
Trend
Score
Total
Indicator
Score
Indicator:
Age-Adjusted
Death Rate due
to Alzheimer’s
Disease a
a
Howard
County
Value
Indiana
State
Value
21.4
28.3
Indiana
State
Indiana
Counties
US
Value
US
Counties
HP2020
Benchmark
Time
Trend
Score
Total
Indicator
Score
0.35
Value represents the number of deaths per 100,000 population
COMMUNITY INPUT
Six out of eight Key Informants cited Mental Health & Mental Disorders as a need for
Howard County.
The most pressing issues in regard to
mental health and mental disorders in
Howard County were access to mental
and behavioral healthcare. There is a
lack of services and support “across the
board,” as well as concern for children
and youth.



“I think mental health issues and the lack of resources in my opinion is the
#1 issue.”
“Across the board, everyone is affected by mental health in the community.
There are simply not enough therapists or psychiatrists to see in the
community.”
“There are not a lot of resources for kids with mental health issues either,
which is a challenge with behaviors and mental health problems in our
Headstart program.”
EXERCISE, NUTRITION, & WEIGHT
Exercise, Nutrition, & Weight’s Poorest Performing Indicators and Rankings


Howard County ranks in the worst quartile for Indiana and Indiana counties for Adults who are Obese –
Approximately 37.8% of adults are obese compared to 31.4% in Indiana.
Howard County ranks in the worst quartile for Indiana and US counties for Grocery Store Density. There are
strong correlations between the density of grocery stores in a neighborhood and the nutrition and diet of its
residents. The availability and affordability of healthy and varied food options in the community increase the
likelihood that residents will have a balanced and nutritious diet. A diet comprised of nutritious foods, in
combination with an active lifestyle, can reduce the incidence of heart disease, cancer and diabetes, and is
essential to maintain a healthy body weight and prevent obesity. Low-income and under-served communities
often have limited access to stores that sell healthy food, especially high-quality fruits and vegetables.
Moreover, rural communities often have a high number of convenience stores, where healthy and fresh foods
are less available than in larger, retail food markets.
Similar to both Access to Health Services and Mental Health & Mental Disorders, Exercise, Nutrition, & Weight
made the initial shortlist for pressing health needs in Howard County due to community input evidence. The
indicators available in the secondary data for this topic aren’t quite as poor performing compared to some other
topics that were presented for consideration. Table 9 below shows all Exercise, Nutrition, & Weight indicators that
contributed to the topic receiving an overall topic score of 1.77. The gauges illustrate how Howard County is faring
compared to the following six comparisons: the Indiana State Value, Indiana County Value, US Value, US Counties
Value, HP2020 if a target is available, and the time trend score. A gauge in the green received a score of 0-1
(good), yellow a score of 1-2 (fair), and red a score of 3 (poor).
Table 9. Comparison Scores for Exercise, Nutrition, & Weight Indicators
Indicator:
Howard
County
Value
Grocery Store
a
Density
0.1
Adults who are
Obese
37.8%
Food
Environment
c
Index
Topic Score 1.77
Indiana
State
Value
Indiana
State
Indiana
Counties
US
Value
US
Counties
HP2020
Benchmark
Time
Trend
Score
Total
Indicator
Score
2.20
31.4
2.18
7
2.18
7.5%
2.10
0.9
2.10
People 65+ with
Low Access to a
Grocery Store
4.9%
2.10
Farmers Market
a
Density
0
2.03
Low-Income
Preschool
Obesity
15.1%
2.00
Low-Income and
Low Access to a
Grocery Store
9.7%
1.90
Food Insecurity
Rate
15.9%
Children with
Low Access to a
Grocery Store
Fast Food
Restaurant
a
Density
15.7
1.90
Indicator:
Howard
County
Value
Indiana
State
Value
Child Food
Insecurity Rate
22.9%
21.8
Health Behaviors
b
Ranking
Indiana
State
Indiana
Counties
US
Value
US
Counties
HP2020
Benchmark
Time
Trend
Score
Total
Indicator
Score
1.85
80
1.80
Adults who are
Sedentary
30.7%
Households with
No Car and Low
Access to a
Grocery Store
2.2%
1.50
SNAP Certified
a
Stores
0.9
1.00
Recreation and
Fitness Facilities
0.1
0.78
a
Access to
Exercise
Opportunities
27.9
77.4%
1.78
63.9
a
Value expressed as the number per 1,000 population
b
Rankings equate to the value out of 92 Indiana counties
c
Index ranges from 0 (worst) to 10 (best)
0.68
COMMUNITY INPUT
Seven out of eight Key Informants cited Exercise, Nutrition & Weight as a need for
Howard County.
The most pressing issues
in regard to exercise,
nutrition & weight, as
cited by key informants
were obesity among
children and adults,
unhealthy habits such as
overeating and lack of
exercise, and the need for
education on nutrition
and access to healthy
foods. Key informants also




“Access to healthy food is tough – lots of organizations are providing food pantries,
but nutrition isn’t great. There is no education around what is healthy for them and
how to prepare something nutritious.”
“Overeating and lack of exercise are issues in the community.”
“For the past several years, we’ve been fighting childhood obesity. A third of our
students are overweight or obese.”
“From my perspective, people who are underinsured, low-income, ethnic groups –
those people are the hardest hit. It’s a really tough nut to crack, whether it be obesity
(we all love to eat!) or something else, education can only do so much. Smoking…
Those two things are wrecking our society and our economic systems in
communities, families, and individually.”
provided insight to the experiences of poor and vulnerable populations pertaining to exercise, nutrition & weight.
The figure to the right includes some direct quotes from key informants regarding the topic area of exercise,
nutrition, and weight in their community and the populations most affected.
DIABETES
Diabetes’ Poorest Performing Indicators and Rankings

Howard County ranks in the worst quartile in the US, US counties, the state and Indiana counties for AgeAdjusted Death Date due to Diabetes— Lawrence county has 32.4 deaths per 100,000 population. Diabetes
can have a harmful effect on most of the organ systems in the human body; it is a frequent cause of end-stage
renal disease, non-traumatic lower-extremity amputation, and a leading cause of blindness among workingage adults. Persons with diabetes are also at increased risk for ischemic heart disease, neuropathy, and stroke.
In economic terms, the CDC estimates that direct medical expenditures attributable to diabetes is over $116
billion.
Health Disparities for Substance Abuse

African-Americans have higher ER Rate for diabetes and long-term diabetes complications.
The topic of Diabetes had the highest topic score in the secondary data analysis that also was mentioned during
the key informant interviews. Table 10 below shows the poorest performing Diabetes indicators that contributed
to the topic receiving an overall topic score of 2.02. The gauges illustrate how Howard County is faring compared
to the following six comparisons: the Indiana State Value, Indiana County Value, US Value, US Counties Value,
HP2020 if a target is available, and the time trend score. A gauge in the green received a score of 0-1 (good),
yellow a score of 1-2 (fair), and red a score of 3 (poor).
Table 11. Comparison Scores for Diabetes Indicators
Diabetes
Topic Score 2.02
Howard
County
Value
Indiana
State
Value
32.4
24.7
2.65
Diabetes:
Medicare
Population
30.2%
27.6
2.50
Diabetic
Screening:
Medicare .
83.5%
84
2.08
Indicator:
Age-Adjusted
Death Rate due
to Diabetes a
Indiana
State
Indiana
Counties
US
Value
US
Counties
HP2020
Benchmark
Time
Trend
Score
Total
Indicator
Score
Howard
County
Value
Indiana
State
Value
Age-Adjusted
ER Rate due to
Diabetes b
32.1
25.8
2.03
Age-Adjusted
Hospitalization
Rate due to
Uncontrolled
Diabetes c
2.5
2.2
2.03
Age-Adjusted
Hospitalization
Rate due to
Short-Term
Complications
of Diabetes c
10.8
7.3
2.03
Age-Adjusted
ER Rate due to
Long-Term
Complications
of Diabetes b
18.6
11.5
2.03
Age-Adjusted
ER Rate due to
Uncontrolled
Diabetes b
3.7
2.1
2.03
Age-Adjusted
Hospitalization
Rate due to
Diabetes c
20.9
20.3
1.88
Age-Adjusted
ER Rate due to
Short-Term
Complications
of Diabetes b
2.9
1.1
1.83
Age-Adjusted
Hospitalization
Rate due to
Long-Term
Complications
of Diabetes c
7
10.4
1.18
Indicator:
Indiana
State
Indiana
Counties
US
Value
US
Counties
HP2020
Benchmark
Time
Trend
Score
Total
Indicator
Score
COMMUNITY INPUT
Three out of eight Key Informants cited Diabetes as a need for Howard County.
Key informants felt that
diabetes was a major issue
in the community and cited
a lack of programs for prediabetics or preventive
services. It was often
brought up along with issues
of nutrition and obesity.


