Logan County Primary Care Planning Needs Assessment

Transcription

Logan County Primary Care Planning
Needs Assessment
Introduction
Logan County is a rural area in north central Ohio faced with a lack of access to primary care
services for the low-income, uninsured, and underinsured members of the community. This lack
of access to primary care services has resulted in mortality rates that are higher than State of
Ohio rates from several causes including malignant neoplasms, chronic lower respiratory
diseases, and cerebrovascular disease. 1
Mary Rutan Hospital is a 501(c)(3) organization which operates the only safety net primary care
health clinic in the county. Mary Rutan Hospital was founded in 1919 and operates a 100 bed
inpatient facility as well as the Mad River Family Practice outpatient safety-net health clinic. In
2011, Mary Rutan Hospital received a U.S. Department of Health and Human Services Health
Resources and Services Administration Affordable Care Act Health Center Planning grant. This
grant is authorized under Section 330 of the Public Health Service Act and has as its goal to
“conduct strategic planning to address the issue of access to primary care services for the lowincome, uninsured, and underinsured members of the Logan County community on a long-term,
sustainable basis.”
This Needs Assessment is the first step of that strategic planning process, and it identifies health
disparities, social determinants of health, and barriers to care in the service area for the target
population and recommends considerations for the development of a community health center to
provide services to remove those health disparities.
Service Area
Logan County is the service area for this Needs Assessment. Figures 1 shows Logan County in
relationship to the State of Ohio, and Figure 2 shows Logan County with incorporated areas and
major roads in the county. Logan County has two significant geographical features. In the
northwest corner of the county is Indian Lake. This man-made lake was created in the 1850’s as
a feeder lake for the Miami and Erie Canal systems. In the central part of the county,
approximately two miles from downtown Bellefontaine, is Campbell Hill, the highest point
above sea level in the State of Ohio.
There are 11 census tracts, 17 zip codes, 12 zip code tabulation areas, 17 townships, 4 school
districts, and 13 incorporated areas in Logan County as summarized in Table 1. This Needs
Assessment will gather and evaluate data from each of these subdivisions within the county as
well as for the county as a whole.
1
Ohio Department of Health, Information Warehouse. “Vital Statistics: Leading Causes of Death 2006-2008.”
http://dwhouse.odh.ohio.gov/datawarehousev2.htm (accessed 26 March 2011).
Figure 1. Logan County, Ohio 2
Figure 2. Logan County, Ohio 3
Table 1. Logan County Sub-Divisions
Division
Identifier
4
Census Tract
9838, 9839, 9840, 9841, 9842, 9843, 9844, 9845, 9846, 9847, 9848
Zip Code 5
43060, 43310, 43311, 43318, 43319, 43324, 43331, 43333, 43336,
43343, 43345, 43347, 43348, 43357, 43358, 43360, 45334
Zip Code Tabulation
43331, 43310, 43347, 43345, 43358, 43311, 43318, 43343, 43357,
6
Area
43360, 43319, 43361
Township 7
Bloomfield, Bokescreek, Harrison, Jefferson, Lake, Liberty,
McArthur, Miami, Monroe, Perry, Pleasant, Richland, Rushcreek,
Stokes, Union, Washington, Zane
8
School District
Bellefontaine City, Benjamin Logan Local, Indian Lake Local,
Riverside Local
9
Incorporated Area
Bellefontaine, Belle Center, DeGraff, Huntsville, Lakeview,
Quincy, Ridgeway, Rushsylvania, Russells Point, Valley Hi, West
Liberty, West Mansfield, Zanesfield
2
Ohio Department of Development, County Profiles. “Logan County Profile 2010.”
http://www.development.ohio.gov/research/files/s0/Logan.pdf (accessed 19 March 2011).
3
Ibid
4
United States Census Bureau. “2000 Decennial Census: Census Tracts in Logan County, Ohio.”
http://factfinder.census.gov/servlet/DTGeoSearchByListServlet?ds_name=DEC_2000_SF3_U&_lang=en&_ts=318618286327 (accessed 19
March 2011).
5
MelissaData.com, “Zip Codes Serving Logan County, Ohio.” http://www.melissadata.com/lookups/CountyZip.asp?fips=39091 (accessed 19
March 2011).
6
UDS Mapper. “Zip Code Tabulation Areas in Logan County, Ohio.” http://www.udsmapper.org/index.cfm (accessed 19 March 2011).
7
United States Census Bureau. “2000 Decennial Census: Townships within Logan County, Ohio.”
http://factfinder.census.gov/servlet/DTGeoSearchByListServlet?ds_name=DEC_2000_SF1_U&_lang=en&_ts=318619426148 (accessed 19
March 2011).
8
Ohio Department of Education, Interactive Local Report Card. “School Districts within Logan County, Ohio.”
http://ilrc.ode.state.oh.us/Districts/District_List.asp?CountyName=Logan County (accessed 19 March 2011).
