Steubenville Health Department 2011 Community Health Assessment

 Steubenville Health Department and Trinity Health System Community Heath Assessment May 19, 2011 Community Health Assessment Conducted By Circinus Group Steubenville Health Department Mission Statement “The m ission of the Steubenville Health Department is to provide and enhance quality public health services through awareness, education, and accessibility. The Steubenville Health Department shall protect and promote the well-­‐being of the citizens of Steubenville.” Trinity Health System Mission Statement “A community partner dedicated to excellence in serving the health needs of the Tri-­‐State area.” @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 2 Table of Content 1. Introduction 1.1 Background ……………………………………………………………………………………….…......... 4 1.2 Community Health Assessment Objectives ……………………………………….…………. 4 1.3 Methodology ……………………………………………………………………………………..………. 4 1.4 Community Health Profile …………………………………………………………………..……… 5 1.4.1 Demographics – City of Steubenville ……..………………………….…………………. 5 1.4.2 Demographic Profile of Survey Participants ………………………….……………... 5 1.4.3 Steubenville History ……………………………………….................................................... 6 2. Community Health Assessment Survey Outcomes …….……………………………………………….. 7 2.1 Respondents …………………………………………………………………………………………......... 7 2.2 Survey Results by Questions ……………………………………………………………..…………. 7 2.3 Focus Group Outcomes ……………………………………………………………………………….. 18 2.3.1 Medicare Focus Group ………………………………………………………………………… 18 2.3.2 Medicaid Focus Group …………………………………..……………………………..…….... 18 2.3.3 Employer Focus Group ………………………………………............................................... 19 2.3.4 Healthcare Provider Focus Group …………………………………………….…….…….. 20 2.4 Comparative Outcome ……………………………………………………………………….….….….. 23 2.4.1 Satisfaction and Confidence Level of Existing Services …………………..…….… 23 2.4.2 Needs Identification of Potential Services …………………………………….….……. 23 2.4.3 Barriers to Service ………………………………………......................................................... 23 2.5 Public Health Aspects and the Community Assessment …………………………….....… 24 2.5.1 Unintentional Injuries ……………………………………………………………….…….…… 24 2.5.2 Preventing the Spread of Infectious Disease …………………….…………...……..… 25 2.6 Vital Statistics ……………………………………….………………………………….……………….….. 26 2.6.1 Birth and Deaths – City of Steubenville ……………….………………………….……… 26 2.6.2 Causes of Death – 2000-­‐2009 …………………………………………….……………..…... 26 3. Public Health Action Plan …………………………………………………………………………………………... 27 4. Footnotes ……………………………………………………………………………………………………………..…... 28 @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 3 1. Introduction 1.1 Background The Steubenville Health Department (SHD) and Trinity Health Systems (THS) partnered to conduct a Community Health Assessment. This collaborative effort provides the opportunity to examine the broad spectrum of health care services offered to the residents of Steubenville while satisfying State requirements for Public Health and Hospitals. SHD/THS retained the services of Circinus Group, a Strategy and Management Consulting Firm, specializing in Marketing Research and Analytics. Circinus Group was responsible for facilitating the assessment effort, developing the community communication plan and providing recommended next steps. ©, ‘
Circinus Analytics – Circinus Group utilizes IBM SPSS Statistics the world’s leading statistical .’