“Overeating and type of eating, lack of exercise, bad daily habits for diabetes &
heart disease.”
Lack of preventive services for diabetics… the food pantries don’t provide healthy
enough foods for them to be compliant. They can’t visit multiple food pantries to
get what they need. There’s no gluten- or salt-free options for people with chronic
health problems who need to visit the food pantries. Not the amount of food
that’s the problem, it’s the quality of it.”
OTHER SIGNIFICANT COMMUNITY HEALTH NEEDS
As part of the community health needs assessment process, the primary and secondary data analysis identified
additional significant community health needs (Table 11). While these health needs have not been prioritized for
this CHNA cycle, St. Vincent Kokomo and other community partners will still continue to work hard to address the
following issues:





Children’s Health
Social Environment
Transportation
Table 11. Other Significant Community Health Needs for Howard County
Health or
Quality of
Life Topic
Insights from Secondary Data
Topic
Score
Warning Indicators
Contributing to Topic Score
Number of Community
Members Citing Topic as
Pressing Health Concern
Score range:
(Total # interviewed=8)
Good
0
Children’s
Health
1.81
Insights from Primary Data/ Community
Input
1
Bad
2
Children with Low
Access to a Grocery
Store
3
Key Themes from
Community Input
=issue cited
=issue not cited
2.10
 Parenting issues and
family stability
Social
1.92
Environment
Transportation
Respiratory
Diseases
Wellness &
Lifestyle
1.42
1.78
2.03
Age-Adjusted ER
Rate due to Pediatric
Asthma
2.03
Low-Income
Preschool Obesity
2.00
Young Children Living
Below Poverty Level
2.45
Children Living Below
Poverty Level
2.35
Single-Parent
Households
2.05
Workers who Drive
Alone to Work
2.50
Households without
a Vehicle
2.20
Workers Commuting
by Public
Transportation
1.80
Asthma: Medicare
Population
2.65
COPD: Medicare
Population
2.10
Age-Adjusted ER
Rate due to Pediatric
Asthma
2.03
Poor Physical Health
Days
2.43
Self-Reported
General Health
Assessment: Poor or
Fair
2.23
Life Expectancy for
Females
2.15
 Poor nutrition and
perceived increase in
food allergies
 Smoking in the home
and high rates of
childhood asthma
 Lifestyle and family
stability; cycle of nontraditional family
structure; domestic
violence
 “Many grandparents are
raising preschoolers, the
parents are out of the
picture for whatever
reason.”
 Free trolley improved
things in city, but not in
county; trolley
schedule/stops may not
be convenient
 Only one cab company
takes Medicaid;
specialists are far away
 Concern with child
asthma rates
 High smoking rates and
smoking during
pregnancy
 N/a, not mentioned as
a top health
need/concern during
community input
process
Conclusion
This community health needs assessment utilized a comprehensive set of secondary data indicators measuring the
health and quality of life needs of Howard County, Indiana, residents and was further informed with community
input from knowledgeable persons representing the broad interests of the community. The prioritization of the
identified health needs will guide the community health improvement efforts of St. Vincent Kokomo Hospital.
From this process, Kokomo Hospital will outline how they plan to address their prioritized health needs of
Substance Abuse, Access to Health Services, Mental Health & Mental Diseases, Exercise, Nutrition & Weight, and
Diabetes into their Implementation Strategy. In addition, we hope to incorporate any feedback on this report into
our next Community Health Needs Assessment process. Please send your feedback and/or comments to
[email protected].
Appendix A: Evaluation of Preceding CHNA
Priorities
FY14- FY15 St. Vincent Kokomo Hospital
Significant health
need identified in
previous CHNA
Strategy/Action Step
Obesity
1) Provide opportunities for physical
activity
 Continue support for the new
YMCA facility which will provide
greater access to fitness activities
2) Model best practices in workplace
based strategies to support physical
fitness. Issue a “Corporate Challenge”
to area businesses to promote health
and wellness with their employees.
This may include:
 Workplace exercise programs
such as walking/biking programs,
on site fitness equipment, or
group fitness classes
 Promotion of healthy foods
through the cafeterias and
catered workplace events
3) Provide access to healthy foods
 Expand in school healthy snack
pilot program with students at
Pettit Park Elementary School and
consider expansion to “take
home” healthy snacks
 Continue to support the Kokomo
Farmers Market and explore
ability of the Farmers Market to
accept WIC vouchers and SNAP
benefits
 Note: Pettit Park Elementary school’s
students are disproportionately low
income with over 95% who qualify for
free or reduced price meals.
Indicators of Success
SV Kokomo Hospital is a
major financial contributor
toward the construction of a
new YMCA in Kokomo. Our
leadership team has been
involved in community fund
raising efforts.
A Corporate Challenge is
being built into the 2014
“Running the Shores” event.
Also, SV Kokomo. A walking
trail has been established on
the campus the public to use.
A wellness program was
established offering a variety
of fitness classes on a
rotating schedule.
The SV Kokomo Cafeteria
continually offers healthy
choices and education
regarding healthy food
selection and preparation.
SV Kokomo dietitians are
available at the local Farmers
Market to promote healthy
eating and lifestyle. Also,
SV Kokomo has supported
Pettit Park Elementary school
in securing a grant from the
Indiana Department of
Education Fresh Fruit and
Vegetable Program to
provide healthy snacks of
fruits and vegetables to the
students at Pettit Park
4) Promote healthy eating and exercise
to the youth of Howard County
 Incorporate healthy eating into
the “Let’s Pretend Hospital”
 Incorporate a “fun run” into the
annual “Running the Shores” 5K
 Partner with Pettit Park
Elementary School to sponsor an
annual Track and Field day for the
students
Hunger
1) Provide access to nutrient dense foods
to school age youth
 Continue the Buddy Bag week-end
meal program with students at
Pettit Park Elementary School
 Expand in school healthy snack
pilot program with students at
Pettit Park Elementary School and
consider expansion to “take
home” snacks
Note: Pettit Park Elementary school’s
students are disproportionately low
income with over 95% who qualify for free
or reduced price meals.
2) Facilitate access to community
resources that connect families to
food resources
 Continue supporting the Health
Access Worker (HAW) position at
St. Joseph Kokomo Ensure that
the HAW is equipped with up-todate information regarding
resources for families
 Continue to support the Kokomo
Farmers Market and explore
ability of the Farmers Market to
accept WIC vouchers and SNAP
benefits
School. SV Kokomo is a
financial sponsor of the local
Farmers Market. The
Farmers Market now accepts
WIC and SNAP benefits.
Let’s Pretend Hospital
promotes healthy lifestyles to
over 1,500 kindergarten
children in Howard County.
The 2014 “Running the
Shores” will offer a fun
walk/run option. We have
begun exploring the
possibility of a Track and Field
day for the students at Pettit
Park.
SV Kokomo sponsored 110
students in 2013-14 who
received “Buddy Bags”
through the Kokomo Urban
Outreach Buddy Bag
program. We will continue
this sponsorship in 2014-15.
We have not expanded to
“take home” snacks.
SV Kokomo continues to
support our Health Access
Worker, equipping him with
the information and
resources to assist families
and individuals in receiving
the health access they need.
The health access worker is
out in the community
connecting with people
where they live and in the
local office located in the
United Way Building. From
September 2013 thru June
2014 the health access
worker met with and served
over 536 households with
232 initial visits and 304
follow-up visits. Services
rendered by the health
access worker include:
-
Coordination of
appointment to Primary
Care and Specialist, help
with co-pay for
medication or purchase
of the medications.
- Help with co-pay at the
PCP and Dentist, or finds
a third party that would
help with the cost of both
medication and
appointment.
- Regularly visits the
Domestic Violence
Shelter, Open Arms
Women and Children’s
Shelter and the Kokomo
Rescue Mission to
provide services.
- Enrolls uninsured
residents of Howard
County in the Project
Access, HIP, Medicaid,
Hoosier Health Wise,
Food Stamps, TANF and
Market Place programs.
SV Kokomo continues to
support the Farmers Market
financially and by sponsoring
a booth staffed with SV
Kokomo dieticians to provide
cooking demonstrations and
healthy eating education.
The Market accepts WIC and
SNAP vouchers.
Jobs/Economic
Development
1) Promote careers in healthcare to
the residents of Howard County.
 Continue to provide opportunities
for people of all ages to connect
to careers in healthcare via
hospital based workshops,
shadowing experiences,
internships, and clinical rotations.
This would include:
SV Kokomo has promoted
careers in healthcare to
residents of Howard County
with the following:
 Let’s Pretend Hospital
introduces healthcare
careers to over 1,500
Kindergarten children of
Howard County.