9
Wikipedia.org, “Villages within Logan County, Ohio.” http://en.wikipedia.org/wiki/Logan_County,_Ohio (accessed 19 March 2011).
Logan County received a Medically Underserved Population designation (ID# 07835) on August
31, 2011. 10 This designation applies to the low-income population of the county. There are no
Primary Care Health Professional Shortage Areas or Dental Care Health Professional Shortage
Areas located in Logan County. The entire county was designated as a Mental Health Care
Professional Shortage area on February 28, 2007. 11 Logan County was designated as an Ohio
Governor’s Certified Shortage Area for the Purposes of the Rural Health Clinic Program on July
18, 2011. 12
Table 2 summarizes population data for Logan County from 1970-2010. The population
increased steadily through 2000, and had a small decline in 2010. The Ohio Department of
Development projects that the population will increase to slightly over 51,000 individuals by
2020. 13 Forty-five percent of the total population is classified as urban and 55% of the
population is classified as rural. Almost 53% of the land area in Logan County is cropland. 14
The City of Bellefontaine is the only urban area in the county. Logan County qualifies for a
variety of programs based on its rurality. 15 These include the Rural Health Clinic and Medicare
Telemedicine Reimbursement programs administered by the Centers for Medicare and Medicaid
Services, and The Small Rural Hospital Improvement Grant, Rural Access to Emergency
Devices Grant, Rural Health Care Services Outreach Grant, Rural Health Network Development
Grant, and Rural Health Network Development Planning Grant programs administrated by the
Office of Rural Health Policy.
Table 2. Logan County Population 16
Population
1970
35,072
1980
39,155
1990
42,310
2000
46,005
2010
45,858
A report by the Jefferson Institute characterizes Logan County as a “service worker center.”
This describes counties with tourist hubs and midsize towns where many workers live without
benefits. Real income has declined from $44,222 in 1080 to $41,775 in 2010 in these areas
across the United States. This decline in income is the result of the loss in manufacturing jobs in
these areas. 17
10
Find Shortage Areas: MUA/P by State and County," Health Resources and Services Administration, accessed October 28, 2011,
http://muafind.hrsa.gov/index.aspx.
11
"Find Shortage Areas: HPSA by State and County," Health Resources and Services Administration, accessed October 28, 2011,
http://hpsafind.hrsa.gov/HPSASearch.aspx.
12
Andy Jordan, Director Office of Shortage Designation Bureau of Health Professions, Health Resources and Services Administration,
Department of Health and Human Services, to The Honorable John Kasich, July 18, 2011.
13
"Ohio County Profiles," Ohio Department of Development Office of Policy, Research and Strategic Planning, accessed February 14, 2012,
http://www.development.ohio.gov/research/files/ s0.htm.
14
Ibid.
15
"Am I Rural?" Rural Assistance Center, last accessed October 28, 2011, http://ims2.missouri.edu/rac/amirural/definitions.asp.
"Logan County, Ohio," Wikipedia, accessed December 18, 2011, http://en.wikipedia.org/wiki/Logan_County,_Ohio.
17
Dante Chinni and James Gimpel, "The 12 States of America: Since 1980, Income Inequality has Fractured the Nation," The Atlantic, April
2011, page 70-71.
16
Target Population
The population with income below 200% of the federal poverty level as designated by the
Medically Underserved Population is the target population for this application. Tables 3 - 6
provide a summary of demographic and socioeconomic information for incorporated areas and
census tracts in Logan County. The 2000 U.S. Census provides a variety of demographic and
socioeconomic data which is included in Tables 3 and 5. In 2010, there were significant changes
to the U.S. Census including the elimination of the long-form questionnaire which collected key
socioeconomic and housing data. This decennial long-form questionnaire was replaced by
annual American Community Survey data. The American Community Survey provides one,
three, and five year estimates depending on the population size of the area of interest. Tables 4
and 6 contain data from the 2010 U.S. Census and the American Community Survey to provide a
complete picture of the demographic and socioeconomic circumstances of Logan County.
The population of Logan County is primarily white and rural. The population decreased slightly
(0.3%) from 2000 to 2010, and the minority population increased slightly. The distribution of
the population from the countryside and small incorporated areas shifted towards the City of
Bellefontaine, and the population is currently evenly split between the two.
The median household income in Logan County has risen only 9% in the past decade. This
compares to a 22% increase in the United States overall during the same time period. Three
incorporated communities in Logan County saw a decline in median household income. The
median household income in Belle Center decreased 3.5%, the median household income in
Rushsylvania decreased more than 6%, and the median household income in Valley Hi decreased
nearly 23%. Three census tracts saw a decline in median household income. These include the
census tract which includes Russell’s Point (9842), and two census tracts in the City of
Bellefontaine (9844 and 9846).