software for business, government, research and academic organizations for statistical analysis of our Community Assessment Survey data. 1.2 Community Health Assessment Objectives The intent of the Community Health Assessment was to gauge the state of health care services in the Steubenville area. The Assessment was designed to meet the following objectives: • Identify health care needs for the residents of Steubenville • Identify gaps in services • Determine satisfaction levels for: -­‐ City residents with existing services -­‐ Hospital care (ER, Out-­‐patient, In-­‐patient) -­‐ Physician services (family physician & specialists) -­‐ Public health sector • Appraise barriers to access to local health services The assessment outcomes will drive an action plan for the Steubenville Health Department. This Action Plan will require the approval of the Steubenville Health Department Board of Trustees. Immediate adoption of this plan is required before action can be taken. Next, the Steubenville Health Department Commissioner and her staff should be prepared to effectively oversee and immediate implement the Action Plan within the specified timeframes. 1.3 Methodology Circinus Group designed and conducted an on-­‐line survey and invited the residents of Steubenville to participate in the assessment process. In addition to the on-­‐line survey, a series of four focus groups were conducted to survey the following groups: Medicare and Medicaid recipients, local employers and local health care providers. To include Steubenville residents who do not have computer access, paper surveys were made available at three sites in the city: a) North End: John F Kennedy Apartments; b) Downtown: Martin Luther King Center; c) West End: Schiappa Branch Public Library. The local media (The Herald Star and WTOV9) supported this community initiative by providing public service @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 4 1.3 Methodology (cont.) announcements throughout the project. These announcements were designed to drive awareness and encourage the participation of all Steubenville residents. Some sections of the results show a superscript reference to footnotes. These footnotes are designed to provide additional data regarding that specific category. For example, the superscript for frequency of physician visits will show the national trend and other information for comparison to the local results. Also note that bold type in the tables denotes the greatest frequency and percentage for that specific question response. 1.4 Community Health Profile 1.4.1 Demographics – City of Steubenville Preliminary 2010 census figures show Steubenville’s population at 18, 659, down just 356 from the last census. Steubenville PopulaLon 40000 35000 30000 25000 20000 15000 1940 1950 1960 1970 1980 1990 2000 2010 Source: U.S. Census Bureau 1.4.2 Demographic Profile of Survey Participants There were a total of 327 respondents to the Community Health Assessment Survey. Two-­‐
thirds of the respondents were women and the average age of the respondents was 50 years. The range of ages of those completing the survey was from 18 to 88. By race, 90.6% of survey respondents were white and 6.7% were black. About 57% were married, 13.1% divorced, and 8.1% widowed. As far as education of the respondents, 19.5% had a bachelor’s degree; 11.8% had some college; and 17.5% were high school graduates. Regarding household income, 30% earned less than $29,000; 33.6% earned $30-­‐60,000; 24.2% earned between $60-­‐99,000. Eight percent earned $100-­‐150,000, and 1.3% stated they earned over $150,000. A detailed analysis of the demographics of the online survey respondents can be found under “demographic profile”. @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 5 1.4.3 Steubenville History Steubenville, the county seat of Jefferson County, is located in southeastern Ohio. The city was founded in 1797 by Bezaleel Wells and James Ross. The Steubenville Federal Land Office was established in 1800 for recording land deeds for the Northwest Territory. Beginning in 1785, Government lands were surveyed by an Act of Congress. The ranges were numbered consecutively with Range 1 Twp 1 of the Seven Ranges being located in the northwest corner of Wells Township in Jefferson County. The first sale of lots in Steubenville was August 25, 1797. The original land office building has been preserved and is located adjacent to the reconstructed Fort Steuben. Fort Steuben was erected here in 1786 to protect the land surveyors from Indian attack. The fort was named for Prussian Drillmaster Baron von Steuben who