“Let’s Pretend Hospital”
program for
Kindergarteners
Shadowing for high school
students enrolled in
Kokomo Area Career
Center
Summer Internship
Program for college
students
Clinical rotations for
Nursing, Radiology,
Emergency Medical
Technician, and
Respiratory Therapist
students
2) Increase career and employment
opportunities for residents of
Howard County.
 Continue leadership role in the
Greater Kokomo Economic
Development Alliance with a focus
on recruiting employers to the
community and preparing
residents to have the workforce
skills to meet the needs of
Howard County employers. This
includes:
 Financial sponsorship
 Participation on the
Governing Board and
Executive Committee
 Hosting of Sister City visit
 Promote and expand the STAR
employment program to adults in
Howard County
3) Explore the development of a
Nurse Practitioner program in
partnership with Ivy Tech
Community College.

In FY 14, provided paid
summer internships for
10 college students as
well as clinical rotations
for more than 120
students from IUK and Ivy
Tech.
 More than 59 nursing
students completing their
Clinical Rotations, 24
EMTs/Paramedics, 8
Respiratory, and 10
Pharmacy students.
 An associate serves on
the Greater Kokomo
Economic Development
Alliance. Two new
employers have been
recruited to the
community: Patriot is
bringing 140 jobs and
Systems In Motion is
bringing 240 jobs.
Update: The STAR program
has been discontinued by St.
Vincent Health.
The Nurse Practitioner
Program is being developed
and is currently awaiting
approval by the I.U. Board of
Trustees (October 2014), as
well as the hiring of a FNP by
SV Kokomo for a dual
appointment at the hospital
and to teach at IUK.
*The last year of the FY14FY16 implementation strategy
will be reported and attached
to the FY16 Form 990.
Appendix B: Secondary Data Analysis
SCORING METHOD
For each indicator, the county was assigned a score based on its comparison to other communities, whether health
targets have been met, and the trend of the indicator value over time. These comparison scores range from 0-3,
where 0 indicates the best outcome and 3 the worst. Availability of each type of comparison varies by indicator
and is dependent upon the data source, comparability with data collected for other communities, and changes in
methodology over time.
Indicators were categorized into 29 topic areas and each topic area receives a score. Indicators may be categorized
in more than one topic area. Topic scores are determined by the comparisons of all indicators within the topic.
COMPARISON TO A DISTRIBUTION OF COUNTY VALUES: WITHIN STATE AND NATION
For ease of interpretation and analysis, indicator data on the St. Vincent Health Community Dashboard is visually
represented as a green-yellow-red gauge showing how the community is faring against a distribution of counties in
Indiana or the United States. A distribution is created by taking all county values within the state or nation,
ordering them from low to high, and dividing them into three groups (green, yellow, red) based on their order.
Indicators with the poorest comparisons (“in the red”) scored high, whereas indicators with good comparisons (“in
the green”) scored low.
HCI Platform County Distribution Gauge
COMPARISON TO VALUES : STATE, NATIONAL AND TARGETS
The county value is compared to the state value, the national value, and Healthy People 2020 (HP2020) target
values. Healthy People 2020 goals are national objectives for improving the health of the nation set by the
Department of Health and Human Services’ (DHHS) Healthy People Initiative. For all value comparisons, the scoring
depends on whether the county value is better or worse than the comparison value, as well as how close the
county value is to the target value.
TREND OVER TIME
The Mann-Kendall statistical test for trend was used to assess whether the county value is increasing over time or
decreasing over time, and whether the trend is statistically significant. The trend comparison uses the four most
recent comparable values for the county, and statistical significance is determined at the 90% confidence level. For
each indicator with values available for four time periods, scoring was determined by direction of the trend and
statistical significance.
MISSING VALUES
Indicator scores are calculated using the comparison scores, availability of which depend on the data source. If the
comparison type is possible for an adequate proportion of indicators on the community dashboard, it will be
included in the indicator score. After exclusion of comparison types with inadequate availability, all missing
comparisons are substituted with a neutral score for the purposes of calculating the indicator’s weighted average.
When information is unknown due to lack of comparable data, the neutral value assumes that the missing
comparison score is neither good nor bad.
INDICATOR SCORING
Indicator scores are calculated as a weighted average of all included comparison scores. More weight was given to
comparison to US counties, comparison to Indiana counties, and trend over time.
If neither of the included comparison types are possible for an indicator, then a score is not calculated and the
indicator is excluded from the data scoring results.
TOPIC SCORING
Indicator scores are averaged by topic area to calculate topic scores. Each indicator may be included in up to three
topic areas if appropriate. Resulting scores range from 0-3, where a higher score indicates a greater level of need
as evidenced by the data.
A topic score is only calculated if it includes at least three indicators. These scores were used to categorize the
topics as red (score ≥1.5), yellow (1.25≤ score <0.1.5), or green (score <1.25).
DISPARITIES
To identify indicators with the largest disparities by gender or
1
race/ethnicity, the Index of Disparity measure was used to
calculate the average of the absolute differences between
rates for each subgroup within a sub-population category and
the overall county rate, divided by the county rate. The index of
disparity summarizes disparities across groups within a
population that can be applied across indicators. The measure
is expressed as a percentage.
Across all indicators, an Index of Disparity score that ranked in
the top 25% of all disparities scores–in either gender or
race/ethnicity category–was identified as having a high
disparity. The availability of sub-population data varies by
source and indicator.
±4.8
±3.3
±11.4
In this example to the right, Age-Adjusted Death Rate due to
Diabetes by Gender has county values for the female and male
subgroups that are closer to each other and close to the overall
county value when compared to the subgroup values for AgeAdjusted Death Rate due to Diabetes by Race/Ethnicity. The
1
Pearcy, J. & Keppel, K. (2002). A Summary Measure of Health Disparity. Public Health Reports, 117, 273-280.
±2.8
absolute difference between the Black or African American value and the overall value is much larger than the
difference between the White value and overall value, resulting in a higher Index of Disparity score than the score
calculated for the gender subgroups.
SCORING RESULTS
The following table lists all indicators by topic area, with the most recent value for Howard County and comparison
scores (0-3 or good to bad). The county value is compared to a distribution of Indiana and US counties, state and
national values, and the HP2020 target. Indicators are also compared across four time periods and are scored
under the trend column. If data was not available for a comparison or disparity score, then the cell is left blank.
Source: http://www.stvincent.org/chna as of January 20, 2015.
Topic Score: 1.08
Cancer
Topic Score: 0.88
Children's Health
Topic Score: 1.81
Diabetes
Indicator
Non-Physician Primary Care Provider Rate
Adults with Health Insurance
Clinical Care Ranking
Primary Care Provider Rate
Children with Health Insurance
Dentist Rate
Preventable Hospital Stays
Oral Cavity and Pharynx Cancer Incidence Rate
Lung and Bronchus Cancer Incidence Rate
Age-Adjusted Death Rate due to Lung Cancer
Mammography Screening: Medicare Population
Age-Adjusted Death Rate due to Breast Cancer
Breast Cancer Incidence Rate
Cancer: Medicare Population
Age-Adjusted Death Rate due to Colorectal
Cancer
Colorectal Cancer Incidence Rate
Prostate Cancer Incidence Rate
Age-Adjusted Death Rate due to Prostate
Cancer
Children with Low Access to a Grocery Store
Age-Adjusted ER Rate due to Pediatric Asthma
Age-Adjusted Hospitalization Rate due to
Pediatric Asthma
Child Food Insecurity Rate
Child Abuse Rate
Children with Health Insurance
Period
2013
2012
2014
2011
2012
2012
2011
2007-2011
2007-2011
2007-2011
2011
2007-2011
2007-2011
2012
Score
1.73
1.40
1.20
1.18
0.98
0.68
0.38
2.10
1.70
1.50
1.13
0.90
0.70
0.55
2007-2011
0.40
2007-2011
2007-2011
0.35
0.35
2007-2011
0.00
2010
2010-2012
2009-2011
2.10
2.03
2.00
2010-2012
1.88
2012
2013
2012
1.85
1.83
0.98
Age-Adjusted Death Rate due to Diabetes
2010-2012
2.65
Topic Score: 2.02
Economy
Topic Score: 1.81
Education
Topic Score: 1.53
Diabetes: Medicare Population
Diabetic Screening: Medicare Population
Age-Adjusted ER Rate due to Diabetes
Uncontrolled Diabetes