The percentage of the population with income below 200% of the federal poverty level has
increased from 24% to 37%, and almost 14,500 individuals were living in poverty in Logan
County in 2010. The percentage of the population with income below 200% of the federal
poverty level ranges from a low of 23% in West Liberty to a high of 53% in Valley Hi. The
distribution of low income individuals has shifted from primarily along the State Route 33
corridor to throughout the county. Notably, one rural census tract (9840) had an increase in the
percentage of the population with income below 200% of the federal poverty level from 22% to
35%.
A study by the Ohio Association of Community Action Agencies indicates that a
disproportionate number of children are living in poverty in Logan County. In 2009, almost 27%
of children under the age of 5 and 20% of children under the age of 18 were living below the
federal poverty level. This compares to 23% of children under the age of 5 and 18% of children
under the age of 18 in the State of Ohio. 18 The Ohio Department of Job and Family Services
reported that the rate of poverty among children under 18 years old had risen to 21.1% by
18
"The State of Poverty in Ohio; A Path to Recovery," Ohio Association of Community Action Agencies, accessed November 8, 2011,
http://www.oacaa.org/index_337_103526955.pdf.
2011. 19 The rate of dependency on income supports in Logan County was 22.9% in 2009,
compared to the State of Ohio rate of 18.2%. This was a significant increase from the 2007 rate
of 18.4% in Logan County. 20
An alternative measure of poverty is the Self-Sufficiency Standard. This measure of income
adequacy calculates the costs of six basic needs and includes the impact of taxes and tax credits.
It assumes the full costs of each need without help from public assistance. This measure is place
specific as it includes measures such as food, housing, and transportation which can vary greatly
from location to location. The 2011 Self -Sufficiency Standard for Logan County indicates that
for a single adult household with one preschool age child, the income level which supports the
family is $30,422; this is 209% of the federal poverty level. 21 This supports research by the US
Census Bureau which indicates that poverty in non-metropolitan parts of Ohio is impacted by the
higher costs of housing. 22
Logan County is the home to two populations with unique cultural characteristics. The first is a
large Amish population. It is difficult to measure the numbers of Amish in the United States
because they do not take a census of their members, however it is possible to estimate this
number based on the number of Amish church districts. The church districts are listed in the
Amish publication Raber’s Almanac, and each church district has an average membership of 168
individuals. There are five church districts located in Logan County resulting in an estimate of
850 Amish individuals. 23
The Logan County Amish population is divided into two settlements, one near DeGraff and the
other near Belle Center. The DeGraff Amish are known as Swiss Amish and speak Bernese
German, which is a form of German spoken on the Swiss plateau and is different from dialects
spoken by other Amish communities. The Swiss Amish allow the use of alcohol and tobacco
products although they are very traditional in limiting their use of technology. About 40% of the
Logan County Amish are part of the DeGraff settlement. The remaining 60% are part of the
Belle Center settlement. This is a New Order Amish settlement, which is more progressive
toward the use of technology, but which does not use alcohol or tobacco. The Belle Center
settlement is a relatively new settlement which was formed by a group from the Plain City, Ohio
area. Plain City is on the outskirts of Columbus, Ohio, and encroaching suburbs and increasing
automobile traffic resulted in the emigration from Plain City to Logan County. The Belle Center
settlement speaks Pennsylvania Deitsch.
19
"2011 Job and Family Services Profile; County Overview," Ohio Department of Job and Family Services, accessed June 19, 2012,
http://jfs.ohio.gov/county/cntypro/index.stm.
20
Ibid.
21
"Find the Self Sufficiency Standard for Your State," The Center for Women's Welfare, accessed November 8, 2011,
http://www.selfsufficiencystandard.org/pubs.html.
22
Trudi Renwick, "Geographical Adjustment of Supplemental Poverty Measure Thresholds Using
the American Community Survey 5-Year Data on Housing Costs," U.S. Census Bureau, accessed November
8, 2011, http://www.census.gov/hhes/povmeas/methodology/supplemental/research/Renwick_SGE2011.pdf.
“Amish Population by State (2011).” Young Center for Anabaptist and Pietist Studies, Elizabethtown College.
http://www2.etown.edu/amishstudies/Population_by_State_2011.asp.