incidentally never set foot on these grounds. Steubenville derives its name from the fort and is steeped in a rich history. The reconstruction of this fort began in 1986. It was re built on the original site. The first Merino sheep in the United States were brought here by Bezaleel Wells in 1814. The first woolen mill in the United States was built in Steubenville by Wells in 1815. The Steubenville Female Seminary operated from 1829-­‐1898 and graduated over 5,000 women from its academy. There have been many industries in Steubenville’s history including coal mining, paper mills, glass factories, potteries, nail factories and steel mills. These industries brought many immigrants to the Ohio Valley making it a melting pot of many nationalities that still call Steubenville their home. Steubenville’s first railroad bridge to cross the Ohio River began in 1857. Delays occurred and it did not open until 1865. One pier of that original span still supports the current Railroad bridge and can be viewed from State Route 7. Edwin McMasters Stanton, President Lincoln’s Secretary of War, maintained a circulating library in his home here as early as 1830. This home library contained his private collection of literary works. The City Library of Steubenville opened in 1848. By 1902, these works were donated to the new Carnegie Library. Industrialist Andrew Carnegie provided the funding for this library that was named for him. Carnegie had been a telegraph operator here early in his career. Today this library is known as the Public Library of Steubenville and Jefferson County. Famous sons include Dean Martin, Edwin Stanton, Jimmy the Greek. Chief Red Cloud is buried in Steubenville Union Cemetery and lived to be 120 years old. Source: Public Library of Steubenville and Jefferson County @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 6 2. Community Health Assessment Survey Outcomes 2. 1 Respondents The Total Respondents=327 2.2 Survey Results by Questions Q1. Are you aware of the services offered by the Steubenville Health Department? # % Yes: 179 55.4 No: 144 44.6 Q2. Have you used Services from the Steubenville Health Department? # % Yes: 184 56.4 No: 142 43.6 Q3. Which Services have you used from the Steubenville Health Department? Plumbing Health Department Services Used Inspect. Nursing Other Immunizaqon
5% 4% 4% s 31% TB Tesqng 9% Vital Staqsqcs 20% Flu Shots 27% Note: ‘Other’ Services included Hepatitis B, HIV, WIC and Food License. @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 7 2.2 Survey Results by Questions (cont.) Q4. How would you rate the services you received from Steubenville Health Department? Health Dept. Services RaLng Excellent Good Fair 2% 30% 68% 2 Q5. How would you describe your current health status?
Self-­‐described Current Health Status Poor Excellent 3% 17% Fair 16% Good 64% Jefferson County Ohio has the highest age-­‐adjusted rate of diagnosed diabetes of all of Ohio's 88 counties. When you couple this data with the fact that we are 4th in the state in obesity and 9th in physical inactivity, it provides a clear picture of how closely tied these three risk factors are. In Steubenville's aging and declining population these are reasons to be concerned since physical inactivity is a risk factor for 6
developing type-­‐2 diabetes. @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 8 2.2 Survey Results by Questions (cont.) Q6. Do you Currently have health Insurance? # % Yes 282 90.1 No 31 9.9 Health Insurance Provider None Other Medicare 1% 15% 14% Medicaid 10% Private 60% Q7. Who is your Insurer? 5
Insurer # % Av. Age Std Dev Medicare 39 13.7 66.9 12.72 Medicaid 28 9.8 32.7 16.49 Private 171 60.0 50.3 11.39 Other 43 15.1 47.6 13.99 None 4 1.4 53.2 25.39 @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 9 2.2 Survey Results by Questions (cont.) Q8. Have you ever been diagnosed with a chronic illness? Chronic Illnesses Respiratory 14% Diabetes Cancer 22% 13% High BP 40% Heart Disease 11% Other: Diverticulosis Asthma Eczema Catamenial epilepsy Crohn’s Disease Depression Rheumatoid arthritis Pelvic floor dysfunction Sleep apnea/Migraines Interstitial Cystitis Hyperthyroidism Circadian rhythm disorder 2.2 Survey Results by Questions (cont.) – Health Services Delivery Q9. Do you obtain health services for you and your family in Steubenville? # % Yes 263 83.5 No 52 16.5 @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 10 2.2 Survey Results by Questions (cont.) – Health Services Delivery Q10. Which, if any, of your health care needs are NOT being met in Steubenville? Specialist Physicians 9 Neurology 2 Endocrinology 8 Low