Age-Adjusted Hospitalization Rate due to ShortTerm Complications of Diabetes
Age-Adjusted ER Rate due to Long-Term
Complications of Diabetes
Age-Adjusted ER Rate due to Uncontrolled
Diabetes
Diabetes
Age-Adjusted ER Rate due to Short-Term
Complications of Diabetes
Age-Adjusted Hospitalization Rate due to LongTerm Complications of Diabetes
Renters Spending 30% or More of Household
Income on Rent
Young Children Living Below Poverty Level
Children Living Below Poverty Level
Homeowner Vacancy Rate
Households with Cash Public Assistance Income
People Living Below Poverty Level
Median Household Income
People Living 200% Above Poverty Level
Low-Income and Low Access to a Grocery Store
Students Eligible for the Free Lunch Program
Families Living Below Poverty Level
Unemployed Workers in Civilian Labor Force
Social and Economic Factors Ranking
Per Capita Income
Severe Housing Problems
Persons with Disability Living in Poverty
Homeownership
SNAP Certified Stores
People 65+ Living Below Poverty Level
4th Grade Students Proficient in Math
High School Graduation
8th Grade Students Proficient in Math
2012
2011
2010-2012
2.50
2.08
2.03
2010-2012
2.03
2010-2012
2.03
2010-2012
2.03
2010-2012
2.03
2010-2012
1.88
2010-2012
1.83
2010-2012
1.18
2009-2013
2.70
2009-2013
2009-2013
2009-2013
2009-2013
2009-2013
2009-2013
2009-2011
2009-2013
2010
2012
2011-2012
2012
2009-2013
Oct 2015
2014
2009-2013
2006-2010
2013
2009-2013
2012
2009-2013
2013
2013
2013
2.45
2.35
2.25
2.15
2.15
2.10
2.00
1.95
1.90
1.90
1.88
1.85
1.75
1.75
1.60
1.50
1.43
1.35
1.30
1.00
0.55
1.98
1.93
1.78
Environment
Topic Score: 1.67
Topic Score: 1.77
8th Grade Students Proficient in
English/Language Arts
People 25+ with a Bachelor's Degree or Higher
Student-to-Teacher Ratio
4th Grade Students Proficient in
English/Language Arts
People 25+ with a High School Degree or Higher
Liquor Store Density
Fast Food Restaurant Density
People 65+ with Low Access to a Grocery Store
Farmers Market Density
Houses Built Prior to 1950
PBT Released
Annual Particle Pollution
Households with No Car and Low Access to a
Grocery Store
Recognized Carcinogens Released into Air
Physical Environment Ranking
Drinking Water Violations
Recreation and Fitness Facilities
Access to Exercise Opportunities
Fast Food Restaurant Density
Farmers Market Density
Health Behaviors Ranking
Adults who are Sedentary
Grocery Store
2013
1.58
2009-2013
2011-2012
1.45
1.43
2013
1.43
2009-2013
2012
2011
2014
2010
2011
2010
2013
2010
2009-2013
2013
2010-2012
0.65
2.45
2.20
2.18
2.10
2.10
2.10
2.03
1.90
1.85
1.80
1.60
2010
1.50
2006-2010
2013
2014
FY 2012-13
2012
2011
2014
2011
2010
2014
2010
2011
2010
2013
2009-2011
2010
2012
2012
2014
2010
1.43
1.40
1.40
1.28
1.00
0.78
0.68
2.20
2.18
2.18
2.10
2.10
2.10
2.03
2.00
1.90
1.90
1.85
1.80
1.78
2010
1.50
2012
1.00
Topic Score: 1.68
Immunizations & Infectious Diseases
Topic Score: 1.36
Topic Score: 1.6
Topic Score: 1.22
Recreation and Fitness Facilities
Access to Exercise Opportunities
Age-Adjusted Death Rate due to Coronary Heart
Disease
Hypertension: Medicare Population
Hyperlipidemia: Medicare Population
Age-Adjusted Death Rate due to
Cerebrovascular Disease (Stroke)
Ischemic Heart Disease: Medicare Population
Atrial Fibrillation: Medicare Population
Stroke: Medicare Population
Heart Failure: Medicare Population
Age-Adjusted Hospitalization Rate due to Heart
Failure
Age-Adjusted ER Rate due to Heart Failure
Bacterial Pneumonia
Hepatitis
Immunization-Preventable Pneumonia and
Influenza
Salmonella Infection Incidence Rate
Age-Adjusted Death Rate due to Influenza and
Pneumonia
Gonorrhea Incidence Rate
Age-Adjusted ER Rate due to Bacterial
Pneumonia
Age-Adjusted ER Rate due to ImmunizationPreventable Pneumonia and Influenza
Chlamydia Incidence Rate
HIV Prevalence Rate
Age-Adjusted ER Rate due to Urinary Tract
Infections
Chronic Kidney Disease: Medicare Population
Age-Adjusted Death Rate due to Kidney Disease
Urinary Tract Infections
Teen Birth Rate
Mothers who Smoked During Pregnancy
Mothers who Received Early Prenatal Care
Preterm Births
Babies with Low Birth Weight
2011
2014
0.78
0.68
2010-2012
2.45
2012
2012
2.15
1.95
2010-2012
1.85
2012
2012
2012
2012
1.75
1.45
1.45
1.40
2010-2012
1.18
2010-2012
1.18
2010-2012
1.83
2010-2012
1.83
2010-2012
1.68
2012
1.63
2010-2012
1.50
2012
1.45
2010-2012
1.33
2010-2012
1.18
2012
2010
1.15
0.00
2010-2012
2.03
2012
2010-2012
1.85
1.55
2010-2012
0.98
2012
2012
2012
2012
2012
2.15
1.70
1.15
0.90
0.70
Men's Health
Topic Score: 0.63
Topic Score: 1.71
Topic Score: 1.68
Prevention & Safety
Topic Score: 1.29
Public Safety
Topic Score: 1.29
Infant Mortality Rate
Life Expectancy for Males
Prostate Cancer Incidence Rate
Age-Adjusted Death Rate due to Prostate
Cancer
Poor Mental Health Days
Age-Adjusted Death Rate due to Suicide
Depression: Medicare Population
Alzheimer's Disease or Dementia: Medicare
Population
Age-Adjusted Death Rate due to Alzheimer's
Disease
Asthma: Medicare Population
Osteoporosis: Medicare Population
Diabetes: Medicare Population
Hypertension: Medicare Population
COPD: Medicare Population
Diabetic Screening: Medicare Population
Depression: Medicare Population
Hyperlipidemia: Medicare Population
Chronic Kidney Disease: Medicare Population
Ischemic Heart Disease: Medicare Population
Rheumatoid Arthritis or Osteoarthritis:
Medicare Population
Atrial Fibrillation: Medicare Population
People 65+ Living Alone
Alzheimer's Disease or Dementia: Medicare
Population
Stroke: Medicare Population
Heart Failure: Medicare Population
People 65+ Living Below Poverty Level
Cancer: Medicare Population
Age-Adjusted Death Rate due to Alzheimer's
Disease
Death Rate due to Drug Poisoning
Age-Adjusted Death Rate due to Unintentional
Injuries
2008-2012
2010
2007-2011
0.70
1.55
0.35
2007-2011
0.00
2006-2012
2010-2012
2012
2.43
2.30
2.00
2012
1.45
2010-2012
0.35
2012
2012
2012
2012
2012
2010
2011
2012
2012
2012
2012
2.65
2.65
2.50
2.15
2.10
2.10
2.08
2.00
1.95
1.85
1.75
2012
1.75
2012
2009-2013
1.45
1.45
2012
1.45
2012
2012
2011
2009-2013
2012
1.45
1.40
1.13
0.55
0.55
2010-2012
0.35
2004-2010
2006-2010
2.33
1.43
2010-2012
0.10
Child Abuse Rate
Alcohol-Impaired Driving Deaths
2013
2008-2012
1.83
1.73
Topic Score: 1.78
Social Environment
Topic Score: 1.92
Substance Abuse
Topic Score: 1.88
Age-Adjusted Death Rate due to Motor Vehicle
Traffic Collisions
Asthma: Medicare Population
COPD: Medicare Population
Age-Adjusted ER Rate due to Pediatric Asthma
Age-Adjusted ER Rate due to Adult Asthma
Age-Adjusted ER Rate due to Asthma
Asthma
Age-Adjusted Hospitalization Rate due to Adult
Asthma
Pediatric Asthma
Bacterial Pneumonia
Age-Adjusted ER Rate due to COPD
Age-Adjusted Death Rate due to Chronic Lower
Lung and Bronchus Cancer Incidence Rate
Immunization-Preventable Pneumonia and
Influenza
Age-Adjusted Death Rate due to Lung Cancer
Age-Adjusted Death Rate due to Influenza and
Pneumonia
Age-Adjusted ER Rate due to Bacterial
Pneumonia
Age-Adjusted Hospitalization Rate due to COPD
Age-Adjusted ER Rate due to ImmunizationPreventable Pneumonia and Influenza
Young Children Living Below Poverty Level
Children Living Below Poverty Level
Single-Parent Households
Child Abuse Rate
Voter Turnout
Social and Economic Factors Ranking
People 65+ Living Alone
Death Rate due to Drug Poisoning
Alcohol Abuse
Age-Adjusted ER Rate due to Alcohol Abuse
Health Behaviors Ranking
2010-2012
0.30
2012
2012
2010-2012
2010-2012
2010-2012
2.65
2.10
2.03
2.03
2.03
2010-2012
1.88
2010-2012
1.88
2010-2012
1.88
2010-2012
1.83
2010-2012
1.83
2010-2012
1.75
2007-2011
1.70
2010-2012
1.68
2007-2011
1.50
2010-2012
1.50
2010-2012
1.33
2010-2012
1.18
2010-2012
1.18
2009-2013
2009-2013
2009-2013
2013
2012
2014
2009-2013
2012
2004-2010
2.45
2.35
2.05
1.83
1.70
1.60
1.45
2.45
2.33
2010-2012
2.03
2010-2012
2014
1.88
1.80
Transportation
Topic Score: 1.42
Topic Score: 2.03
Women's Health
Topic Score: 1.22
Alcohol-Impaired Driving Deaths
Adults who Smoke
Mothers who Smoked During Pregnancy
Adults who Drink Excessively
Workers who Drive Alone to Work
Households without a Vehicle
Workers Commuting by Public Transportation
Grocery Store
Mean Travel Time to Work
Solo Drivers with a Long Commute
Age-Adjusted Death Rate due to Motor Vehicle
Traffic Collisions
Poor Physical Health Days
Self-Reported General Health Assessment: Poor
or Fair
Life Expectancy for Females
Morbidity Ranking
Life Expectancy for Males
Life Expectancy for Females
Age-Adjusted Death Rate due to Breast Cancer
Breast Cancer Incidence Rate
2008-2012
2006-2012
2012
2006-2012
2009-2013
2009-2013
2009-2013
1.73
1.73
1.70
1.23
2.50
2.20
1.80
2010
1.50
2009-2013
2008-2012
0.95
0.68
2010-2012
0.30
2006-2012
2.43
2006-2012
2.23
2010
2014
2010
2010
2011
2007-2011
2007-2011
2.15
1.80
1.55
2.15
1.13
0.90
0.70
DATA SOURCES
The St. Vincent Data Platform utilizes indicator data from the following data sources:
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
American Community Survey
American Lung Association
Annie E. Casey Foundation
Centers for Disease Control and Prevention
Centers for Medicare and Medicaid Services
County Health Rankings
Feeding America
Indiana Hospital Association
Indiana Secretary of State
Indiana State Department of Health
Indiana University Center for Health Policy
Institute for Health Metrics and Evaluation