23
This community has difficulty accessing care for a variety of reasons including cultural barriers,
linguistic barriers, geographic barriers and financial barriers. While the Amish do avail
themselves of conventional medicine, preventive medicine is often viewed as unnecessary or
Table 3. 2000 Demographics: Incorporated Areas 24
Population
1999 Median
Household Income
% of Population
Below 200% FPL
Total Population
Below 200% of FPL
(for whom poverty is
determined)
Age 25+ w/o High
School Diploma /GED
Linguistic Isolation
% Rural
% Minority
Logan County
Belle Center
Bellefontaine
DeGraff
Huntsville
Lakeview
Quincy
Ridgeway
Rushsylvania
Russell’s Point
Valley Hi
West Liberty
West Mansfield
Zanesfield
46,005
$41,479
818
$45,486
13,051
$36,029
1,226
$34,833
453
$40,156
1,082
$34,297
706
$31,250
348
$43,542
544
$44,333
1,625
$27,589
433
$43,125
1,798
$38,819
704
$41,731
211
$41,667
24%
19%
32%
28%
34%
36%
38%
22%
22%
40%
26%
15%
15%
16%
10,974
156
4,146
346
154
389
268
77
118
635
110
233
104
35
16%
16%
15%
16%
14%
29%
19%
19%
19%
27%
14%
13%
14%
2%
<1%
55%
4%
0%
100%
2%
1%
2%
10%
0%
100%
1%
0%
100%
4%
1%
0%
3%
0%
100%
3%
<1%
100%
2%
0%
100%
1%
<1%
1%
4%
1%
100%
4%
<1%
100%
2%
0%
100%
1%
0%
100%
3%
Table 4. 2010 25/2005-2009 26 Demographics: Incorporated Areas
Logan County
Belle Center
Bellefontaine
DeGraff
Huntsville
Lakeview
Quincy
Ridgeway
Rushsylvania
Rusells Point
Valley Hi
West Liberty
West Mansfield
Zanesfield
Population
45,858
813
13,370
1,285
430
1,072
706
338
516
1,391
212
1,805
682
197
Median Household
Income
% of Population
Below 200% FPL
Total Population
Below 200% of FPL
(for whom poverty is
determined)
Age 25+ w/o High
School Diploma /GED
% Rural
% Minority
$45,190
$43,875
$38,519
$50,000
$63,333
$38,194
$32,311
$47,679
$41,607
$28,250
$33,259
$50,202
$49,167
$51,250
37%
32%
43%
28%
26%
39%
47%
43%
32%
51%
53%
23%
25%
33%
14,443
283
5,556
389
141
467
411
189
139
646
180
294
184
55
13%
8%
%
%
%
%
%
%
%
%
%
%
%
%
<1%
50%
5%
0%
N/A
2%
9%
N/A
10%
0%
N/A
3%
0%
N/A
2%
0%
N/A
3%
0%
N/A
4%
0%
N/A
3%
0%
N/A
4%
0%
N/A
3%
0%
N/A
4%
0%
N/A
4%
0%
N/A
3%
0%
N/A
4%
24
"American Factfinder," U.S. Bureau of the Census, accessed November 4, 2011, http://factfinder.census.gov/servlet/DTSubjectShowTablesServlet?_lang=en&_ts=338581057989
“American Factfinder," U.S. Census Bureau, accessed February 14, 2012, http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml.
26
"American Community Survey," U.S. Census Bureau American Factfinder, accessed November 14, 2011, http://factfinder.census.gov/servlet/ DTTable?_bm=y&-context=dt&-ds_name=ACS_2009_5YR_G00_&-_geoSkip=10&-CONTEXT=dt&-mt_name=ACS_2009_5YR_G
2000_B01003&-mt_name=ACS_2009_5YR_G2000_B15002&-mt_name=ACS_2009_5YR_G2000_B16002&-mt_name=ACS_2009_5 YR_G2000_C17002&-mt_name=ACS_2009_5YR_G2000_B19013&-mt_name=ACS_2009_5YR_G2000_B02001&-tree_id=5309&_skip=0&-redoLog=false&-geo_id=05000US39091&-geo_id=16000US3905130&-geo_id=16000US3921378&-geo_id=160 00US3936988&-geo_id=16000US3941608&-geo_id=16000US3965200&-geo_id=16000US3967118&-geo_id=16000US39691
76&-geo_id=16000US3969302&-geo_id=16000US3979226&-geo_id=16000US3983734&-geo_id=16000US3983818&-geo_id=16000US3988070&-search_results=16000US3988070&-_showChild=Y&-format=&-_lang=en&-_toggle=.