Income clinic 2 Primary Care Physician 7 Pulmonology 2 Dentist 7 Allergist 1 Ophthalmology 5 ER 1 OB/GYN 5 Women’s Health 1 Mammography 3 Oncologist 1 Gynecology 3 Advanced Peds 1 Dermatology 3 Oral Surgery 1 Pain Management 3 Specialist Peds 1 Rheumatology 3 Breast Specialist 1 Weight Management 3 Prevention 1 Orthopedics 3 Chiropractor 1 Surgery 3 Autism Specialist 1 Q11. Are there any obstacles in your seeking/receiving health care services? # % Yes 61 19.6 No 250 80.4 Q12. If yes, what are the obstacles? • Not enough doctors (specialists) from Pittsburgh are approved as participants in our insurance plan • Unable to see family physician in a timely manner. Seek medical care only when sick and often times aren't able to see the doctor. • No vision or dental health care coverage • Time off work, waiting for appointment, too much copay, out of pocket expense • Sometimes the front desk people in the office are not willing to "fit" a patient in and I feel perhaps don’t "hear" me...some doctors have EXCESSIVE wait periods in the office (something not really experienced in Pittsburgh doctors I see • MONEY • Being on unemployment I no longer qualify for some due to income being too high. But my income it not even much to live on. • No doctors are accepting new patients. • I can’t afford a doctor • Can't afford • Accessibility • No insurance @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 11 2.2 Survey Results by Questions (cont.) – Health Services Delivery • Locating a physician who will accept patients, either they are not accepting new patients or they are Pittsburgh leftovers that work here one day a week. • Car, money, time • COST • For one thing, if you are a single adult who has fallen on hard times and have no children there seems to be no program that can help single adults with no children. For example, you cannot get public assistance for coverage through the welfare department if you make more than $150.00. Now however that was ten years ago, things have improved for me, and things have changed for me. But back at that time, it was ruff and it seems there was no help. I do however, praise the charity program it should be maintained. • My health insurance has a high ($7500.00) deductible and pre-­‐existing conditions are not covered. • Money...no insurance • I work and have student loans beyond my budget and cannot pay my medical bills. • No insurance • Birth control not covered by my insurance • Can't afford the insurance I can get 500.00-­‐800.00 a month on the outside. • Money • Transportation • I will be losing my employee health insurance on March 1, 2011 and I can't afford to buy insurance on my own • My plan is 80/20... the 20% adds up, so we tend to avoid hospitals if we can help it. • Health care service is decided by my health insurance coverage. •
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Yes there are obstacles...... health care is too expensive. Income Money, Knowledge of what is out there for me Doctors Hours OFFICE hours DO NOT WORK WELL with work times Finding psychological type services/ Workers Comp approved Doctors, specialists Cost of copays and deductibles No insurance or stable income Timing -­‐ it's difficult to seek services during regular work hours. I would be helpful if doctors would be available on some non-­‐traditional hours. Expense Unemployed cannot get Medicaid Cost of co-­‐pays, deductibles, and prescriptions, even though having insurance. Deductibles and co-­‐pays are high. I work at Weirton Medical Center, so in order to have health services covered at highest amount I must go there for all medical care. Not a lot of services for Autism Can not afford. I go to Trinity because I can do charity care. Live in low income. The program for insurance that I was on was terminated. Do not have money to get x-­‐rays, blood work, meds and cannot afford insurance. Time & Money @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 12 2.2 Survey Results by Questions – Physician Services Q13. Do you have a family physician? # % Yes 279 89.7 No 32 10.3 3