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
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
National Cancer Institute
National Center for Education Statistics
National Center for HIV/AIDS, Viral
Hepatitis, STD, and TB Prevention
Nielsen Claritas
Small Area Health Insurance Estimates
US Bureau of Labor Statistics
US Census County Business Patterns
US Department of Agriculture: Food
Environment Atlas
US Environmental Protection Agency
Appendix C: Community Input – Key Informant
Interview Questions
Questions that were asked during the Key Informant Interviews are presented below:
Q1. Could you tell me a little bit about yourself, your background, and your organization?
Q2. What are the major health needs/issues you see in the community?
Q3. Who in your community appears to struggle most with these issues you’ve identified and how does it
impact their lives?
Q4. Are there any barriers to receiving care in the community?
Q5. Could you tell me about some of the strengths and resources in your community that address these issues,
such as groups, initiatives, services, or programs?
Q6. What advice do you have for a group developing a plan to address these needs?
Q7. Is there anything else you’d like us to note?
Appendix D: Prioritization Tools
Prioritization Matrix Tools – Howard County
This packet will help you assess each of the 10 pressing health needs identified by HCI’s data analysis, and
how each of those health needs relate to the criteria set forth by St. Vincent for prioritizing health topics in your
service area. Please have a quick look through the packet, and then follow the directions below to score how well
each of the health topics meets the prioritization criteria. After you have completed the ranking below, please
submit your results on the Poll Everywhere software. The software will collate your results with those of other
participants, and will instantaneously show the group’s collective ranking of the most pressing health needs in your
service area.
Directions
1.
2.
3.
4.
On the following pages, score each health need for how well it meets each criteria:
1= Low (Does Not Meet Criteria) 2= Medium (Meets Criteria) 3= High (Meets Criteria Well)
Add total scores for each health need and write total in “Total Health Topic Score” column.
Write the total scores for each topic in the table below.
Assign ranking to health needs based on total score, with highest score receiving a
ranking of 1. If you have tying scores for health topics, assign rank as you see best fit.
Please feel free to work in groups and ask questions of HCI staff and your colleagues!
Health Topics
Total Score
Social Environment
Transportation
Diabetes
Substance Abuse
Children’s Health
If you feel a health topic is missing from this list, please write it here:
Rank
Social Environment
Topic
Score
1.92
Health Topic
Community
Input
(Total N=8)
Social
Environment
Prioritization Criteria
Warning Indicators from
Secondary Data
Lifestyle and family stability;