25
Table 5. 2000 Demographics: Census Tracts 27
Incorporated Areas in Census Tract
Population
Median Household Income
% of Population Below 200% FPL
Total Population Below 200% of FPL
(for whom poverty is determined)
Age 25+ w/o High School Diploma
/GED
% Rural
% Minority
9838
9839
9840
9841
9842
9843
9844
9845
9846
9847
9848
Ridgeway,
Rushsylvania
West
Mansfield
Belle Center,
Huntsville
None
Lakeview
Russell’s
Point
DeGraff,
Quincy
Bellefontaine
Bellefontaine
Bellefontaine
Valley Hi,
Zanesfield
West Liberty
3,808
4,416
2,834
3,225
2,289
5,729
4,768
4,713
4,795
5,117
4,311
$45,353
21%
801
$50,642
17%
726
$41,905
22%
613
$30,616
37%
1,178
$29,647
36%
821
$41,900
22%
1,238
$30,618
40%
1,837
$37,477
30%
1,393
$44,731
21%
1,011
$52,163
15%
780
$47,321
14%
576
14%
20%
17%
28%
27%
18%
22%
14%
8%
9%
10%
<1%
100%
1%
2%
90%
2%
<1%
27%
6%
1%
1%
4%
<1%
2%
4%
<1%
99%
1%
0%
19%
12%
<1%
0%
7%
3%
10%
7%
<1%
100%
4%
<1%
100%
2%
9838
Ridgeway,
Rushsylvania
West
Mansfield
9839
Belle Center,
Huntsville
9840
None
9841
Lakeview
9842
Russell’s
Point
9843
DeGraff,
Quincy
9844
Bellefontaine
9845
Bellefontaine
9846
Bellefontaine
9847
Valley Hi,
Zanesfield
9848
West Liberty
4,378
$52,101
26%
1,155
4,347
$54,973
24%
1,061
3,224
$48,117
35%
1,132
3,280
$40,530
33%
1,081
2,042
$25,750
60%
1,229
5,726
$47,907
27%
1,539
5,024
$29,629
49%
2,433
4,210
$45,652
39%
1,623
4,880
$40,677
36%
1,731
5,306
$65,281
11%
576
4,013
$56,714
18%
714
13%
14%
17%
23%
17%
15%
23%
10%
11%
7%
8%
<1%
2%
0%
2%
0%
4%
0%
3%
0%
3%
0%
4%
<1%
9%
<1%
9%
<1%
9%
0%
2%
0%
6%
Table 6. 2010 Demographics: Census Tracts
Incorporated Areas in Census Tract
Population
Median Household Income
% of Population Below 200% FPL
Total Population Below 200% of FPL
(for whom poverty is determined)
Age 25+ w/o High School Diploma
/GED
% Minority
27
"American Factfinder," U.S. Bureau of the Census, accessed November 4, 2011, http://factfinder.census.gov/servlet/DTSubjectShowTablesServlet?_lang=en&_ts=338581057989
Figure 3. 2000 Highest Poverty Areas
36%
<200% FPL
40%
<200% FPL
34%
<200% FPL
32%
<200% FPL
38%
<200% FPL
Figure 4. 2005-2009 Highest Poverty Areas
39%
<200% FPL
32%
<200% FPL
43%
<200% FPL
51%
<200% FPL
32%
<200% FPL
43%
<200% FPL
47%
<200% FPL
53%
<200% FPL
wasteful. 28 Language presents a barrier to care because the Amish use Pennsylvania Deitsch, an
idiomatic form of German, or Bernese German in their everyday lives. Most speak, read and
write English, albeit in a very formal manner and limited context, and lack many words and
phrases that are part of modern English. Common American speech patterns and colloquialisms
are not familiar to the Amish community. 29 U.S. Census data does not reflect the linguistic
isolation of these households. Members of the Amish community use horse and buggy for
everyday transportation making travel time-consuming year-round, and extremely difficult
during the winter on the hilly terrain of Logan County. Amish communities do not participate in
government social service programs such as Social Security, Medicare, or Medicaid. 30
The second population with unique cultural characteristics is the Asian population that has
immigrated to work at the Honda automobile plant located 18 miles to the southwest of the City
of Bellefontaine. This population is responsible for the unusual spike in linguistically isolated
individuals in Logan County whose primary language is identified as Asian/Pacific Island by the
U.S. Census. While the numbers of individuals living in these linguistically isolated households
are small relative to the total population, this isolation does present a barrier to accessing primary
care. The majority of these individuals live in Census Tract 9846 which is relatively average
from a socioeconomic standpoint.
Logan County does not have any significant numbers of individuals who are special populations
for the purposes of §330 of the Public Health Service Act. There are no migrant and seasonal
farmworkers identified by the Ohio Department of Job and Family Services 2010 Ohio Migrant
Census. 31 There are 100 public housing units in Logan County with an average annual income
of $13,492. Seventy-five percent of residents of public housing have income levels classified as
“extremely low” by the U. S. Department of Housing and Urban Development. Ninety-six
percent of residents are white, and there are no Hispanics reported. 32 There were 108 individuals
identified in the 2007 Point-in-Time Homeless Count; 91% of these were unsheltered. 33
Existing Services
Barriers to health care include the existence and physical infrastructure of providers and
locations offering health care that is accessible to the target population. This Needs Assessment
includes an inventory of this infrastructure including primary care, hospital care, dental care,
mental health and substance abuse care, and pharmacological care.
28
The Cleveland Clinic Foundation. “Treating the Amish and Addressing their Health Care Concerns.” http://my.clevelandclinic.
org/healthy_living/healthcare/. (accessed August 2009).
29
Hostetler, John A. (1993), Amish Society, Johns Hopkins University Press, Baltimore, p. 241.
Wall Street Journal. “Opting Out: 'Old Order' Mennonites and Amish Who Shun Insurance Face Rising Bills.” June 28, 2008.
http://online.wsj.com/public/article/SB121460367338511945.html?mod=2_1566_leftbox. (accessed November 2010).