Q14. How many times a year do you visit your physician? All participants average: 2.6 times/year. Range: 0 to 15 times/year 70 60 50 40 Male 30 Female 20 10 0 0 1 2 3 4 5 Q15. Is your family physician located in Steubenville? # % Yes 196 65.8 No 102 34.2 2.2 Survey Results by Questions – Social Services Q16. Have you used the services of a social service agency? # % Yes 59 19.1 No 250 80.9 @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 13 2.2 Survey Results by Questions – Social Services (cont.) Q17. Satisfaction with Social Service Agencies? V Disat 6% V Saqs Dissat 10% 6% Saqs Neutral 38% 40% 2.2 Survey Results by Questions (cont.) – Satisfaction Levels Q18. What is your overall satisfaction with health services in Steubenville? Dissat V Dissat 5% 2% V Saqs Neutral 17% 21% Saqs 55% Social Service Agencies Health Services @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 14 2.2 Survey Results by Questions (cont.) – Satisfaction Levels Q19. Satisfaction with Steubenville Health Department Services? Dissat 2% V Saqs Neutral 30% 23% Saqs 44% 2.2 Survey Results by Questions (cont.) – Demographic Profile Q20. Gender: # % Male 92 31.0 Female 205 69.0 Q21. Average Age of respondent: 50.0 years (Male -­‐ 52; Female -­‐ 49) Age Range: 18 – 88 Steubenville Health Department V Disat 1% @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 15 Q22. Race: White Black Hispanic/Laqno Other 7% 1% 91% Q23. How long have you been a resident of the city of Steubenville? All participants average: 31 years. Q24. What is your marital status: 20% Married Widowed 2% Divorsed 57% 13% Separated Never Married 8% Race of Respondents Marital Status @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 16 2.2 Survey Results by Questions (cont.) – Demographic Profile Q25. Educational Level: th
8 grade or less th
th
th
9 , 10 or 11 grade th 12 grade, no diploma High school graduate Some college, <1 yr. 1 or more yrs, no degree Associate Degree Bachelor’s, (BS, BA) Master’s (MA, MS, MBA) Professional degree, (MD, JD) Doctorate – (PhD, EdD) # 1 6 2 52 35 47 54 58 34 4 4 297 % 0.3 2.0 0.7 17.5 11.8 15.8 18.2 19.5 11.4 1.3 1.3 Q26. Employment status: Employed for Wages Self-­‐employed Out of work, looking Out of work, not looking Homemaker Student Retired Unable to work # 177 19 13 3 19 5 44 17 % 59.6 6.4 4.4 1.0 6.4 1.7 14.8 5.7 # 45 94 44 38 2 8 16 48 2 % 15.2 31.6 14.8 12.8 0.7 2.7 5.4 16.2 0.7 Q27. Type of work: Retired Employee – For Profit company Employee, not-­‐for-­‐profit company Local Government State Government Federal Government Self-­‐employed Unemployed Work w/o pay Av. Age Std Dev. 88.0 -­‐-­‐ 34.5 14.19 58.0 8.48 51.5 17.11 52.6 13.59 49.5 15.08 46.7 13.32 47.6 14.41 54.3 13.40 61.0 13.09 54.0 19.13 49.96 15.05 @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 17 2.2 Survey Results by Questions (cont.) – Demographic Profile Q28. Household Income: # % Avg Age < $10,000 33 11.1 43.2 $10,000 -­‐$19,999 35 11.8 48.2 $20,000 -­‐ $29,999 22 7.4 49.1 $30,000 -­‐ $39,999 33 11.1 50.2 $40,000 -­‐ $49,999 34 11.4 55.6 $50,000 -­‐ $59,999 33 11.1 54.1 $60,000 -­‐ $69,999 28 9.4 45.9 $70,000 -­‐ $79,999 19 6.4 51.0 $80,000 -­‐ $89,999 25 8.4 49.8 $90,000 -­‐ $99,999 9 3.0 51.1 $100,000 -­‐ $149,999 22 7.4 48.9 $150,000 > 4 1.3 66.7 2.3 Focus Group Outcomes 2.3.1 Medicare Focus Group Date: February 25, 2011 Location: Health Department Conference Room, City Building Findings Summary: • COST: All participants agreed that the Medicare Program required too much paperwork and the drug program is very expensive. They were concerned about overall rising cost of the Medicare benefits and how future cuts might impact them. The group agreed the impact of cost would affect their frequency of seeking medical care. Several of the participants had additional medical coverage (Jefferson County and School District) beyond Medicare benefits. This supplemental coverage appears to ease the cost burden. • In the past, the participants used the Steubenville Health Department for Flu shots. 2.3.1 Medicare Focus Group (cont.) • Expectations for health care in 5 to 10 years? -­‐ Hospitalist -­‐ Expects the latest technology even though it drives cost -­‐ Mobile office for Medicare -­‐ Satellite facilities to lessen the burden of main facilities in terms of wait time, cost and patient care @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 18 2.3 Focus Group Outcomes (cont.) 2.3.2 Medicaid Focus Group Location: Women’s Health Center, Washington Street Date: February 25, 2011 Findings Summary: • Transportation: lack of public transportation and job opportunities • Cost of healthcare 2.3.3 Employer Focus Group Date: March 1, 2011 Location: D’Anniballe Business Center, Sunset Boulevard Findings Summary: The participants represented small, medium and large employers within the Steubenville area. We had a diverse mix of private, city and county organizations represented. • In the past three years, all organizations have experienced some level of increase in their premiums, deductibles and drug co-­‐pays -­‐ The government experienced increase in cost but did not pass the cost onto their employees. -­‐ Private sector organizations are passing