cycle of non-traditional
family structure; domestic
violence. “Many

grandparents are raising
preschoolers; the parents

are out of the picture for
whatever reason.”
Young Children Living
Below Poverty Level
Children Living Below
Poverty Level
Single-Parent
Households
Key Data Insights
How Well Does
Health Topic Relate
to Criteria
1=Low 2=Medium
3=High
Alignment w/Ascension
Health Strategies – Leave no
one behind & care for poor &
vulnerable
Opportunity for Partnership
Availability of Existing
Resources or Programs
Availability of Evidence-Based
Practices
Are There Disparities Among
Sub-Groups?
Key Themes from Community Input &
Secondary Data Indicators indicate this issue
affects poor & vulnerable populations
Min. of 3 community organizations in
Resource List who directly address this health
topic. (Refer to Resource Handout)
Not covered in HCI Data Analysis – does your
hospital or any community partners have
current resources or programs?
Approx. 200 Promising or Effective Practices
on St. Vincent Data Platform – Promising
Practices Database
(stvincent.org/chna/)
No race or gender disparity data
Cited by 3 out of 8 Key Informants
Community Input
Total Health Topic Score
Transportation
Topic
Score
1.42
Health Topic
Community
Input
(Total N=8)
Transportation
Free trolley improved things in
city, but not in county, trolley
schedule/stops may not be
convenient; only one cab
company takes Medicaid,
specialists far away.
Secondary Data
•
•
•
Key Data Insights
Workers who Drive
Alone to Work
Households without a
Vehicle
Workers Commuting
by Public
Transportation
How Well Does
Health Topic Relate
to Criteria
1=Low 2=Medium
3=High
vulnerable
Practices
Sub-Groups?
Key Themes from Community Input &
3 community organizations in Resource List
who address this health topic. (Refer to
Resource Handout)
Approx. 70 Promising or Effective Practices on
St. Vincent Data Platform – Promising
Practices Database
No race or gender disparity data in HCI data
analysis
Community Input
Topic
Score
Health Topic
Community
Input
(Total N=8)
Secondary Data
•
•
2.03
Wellness &
Lifestyle
N/a, not mentioned as a top
health need/concern during
community input process
•
Poor Physical Health Days
Self-Reported General
Health Assessment: Poor
or Fair
Life Expectancy for
Females
Key Data Insights
How Well Does
Health Topic Relate
to Criteria
1=Low 2=Medium
3=High
vulnerable
Practices
Sub-Groups?
Not enough data to determine in HCI data
synthesis
Resource Handout)
Practices Database
analysis
Community Input
Diabetes
Topic
Score
Health Topic
Community
Input
(Total N=8)
Secondary Data
•
2.02
Diabetes
Diabetes frequently
mentioned as an issue; lack of
preventive services or
programs for pre-diabetics.
•
•
Age-Adjusted Death Rate
due to Diabetes
Diabetes: Medicare
Population
Diabetic Screening:
Medicare Population
Key Data Insights
How Well Does
Health Topic Relate
to Criteria
1=Low 2=Medium
3=High
vulnerable
Practices
Sub-Groups?
synthesis
Resource Handout)
Approx. 90 Promising or Effective Practices on
St. Vincent Data Platform – Promising
Practices Database
African-Americans have  ER Rate for
diabetes and long-term diabetes complications
Community Input
Substance Abuse
Topic
Score
1.88
Health Topic
Community
Input
(Total N=8)
Substance
Abuse
Secondary Data
Drug and alcohol abuse
perceived as high; heroin and
meth use on rise; smoking a
big issue.
•
•
•
Death Rate due to Drug
Poisoning
Age-Adjusted Hosp. Rate
for Alcohol Abuse
Key Data Insights
How Well Does
Health Topic Relate
to Criteria
1=Low 2=Medium
3=High
vulnerable
Practices
Sub-Groups?
synthesis
Resource Handout)
Practices Database
Males have  hospitalization and ER rates due
to alcohol abuse
Community Input
Children’s Health
Topic
Score
1.81
Health Topic
Community
Input
(Total N=8)
Children’s
Health
Secondary Data
Parenting issues and family
stability; nutrition and food
allergies; smoking in the home
and childhood asthma.
•
•
•
Children with Low Access
to a Grocery Store
Age-Adjusted ER Rate due
to Pediatric Asthma
Low-Income Preschool
Obesity
Key Data Insights
How Well Does
Health Topic Relate
to Criteria
1=Low 2=Medium
3=High
vulnerable
Practices
Sub-Groups?
Some key themes from Community Input &
Resource Handout)
Practices Database
Boys have  hospitalization rates for pediatric
asthma
Community Input
Topic
Score
1.78
Health Topic
Community
Input
(Total N=8)
Respiratory
Diseases
Secondary Data
Concern with child asthma
rates; smoking rates and
smoking during pregnancy.
•
•
•
Asthma: Medicare
Population
COPD: Medicare
Population
Age-Adjusted ER Rate due
to Pediatric Asthma
Key Data Insights
How Well Does
Health Topic Relate
to Criteria
1=Low 2=Medium
3=High
vulnerable
Practices
Sub-Groups?
synthesis
1 community organization in Resource List
Resource Handout)
Practices Database
Women and African-Americans have  ER
rates due to adult asthma
Community Input
Topic
Score
1.77
Health Topic
Community
Input
(Total N=8)
Exercise,
Nutrition &
Weight
Secondary Data
Obesity; unhealthy habits overeating, lack of exercise;
lack of nutrition availability
and education




Key Data Insights
Access to Grocery
Stores
Low Income Preschool
Obesity
Fast Food Restaurant
Density
How Well Does
Health Topic Relate
to Criteria
1=Low 2=Medium
3=High
vulnerable
Practices
Sub-Groups?
synthesis
Resource Handout)
Practices Database
analysis
Community Input
Topic
Score
1.71
Health Topic
Community
Input
(Total N=8)
Mental Health
& Mental
Disorders
Lack of mental and behavioral
health services, not enough
therapists and psychiatrists;
long wait time for
appointments;
Secondary Data