31
"2010 Ohio Migrant Census," State of Ohio; Department of Job and Family Services: Agriculture, accessed November 14, 2010,
http://jfs.ohio.gov/agriculture/index_EN-old.stm.
32
"Resident Characteristics Report," U.S. Department of Housing and Urban Development, accessed November 14, 2011, last modified
October 31, 2011, http://portal.hud.gov/hudportal/HUD?src=/ program_offices/public_indian_housing/systems/pic/50058/rcr.
33
"County Homelessness Statistics," Ohio Legal Services, accessed November 14, 2011,
http://www.ohiolegalservices.org/public/legal_problem/housing/homelessness/county-homelessness-statistics/logan-county-2007-point-in-timehomeless-population-stats/ logan-county-07.pdf.
30
Primary Care
The State of Ohio ranks 50th out of 51 states and territories in funding per uninsured individual
received from Public Health Service Act §330 for the time period 2002-2009. Ohio received
only $7.29 per uninsured individual versus the national average of $14.30 per uninsured
individual. 34 In 2007, 38% of federally designated medically underserved areas in Ohio lacked a
health center site. 35 Only three percent of the Ohio population is served by a federally qualified
community health center. 36
In Ohio, the distribution of Public Health Service Act §330 funded and Look-Alike health
centers is uneven and most sites are clustered across the southern and eastern portions of the state
(Figure 5). There are no existing Public Health Service Act §330 grantees or Federally Qualified
Health Center Look Alikes in Logan County. Table 7 provides information on the nearest
Federally Qualified Health Centers and Table 8 provides information on the use of Federally
Qualified Health Centers by Logan County residents. Data on usage is collected by Zip Code
Tabulation Areas, which do not conform exactly to the county boundaries. Figure 6 is a map of
the Zip Code Tabulation Areas included in this analysis.
Figure 5. FQHC Distribution 37
Logan County
34
United States Government Accountability Office. “Highlights of GAO-09-667T: Many Underserved Areas Lack a Health Center Site.” Health
Resources and Services Administration, 2009.
35
Ibid.
36
Adashi, Eli Y. et al. “Health Care Reform and Primary Care: The Growing Importance of the Community Health Center.” New England
Journal of Medicine, April, 2010.
37
"Find a Health Center," The Ohio Association of Community Health Centers, accessed November 15, 2011,
http://www.ohiochc.org/associations/10460/files/OACHC_MAP_2011_11-2-11.pdf.
Table 7. Federally Qualified Health Centers 38
Health Center
Location
Rocking Horse Center
Dr Gene Wright Community
Health Center
New Carlisle Community Health
Center
Center Street Community Health
Center
Community Health Centers of
Greater Dayton
Springfield; Clark
County
Lima; Allen County
35 miles
Health
Medical, Behavioral
Health, Dental, Pharmacy
New Carlisle; Clark
County
35 miles
Medical, Behavioral
Health, Dental, Pharmacy
Marion; Marion County
45 miles
Dayton; Montgomery
County
50 miles
Medical, Behavioral
Health, Dental, Contract
Pharmacy
Medical, Behavioral
Health, Contract Pharmacy
Table 8. Logan County FQHC Usage 39
Zip Code
ZCTA Name
Individuals
Tabulation
Served by
Area
FQHC
43060
43310
43311
43318
43319
43324
43331
43333
43343
43345
43347
43357
43358
43360
Total
38
North Lewisburg
Belle Center
Bellefontaine
De Graff
East Liberty
Huntsville
Lakeview
Lewistown
Quincy
Ridgeway
Rushsylvania
West Liberty
West Mansfield
Zanesfield
Distance from
Services
Bellefontaine
Medical, Behavioral
31 miles
0
16
86
0
0
14
47
0
0
0
0
0
0
0
163
Low Income
Individuals
Unserved by
FQHC
574
818
6,780
1,004
101
715
1,470
257
431
261
481
877
533
195
14,497
Dominant FQHC
N/A
Dr Gene Wright CHC
Dr Gene Wright CHC
N/A
N/A
Dr Gene Wright CHC
Dr Gene Wright CHC
N/A
N/A
N/A
N/A
N/A
N/A
N/A
"Find a Health Center," U.S. Department of Health and Human Services Health Resources and Services Administration, accessed November
16, 2011, http://findahealthcenter.hrsa.gov/ Search_HCC.aspx?byCounty=0.
39
UDSMapper, accessed November 16, 2011, http://www.udsmapper.org/index.cfm.
Figure 6. Zip Code Tabulation Areas 40
16 Patients
47 Patients
14 Patients
86 Patients
The closest health center to Logan County is located in the City of Springfield, which is 31 miles
directly to the south of Logan County. The Rocking Horse Center in Springfield currently has a
6-8 month wait for new adult patients.