on +3% to their employees while increasing deductibles and co-­‐pays • Do most of your employees get their health services in Steubenville? -­‐ Most of their employees seek primary care medical treatment in Steubenville, Wheeling, Martins Ferry, Pittsburgh, St. Clairsville, Robinson, and Weirton -­‐ 20% go outside the area for specialty services -­‐ Peds. Diabetic, Neurology, Transplantation, Cardiac, Orthopedics, Rheumatology and Geriatrics Overall satisfaction ‘feebdack’ … • Opportunity for Wellness Program -­‐ City has a health and wellness program with 50% enrolled (diabetic, weight loss, alcohol/drug) -­‐ WTOV has online health and wellness but sees more need for metal health (EAP Program, Depression) -­‐ County has a nurse that follow up with employees to answer medication questions or provide guidance on chronic illnesses -­‐ FUS has a health and wellness program • Barriers/Access to Healthcare -­‐ City and County PPT headcount is not eligible for insurance -­‐ Transportation -­‐ Cost • Group agreed employers’ big issues include: -­‐ Unemployment -­‐ Workers comp cost -­‐ Health insurance @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 19 2.3 Focus Group Outcomes (cont.) 2.3.4 Healthcare Provider Focus Group Location: Health Department Conference Room, City Building Date: March 10, 2011 The participants represented a diverse mix of health care providers to include: nursing, acuity, hospital, hospice, physicians and non-­‐profit facilities. • State of health in our community? Are we making any progress from 1996? -­‐ Overall, there has been progress in awareness and access. -­‐ Improvements needed: -­‐ Mental health -­‐ Drugs use (street and prescription) -­‐ Severity of critically ill -­‐ Elderly members are driving cost and lack of preventative care for the caretakers • What are we doing well? -­‐ Range of service and access -­‐ Cancer care -­‐ Cardiology -­‐ End of life care -­‐ Long-­‐term care -­‐ Better with geriatric care . However, we need to deal with patients who are on their own. Growing incidence of dementia. -­‐ Community agencies are well connected to healthcare providers -­‐ Jefferson County takes care of the community needs -­‐ Health department provides easy access and the public takes advantages of those services. • Areas for development? -­‐ Once people turn 18, the system leaves them to their devices -­‐ Compliance is a big concern (coverage, transportation) -­‐ Lack of education ... healthcare is complicated -­‐ Literacy drives lack of compliance -­‐ Economy -­‐ Healthcare reform -­‐ Inability to collaborate and integrate resources within a community -­‐ Aging population and aging physicians -­‐ Some programs are not advertised (ex. people know about WICK but not breast and cervical programs) -­‐ We have easy access but the outreach programs are weak • How are we doing on the continuum of care (birth of a baby through end of life care)? -­‐ Younger physicians are not visiting the nursing home -­‐ People can stay homebound longer … when the nursing home gets the patient, they are more critically ill -­‐ Lack of Medicare and Medicaid dollars @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 20 2.3 Focus Group Outcomes (cont.) 2.3.4 Healthcare Provider Focus Group -­‐ Need a greater skill of workers because of the severity of the patients’ condition -­‐ Reimbursement is driving the type and quality of care • Most important issues? -­‐ We are expected to provide high level of care with fewer resources because of reimbursement rate -­‐ Patients are getting moved into multiple facilities because of care requirement and reimbursement -­‐ There is a lack of communication between facilities and physicians -­‐ Physicians limit services because they can't meet the expectations -­‐ Quality of the workforce is limited from skills and work ethic -­‐ Need electronic sharing of information -­‐ Media is influencing people to self medicate and diagnosis • What are the needs with physician services? -­‐ Rheumatology, endocrinology, geriatric, neurology ... missing -­‐ Needs to expand orthopedic and mental health -­‐ Pharmacology -­‐ Psych for adolescence -­‐ Addiction care -­‐ Pulmonologist ... succession planning for elder physician population -­‐ -­‐ Hospitalist will be taking care of the community -­‐ Some think this is good but it is important for communication whether electronic or collaboration. -­‐ This present care continuity concerns -­‐ Cost of pharmaceutical ... most people have part Medicare D -­‐ There are gaps with specialized treatment and care -­‐ Not everything prescribed is covered and this impacts physician. Some