Key Data Insights
Poor Mental Health
Days
Age-Adjusted Death
Rate due to Suicide
Depression in
Medicare Population
How Well Does
Health Topic Relate
to Criteria
1=Low 2=Medium
3=High
vulnerable
Practices
Sub-Groups?
synthesis
Resource Handout)
Practices Database
analysis
Community Input
Topic
Score
1.08
Health Topic
Community
Input
(Total N=8)
Access to
Health
Services
Secondary Data
Difficulties with health system
navigation; lack of
transportation; issues with
understanding new coverage;
provider retainment; long wait
times;

Key Data Insights
Non-Physician Primary
Care Rate
How Well Does
Health Topic Relate
to Criteria
1=Low 2=Medium
3=High
vulnerable
Practices
Sub-Groups?
Some key themes from Community Input
indicate this issue affects poor & vulnerable
populations
Resource Handout)
Practices Database
analysis
Community Input
Appendix E: Authors
Heather Cobb, MPH
HCI Public Health Consultant
Project Lead
Norwin Espiritu, MPH
HCI Senior Researcher
Lead Project Researcher
Mari Rasmussen, MPH
HCI Public Health Consultant
Primary Data Specialist
Nicolia Eldred-Skemp, MPH
HCI Research Associate
Project Support
Claire Lindsay, MPH
HCI Research Associate
Project Support
Yelena Meisel, MPH
HCI Director of Consulting Services
Project Advisor
Appendix F: Community Input Report for
Howard County
The purpose of this work is to provide a report of the input from community members about the health needs of
Howard County. It is designed to be either a stand-alone report or appendix to the Community Health Needs
Assessment (CHNA) report prepared by the Healthy Communities Institute (HCI). Using results from the CHNA
report, the top three system-wide health priorities were identified as:
 Behavioral Health
 Access to Health Services
 Exercise, Nutrition, and Weight
For this reason, this report will focus on the interpretation of the sample results for these priorities. NOTE:
Behavioral health consists of the health needs: mental health/mental disorders, substance abuse, and
smoking/tobacco use. The decision to fold these health needs into one health priority was obtained through group
consensus during sessions. Details about the methods and analysis, results, interpretation, and a conclusion
comprise the report.
METHODS
“Take the Survey – Your Input Counts!” survey is an online, opinion tool designed by a collaborative of 4 hospital
systems to gather community input about the health needs in Indiana (n=92 counties) (CHNA Hospital
Collaborative, 2014). The survey contains 25 closed questions (with optional Comment box) and collects
information at the county level from October 1, 2014 to August 31, 2015 (see Supplement - Survey). Questions for
this survey and those used by HCI in the CHNA prioritization session and key informant interviews were developed
independently of each other. This sample’s respondents were not administered the same survey given in the
session and interview; however, questions assessing similar health needs were identified. Areas of apparent
differences and congruency are highlighted in this report.
A total of 7,102 responses were received from Indiana residents. For this report, county (county=Howard) and zip
codes within the county were used as inclusion criteria for this report (see Supplement – Zip Codes) (ZipCodes.com, 2015). The initial sample included 250 respondents. Exclusion criteria applied to the initial sample
were records outside data collection period, zip codes outside of the county, or incomplete/incorrect zip codes
(n=1). After applying both criteria, 249 respondents (0.04%) self-identified as Howard County residents. Descriptive
statistics were performed using Microsoft Excel© and analytic tools within Survey Monkey©.
RESULTS
Table 1 provides demographic results for the sample’s respondents. Race and ethnicity were reflective of HCI
findings (Health Communities Institute, 2015). Most of the respondents self-identified as Caucasian (n=240,
96.39%). Ethnicity was 0.40% (n=1). The majority of respondents were between 55-64 years old (n=79, 31.73%).
The most frequently reported household income range was $50,000-74,999 (n=66, 27.85%).
Table 1. Respondent Demographics
Characteristics
Race/Ethnicity
n (%)
American Indian/Alaskan Native
8 (3.21%)
Asian/Pacific Islander
2 (0.80%)
Black/African American
5 (2.10%)
White/Caucasian
Hispanic
240 (96.39%)
1 (0.40%)
*Respondents=249 (100%)
18-24
5 (2.10%)
25-34
43 (17.27%)
Age
35-44
35 (14.06%)
Range
45-54
67 (26.91%)
(years)
55-64
79 (31.73%)
65-74
20 (8.03%)
Respondents=249 (100%)
$0-24,999
Household
Income
Range
21 (8.86%)
$25,000-49,999
41 (17.30%)
$50,000-74,999
66 (27.85%)
$75,000-99,000
52 (21.94%)
$100,000-124,999
26 (10.97%)
$125,000-149,999
13 (5.49%)
$150,000-174,999
8 (3.38%)
$175,000-199,999
4 (1.69%)
$200,000 and up
6 (2.53%)
Respondents=237 (95%)
*The survey allowed multiple selections for race/ethnicity.
Respondents were asked in Question 3 to “Select the top five health needs in your community
(city/town/neighborhood/zip code)” (CHNA Hospital Collaborative, 2014). Predetermined needs were presented to
respondents who ranked the needs in order from 1 to 5 (top health need=1, descending scale to 5). The majority
(n=210, 84.34%) ranked mental health as the top health need in Howard County. The remaining four identified
health needs were substance abuse (n=208, 83.53%), obesity (n=180, 72.29%), access to healthcare (n=144,
57.83%), and smoking and tobacco use (n=141, 56.63%). Aggregate rankings for the other health needs are
provided in Figure 1.
Figure 1. Frequencies of Reported Health Needs
400
210
208
180
200
144
141
135
60
38
23
16
13
11
0
Frequency
Mental health (depression, anxiety, sadness)=210
Substance abuse (alcohol, other drugs)=208
Obesity=180
Access to healthcare=144
Smoking and tobacco use=141
Chronic disease (cancer, heart disease, etc.)=135
Dental/oral health=60
Prenatal health=38
Injury prevention=23
Hearing/vision problems=16
Infant mortality=13
Asthma=11
Question 5 of the survey asked respondents to “Select the top 3 ways to improve mental health in your
community” (CHNA Hospital Collaborative, 2014). Response scheme was similar to Question 3. Ways to improve
mental health were presented in a list format and respondents ranked each way in order from 1 to 3 (top way=1,
descending scale to 3). Most respondents indicated that an “increase in programming for mental health problems”
was the top way to improve mental health in Howard County (n=164, 65.86%). The two other ways that rose to the
top were increases in awareness of mental health services (n=121, 48.59%) and the number of treatment facilities
(n=116, 46.49%). Findings for the remaining ways to improve mental health are provided in Figure 2.
Figure 2. Frequencies of Reported Ways to Improve Mental Health
200
164
121
100
116
111
74
72
54
9
0
Frequency
Increase programs for mental health problems (depression, anxiety, and suicide)=164
Increase awareness of mental health services=121
Increase number of treatment facilities=1116
Increase substance abuse program and resources=111
Increase mental health screenings from doctor=74
Increase prevention programs=72
Increase mental health treatment from doctor=54
Not a problem=9
Access to health services was assessed in Question 12 (see Figure 3). Respondents were presented a list of
potential challenges to their household in receiving healthcare, then ranked them in order from 1 to 3 (top
challenge=1, descending scale to 3). No problems receiving health services (n=105, 42.16%) was the most
frequently reported response. About one-third indicated that the cost of co-pay and limited hours at doctor’s
office were challenges to getting health services (n=82, 32.29%, respectively). A small percentage of the
respondents perceived transportation to be a challenge to receiving health services (n=5, 2%).
Figure 3. Perceived Challenges to Receiving Health Services
Question 4 collected respondents opinions about reasons why obesity was a health problem in their community.
Respondents ranked perceived reasons in order from 1 to 3 (top challenge=1, descending scale to 3). Most
respondents indicated that an “unhealthy diet and exercise habits” was the main reason for obesity in Howard
County (n=235, 94.38%). The two other reasons that rose to the top were access to healthy and affordable foods
(n=172, 69.08%) and not promoting healthy habits in the community, schools, and churches (n=133, 53.41%).
Findings for the remaining opinions about reasons for obesity are provided in Figure 4.
Figure 4. Perceived Reasons for Obesity