Only 163 individuals in Logan County are currently receiving Public Health Service Act §330
services. The majority of these individuals are receiving care at the Dr. Gene Wright
Community Health Center located in Lima, Ohio. This health center is over 35 miles away from
the City of Bellefontaine. Almost 14,500 low income individuals in Logan County remain
unserved by a Public Health Service Act §330 health center.
There are twenty one active Rural Health Clinics in the State of Ohio, and none are located in
Logan County. Figure 7 shows the locations of the existing Rural Health Clinics which are
clustered in the southern and eastern parts of the state, and in the north central part of the state.
The only safety-net primary care provider in Logan County is Mad River Family Practice which
is located in the south central portion of the county (Figure 8). Mary Rutan Hospital operates
this outpatient primary care clinic, and all patients including Medicaid and uninsured patients are
accepted at the practice. Mad River Family Practice provides an average of 10,000 primary
medical care and obstetric care encounters to 2,800 unduplicated patients on an annual basis. In
2010, Mad River Family Practice providers attended 73 births. Mad River Family Practice does
not have a sliding fee schedule but provides a 20% discount for uninsured patients.
Tables 9-15 provide Mad River Family Practice patient data for 2011. Table 9 provides
information on patient age and gender. The current patient population is majority female, and
services are provided across the entire lifecycle. Patients’ race, ethnicity, and language reflect
40
UDSMapper, accessed November 16, 2011, http://www.udsmapper.org/index.cfm.
the demographics of Logan County as a whole. Thirty percent of the patient population is
covered by Medicaid or uninsured.
Table 15 provides data on patient origin by zip code. Eighty-eight percent of the current patient
population resides in Logan County. Almost 1,000 or 36% of the current patients reside in the
City of Bellefontaine. About 12% of the patients reside outside Logan County, most notably
11% reside in Champaign County to the south of Logan County. The City of Urbana in
Champaign County has the third largest patient population representing 8% of the current patient
population.
Figure 7. Rural Health Clinic Locations 41
Logan County
41
"Health Care Providers and Suppliers: Rural Health Clinics," Ohio Department of Health, accessed November 16, 2011,
http://publicapps.odh.ohio.gov/publicinfo/publicinfov6.aspx.
Figure 8. Mad River Family Practice Location
Mad River Family
Practice
Table 9. Patients by Age and Gender
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
Age Groups
Under Age 1
Age 1
Age 2
Age 3
Age 4
Age 5
Age 6
Age 7
Age 8
Age 9
Age 10
Age 11
Age 12
Age 13
Age 14
Age 15
Age 16
Age 17
Age 18
Age 19
Age 20
Age 21
Male Patients
24
19
24
16
27
18
8
22
14
17
11
15
24
15
16
20
22
22
21
17
13
7
Female Patients
23
26
16
17
24
8
19
11
12
17
8
21
14
16
22
19
27
37
30
29
29
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
Age Groups
Age 22
Age 23
Age 24
Age 25-29
Age 30-34
Age 35-39
Age 40-45
Age 46-49
Age 50-54
Age 55-59
Age 60-64
Age 65-69
Age 70-74
Age 75-79
Age 80-84
Age 85 and over
Total Patients
Male Patients
6
9
8
25
45
55
59
73
87
80
52
38
39
19
19
5
1,010
Table 10. Patients by Ethnicity
Patients by Ethnicity
Hispanic or Latino
All Others
Total Patients
Number
77
2,502
2,579
Table 11. Patients by Race
Patients by Race
Native Hawaiian
Other Pacific Islander
Total Hawaiian/Pacific Islander
Asian
Black/African American
American Indian/Alaska Native
White
More than one race
Unreported
Total Patients
Number
0
0
0
50
129
0
2,400
0
0
2,579
Female Patients
27
19
17
114
108
106
88
125
115
100
72
62
55
36
33
45
1,569
Table 12. Patients by Language
Patients by Language
Patients Best Served in English
Patients Best Served in a Language Other than English
Total Patients
Number
2,554
25
2,579
Table 13. Patients by Poverty Level
Patients by Poverty Level
Number
100% and below
101% - 150%
151% - 200%
Over 200%
Unknown
Total Patients
2,579
Table 14. Patients by Payor Source
0-19 Years Old
Payor Source
Number Percent
Uninsured
66
8%
Medicaid
336
41%
Medicare
2
<1%
Other Public Insurance
0
0%
Commercial Insurance
406
50%
Total
810
100%
Table 15. Patient Origin
Zip Code
Number of
Patients
43333
14
43345
16
43326
20
43009
29
43343
29
43348
34
43319
40
43072
43
43358
63
43331
67
43360
69
43347
71
43324
76
43310
109
43318
183
43078
211
43357
482
43311
925
Percent of
Patients
1%
1%
1%
1%
1%
1%
2%
2%
2%
3%
3%
3%
3%
4%
7%
8%
19%
36%
20 and Older
Total
Number Percent Number Percent
183
10%
249
9%
201
11%
537
21%
330
18%
332
14%
29
4%
29
1%
1,026
57%
1,432
55%
1,769
100%
2,579
100%
City/Village
County
Lewistown
Ridgeway
Kenton
Cable
Quincy
Russell’s Point
East Liberty
St. Paris
West Mansfield
Lakeview
Zanesfield
Rushsylvania
Huntsville
Belle Center
DeGraff
Urbana
West Liberty
Bellefontaine
Logan
Logan
Hardin
Champaign
Logan
Logan
Logan
Champaign
Logan
Logan
Logan
Logan
Logan
Logan
Logan
Champaign
Logan
Logan
There are no free clinics in Logan County. The closest free clinics are located in the City of
Sidney, 25 miles to the southeast, the City of Dayton, 56 miles to the southwest, and the City of
Columbus, 58 miles to the southeast. The closest free clinic, Compassionate Care of Shelby
County provides four hours of medical care per week, and four hours of dental care per week.