people will self medicate because of cost -­‐ We are going to a general formula for care • Is there an appropriate level of collaboration on the continuum of care? -­‐ We can do better with end of life -­‐ There is a lack of communication because Physicians live out of town -­‐ They fail to consult at the needed level -­‐ The number of physicians providing care for one patient is growing and the ability to collaborate and communicate is lacking -­‐ Due to larger number of patients, doing more with less. This lack of continuity impacts the quality of care. -­‐ Multiple physician, multiple facilitates ... Both in town and out of town equals FRAGMENTED CARE (use of PA, NPA) -­‐ Profitability drives quality @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 21 2.3 Focus Group Outcomes (cont.) 2.3.4 Healthcare Provider Focus Group • Where can we do better with Public Health? -­‐ H1flu vac ... Federal programs are difficult to collaborate with the private sector. Sometime it is better to keep the service at health department. Otherwise collaboration is good. -­‐ Patty Reda ...city council provides half of funding and the rest is provided by generating fees for service -­‐ Promote health department services -­‐ Volunteers are concerned about time and liability coverage @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 22 2.4 Comparative Outcomes Focus Group Findings Fall 1996 -­‐ Spring 2011 2.4.1 Satisfaction & Confidence Level of Existing Services 1996: a. Lack of confidence in existing services b. Better quality in Pittsburgh c. Dissatisfaction w/ physician services 2011: a. Dissatisfaction with Hospital Emergency services (wait time, professionalism, quality of care) b. Dissatisfaction w/ physician services (availability, wait time, face time) c. Very Satisfied with Cancer care and Health Department Services 2.4.2 Needs Identification of Potential Services 1996: a. Mental health services b. Lack of primary care physicians c. Pediatric services d. Geriatric services e. Dental services (Medical Assistance patients) 2011: a. Mental health/addition services b. Drug services c. Specialty services (geriatric, endocrinology, rheumatology) 2.4.3 Barriers to Services 1996: a. Lack of transportation for low income residents b. Rivalry among psychiatrist c. Physician lack of consumer component in their approach d. Cost Issues e. Lack of integration and coordination between public/private health care 2011: a. Lack of transportation for low income residents b. Cost Issues c. Outreach programs to drive awareness and access d. Lack of integration and coordination between private health care providers/facilities for continuum of patient care @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 23 2.5 Public Health Aspects & the Community Assessment 2.5.1 Unintentional Injuries: th
Accidents, or unintentional injuries, is the 5 leading cause of death in the United States prompting over 28 million ER visits a year. Unintentional injuries accounts for 41 deaths per 100,000 population. Contained in this category are fires, fall deaths, motor vehicle deaths and poisoning deaths. A local focus could be the development of a strategy that could reduce the behavioral and environmental health risks that are primary contributors to unintentional injuries. City safety forces could assist. Bicycle injury – Promote helmet use among parents and children, enforce traffic laws for bicyclists Fires, falls and other home hazards -­‐ Education, fire safety education, enforce smoke alarm legislation Seat belt use – Enforce existing state and local legislation In some communities car surfing represents a hazard especially for young males. Car surfing is riding on the roof or hood of moving vehicles. Vehicle speeds as slow as 5mph and as fast as 80 have been observed. A key risk is from sudden unexpected maneuvers such as swerving or braking that can force a car surfer off the vehicle. City safety forces are key in curtailing this type of behavior. Violence also falls into the unintended injury category. Of recent concern has been bullying in schools. Our preventive strategy needs to be designed to protect victims and prevent violence and suicide from occurring. There is a need for health education and behavioral change. There may be school rules against fighting and bullying, teaching children how to emotionally deal with social situations will address the problem even further. Reference: CDC, SOPHE @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 24 2.5.2 Preventing the Spread of Infectious Diseases: Infectious diseases are all caused by infective agents — such as