400
235
200
172
133
71
36
24
14
8
0
Frequency
Unhealthy diet and exercise habits=235
Access to healthy and affordable foods (fruits & vegetables)=172
Not promoting healthy habits in our community, schools, and churches=133
Lack of recreation, physical activity programs=71
Safety reasons (personal, traffic, neighborhood)=36
Lack of sidewalks, bike trails=24
Access to parks and places to exercise=14
Not a problem=8
Question 10 assesses the conversation topics that respondents are having with their doctor. A “select all that
apply” response scheme was used to collect the information (CHNA Hospital Collaborative, 2014). More than onethird indicated that the topics did not apply to them (n=104, 41.76%). Out of all the topics, diet/nutrition (n=104,
41.76%) and exercise (n=94, 37.75%) were the most frequently reported. Domestic violence/abuse (n=5, 2%) was
the least reported topic (see Figure 5).
Figure 5. Conversation Topics with Doctors
INTERPRETATION
HEALTH NEEDS
The main difference between the top five community health needs identified in the prioritization session and by
respondents was diabetes (session). Possible factors that may explain the difference might be, but not limited to,
the current health needs of respondents and the professional backgrounds of those at the prioritization session. It
is noteworthy that respondents confirmed four needs identified in the session (see side-by-side comparison).
Prioritization Session:
Community Respondents (n=249):
Substance Abuse (BH)
Mental Health (BH)
Access to Health Services (AHS)
Substance Abuse (BH)
Mental Health & Mental Disorders (BH)
Obesity (ENW)
Exercise, Nutrition, & Weight (ENW)
Access to Healthcare (AHS)
Diabetes
Smoking & Tobacco Use (BH)
BEHAVIORAL HEALTH
In conversations with doctors, respondents indicated that topics largely centered on exercise, diet/nutrition – not
substance abuse or mental health. This apparent discrepancy may explained by the (1) reason for doctor visit (i.e.,
something other than substance abuse/mental health), (2) limited time doctors have during appointments, and/or
(3) respondents do not have these problems or did not report it in this survey. Key informants echoed
respondents’ input about the lack of services and resources for mental health in the community. They also
expressed the need for mental health services for kids/youth. Anecdotally, informants’ lack of public policy and
limitations on law enforcement’s reach as shortfalls that complicate the community’s substance abuse problem.
ACCESS TO HEALTH SER VICES
The majority of respondents indicated no challenges to receiving health services (42.16%). Key informants
reported that the “lack of general practitioners in the community” was a barrier to receiving health services (page
28) (Healthy Communities Institute, 2015). This is counter to the respondents’ perception of their ability to find a
doctor (n=211, 85%). The difference in perceptions may be due to the professional backgrounds of the key
informants and the access that individual respondents have to doctors. About one-third of respondents reported
that they did not have a primary care physician (n=84, 34%). In this subgroup, long wait times (n=50, 59.52%) and
cost of visits/co-pay (n=23, 27.38%) were the found to be the greatest challenges to health services. These findings
are congruent with those reported by key informants.
EXERCISE, NUTRITION, & WEIGHT
In contrast to behavioral health, respondents do report having conversations with their doctors about exercise and
diet/nutrition. This finding is suggestive of a possible relationship with the majority of respondents’ opinions that
unhealthy eating and exercise habits are the prime reason for obesity in Howard County (e.g., A person has
unhealthy eating habits and their doctor talks to them about eating healthier.) This feedback is consistent with key
informants’ comments about exercise, nutrition and weight (Health Communities Institute, 2015).
STRENGTHS AND LIMITA TIONS OF THE ANALYSIS
This analysis has several strengths. First, the survey used was collaboratively developed by the four hospital
systems serving Indiana. Because development was a team effort, survey bias toward any one system was
reduced. The second and third strengths were the reach survey distribution (online) and its availability for
completion at approximately the same time as the HCI interviews. These two strengths encourage the capture of
many comments, as well as provide a variable (timeframe) to align responses with key informants’ input on
same/similar questions.
The limitations of the analysis were the opt-in nature of the survey (volunteer bias); no control over the number of
times a person responded (repeat responders); collection of race and ethnicity in the same survey field; gender
and education were not collected; and some data were only collected at the aggregate level (unable to view at
respondent level). Although no strategy was put into place to mitigate these limitations, this omission was
determined to be acceptable for this iteration of community input. It is noteworthy that the collaborative between
the four hospitals systems is considered by those involved to be a successful working relationship with the
potential to bring about positive health changes in Indiana.
CONCLUSION
Community input provides information critical to the successful development, launch and sustainability of health
programming. Overall, this report supports the findings in the HCI Community Health Needs Assessment for
Howard County. Moving forward, the Community Development Liaison and Data Analyst will work with the
Howard County team to start development of an implementation strategy based on the results of the Community
Health Needs Assessment.
REFERENCES
[1] CHNA Hospital Collaborative, "Take the Survey – Your Input Counts!," 14 October 2014. [Online]. Available:
https://www.surveymonkey.com/home/. [Accessed 10 September 2015].
[2] "Zip-Codes.com," 2015. [Online]. Available: http://www.zip-codes.com/county/IN-HOWARD.asp. [Accessed 10
September 2015].
[3] Health Communities Institute, "St. Vincent Kokomo Hospital Community Health Needs Assessment Report –
2015," HCI, Berkley, 2015.
SUPPLEMENT SURVEY: “TAKE THE SURVEY YOUR INPUT COUNTS!”
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)
Select the top three social issues in your community (city/town/neighborhood/zip code).
Select the top five health needs in your community (city/town/neighborhood/zip code).
Select the top 3 reasons why obesity is an issue in your community (city/town/neighborhood/zip code).
Select the top 3 ways to improve mental health in your community.
In the past 12 months have you or anyone in your household visited the Emergency Room (ER) for any of
the following?
In the past 12 months, have you or anyone in your household missed school/work due to the following?
How do you pay for your health needs?
What keeps you from your healthy weight? (Select all that apply)
Has your doctor talked to you about: (Select all that apply)
In the past 30 days have you or anyone in your household used any of the following?
What are the top three challenges for you and your household when receiving healthcare?
When you have a doctor's appointment, lab work, x-rays etc., how do you get to your appointment?
What is your primary way for receiving health information?
What can hospitals and healthcare organizations do to help improve the health of your community?
In the past 12 months what positive changes have you made for your own health?
What is your age?
What is your ethnicity? (Please select all that apply.)
What is your average household income?
In what county do you reside?
If you do not have a primary care physician or family doctor, what are the challenges to seeing one?
Please select which services you and your household use and where you go for those services. Check all
that apply.
In the last twelve months, where di your household get health care and how often?
Which of the following do you think is the most important behavioral health issue in your community?
Select one only.
Please select who in your household has participated in these health prevention activities in the last 12
months to stay healthy. Check all that apply.
ZIP CODES - HOWARD COUNTY ZIP CO DES [2]
46068, 46076, 46901, 46902, 46903, 46904, 46919, 46928, 46929, 46932, 46936, 46937, 46965, 46979, 46995

ST. VINCENT KOKOMO HOSPITAL COMMUNITY HEALTH NEEDS

Transcription

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