bacteria, viruses, fungi or parasites. Some infectious diseases can be passed from person to person. Some, however, are transmitted via bites from insects or animals. Others are acquired by ingesting contaminated food or water or other exposures in the environment. Signs and symptoms of infectious diseases vary, but often include fever and chills. Mild complaints may respond to home remedies, while some life-­‐threatening infections may require hospitalization and intravenous antibiotics. Many infectious diseases, such as measles and chickenpox, can now be prevented by vaccines. Frequent and thorough hand washing also helps protect you from infectious diseases. Contagious diseases that pose a health risk to people have always existed. While the spread of many of these diseases has been controlled through vaccination and other public health efforts, terrorist acts worldwide have raised concerns about the possibility of a biological attack. That makes it important for people to understand what can and would be done to protect the public from the spread of dangerous contagious diseases. The Centers for Disease Control and Prevention (CDC) is the U.S. government agency responsible for identifying, tracking and controlling the spread of disease. With the help of the CDC, state and local health departments have created emergency preparedness and response plans. In addition to early detection, rapid diagnosis and treatment with antibiotics or antivirals, these plans use two main traditional strategies—quarantine and isolation—to contain the spread of illness. These are common health care practices to control the spread of a contagious disease by limiting people's exposure to it. The Steubenville Health Department is part of this network and has developed preparedness and response plans for the citizens of the city. Tabletop exercises are held on a regular basis and the plans continue to be reviewed and refined over time. @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 25 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 2.6 Vital Statistics: 2.6.1 Births and Deaths – City of Steubenville Residents 350 300 250 200 150 100 50 0 2.6.2 Causes of Death -­‐ 2000-­‐2010 300 250 200 150 100 50 0 Births Deaths Heart Cancer Pulmonary Vascular 2010 @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 26 3. Public Health Action Plan @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 27 4. Footnotes: ©, ‘
1. Circinus Analytics – Circinus Group utilizes IBM SPSS Statistics the world’s leading statistical .’
software for business, government, research and academic organizations for statistical analysis of our Community Assessment Survey data. 2. Research has indicated that self-­‐reported health status usually has no significant differences between genders. The proportion reporting good to excellent drops steadily by age group. Income and education levels are the strongest predictors of self-­‐reported health status. (Washington State Health Department) 3. Seventy-­‐one percent of Americans visit the doctor for a regular check-­‐up at least once a year. This is less true among young adults 18-­‐25 (55%) and increases steadily with age. By the time Americans are over 75, 92% are visiting the doctor for check-­‐ups at least on an annual basis. For existing conditions, the frequency of doctor visits tends to be every few months or a couple of times per year. However, as might be expected, the frequency of physician visits for known conditions increases steadily with age. (CDC) 4. Community Benefit -­‐ Nonprofit hospitals receive various tax exemptions from federal, state, and local governments with the expectation that, in return, they will provide benefits to the community. (Congressional Budget Office) 5. Standard Deviation – a measurement of variability. It shows how much variation there is from the average. A low standard deviation shows that the data points tend to be very close to the mean. A high standard deviation indicates that the data are spread out over a large range of values. Thus in our measure of the mean age of respondents claiming no health insurance, four respondents are spread out across a range of 269 surveys. 6. Health Risks Identified -­‐ CDC study of 2008 data from 3141 counties in the US. States where residents were least likely to be active were Alabama, Kentucky, Louisiana and Mississippi. States most likely to be active were California, Colorado, Hawaii and Minnesota. (CDC Maps & USA Today: 2/17/11) @2011 Circinus Group, 1439 Sunset Blvd., Steubenville, Ohio 43952 * 614-­‐747-­‐6322 * @2011 Circinus Group, LLC. All Rights Reserved 28