There were 9,925 Medicaid enrollees in Logan County in 2009. Only 71.7% of enrollees had a
physician visit during 2009. 42
Hospitals
Just over 50% of hospital visits by Logan County residents took place in hospitals outside Logan
County in 2009. 43
There is one hospital located in Logan County. Mary Rutan Hospital is designated as a Sole
Community Hospital and provides 24 hour emergency department services, comprehensive
surgical services, corporate health services, family birth center services, heart and vascular
catherization laboratory services, intensive coronary care services, laboratory services,
nutritional counseling, occupational therapy, oncology clinic, outpatient specialists, pastoral care,
pediatric services, physical therapy, radiology/imaging services, respiratory care, sleep disorders
clinic, and speech/hearing services.
Inpatient hospitalizations are reported for the top 50 diagnostic related groups by the Ohio
Department of Health. The primary causes of inpatient hospitalizations at Mary Rutan Hospital
are related to birth including newborn hospitalizations and delivery related hospitalizations, and
joint replacement related hospitalizations. Ambulatory care sensitive condition related inpatient
hospitalizations are common for pneumonia, kidney and urinary tract infections, miscellaneous
digestive disorders, cellulitis, and chronic obstructive pulmonary disease. 44 Table 15 provides
2011 emergency department visits for ambulatory care sensitive conditions. In addition to use of
the emergency room for these common ambulatory care sensitive conditions, the emergency
department also saw forty patients in 2011 whose primary purpose for visiting the emergency
department was for a medication refill.
Table 15. 2011 Emergency Department Ambulatory Care Sensitive Visits
ICD-9
Description
462/463
Severe ear, nose, and throat infections
521/522/523/525/528
Dental Conditions
681/682/683/686
Cellulitis
599
Kidney/urinary infection
481/482.2/486
Bacterial Pneumonia
558.9
Gastroenteritis
493
Asthma
466/496
Chronic obstructive pulmonary disease
401.0/401.9
Hypertension
250.0/250.1/250.2/250.3/250.8/250.9 Diabetes
428, 402.01, 402.11, 402.91, 518.4
Congestive Heart Failure
42
Visits
665
557
529
449
271
222
165
162
127
121
115
Health Policy Institute of Ohio, Ohio Medicaid Atlas 2010, accessed November 17, 2011, http://www.healthtransformation.ohio.gov/
LinkClick.aspx?fileticket=Yz-Wg0AyPb8%3D&tabid=70.
43
"2009 Job and Family Services Profile; County Overview," Ohio Department of Job and Family Services, accessed February 14, 2012,
44
"Ohio Hospital Compare," Ohio.gov: Ohio Department of Health, accessed February 14, 2012, http://ohiohospitalcompare.ohio.gov/.
251.2
411.1
Hypoglycemia
Angina
26
16
There are no critical access hospitals in Logan County. Figure 9 provides the locations of the
nearest critical access hospitals. Hardin Memorial Hospital is located in Kenton, directly to the
north of Logan County, and Mercy Memorial Hospital is located in Urbana, directly to the south
of Logan County.
Sixty-two percent of Medicaid enrolled adults had one or more emergency department visits
during 2009. 45
Figure 9. Critical Access Hospitals
Logan County
Hardin Memorial
Hospital
Mercy Memorial
Hospital
Dental
There are no safety-net dental clinics in Logan County. The nearest safety-net dental clinics are
located in Lima, 35 miles to the northwest, and in New Carlisle, 35 miles to the southwest.
Figure 10 shows the locations of these dental clinics. Both are operated by Health Partners of
Western Ohio, a Public Health Service Act §330 grantee. Health Partners operates under an
integrated, medical home model of care and requires all dental patients to also be medical
patients.
There are ten primary care dentists in Logan County, only three of whom provide care to
Medicaid patients. 46 In 2009, only 28.9% of adult Medicaid enrollees in Logan County received
dental services. 47
45
46
"Oral Health Surveillance System 2010," Ohio Department of Health, accessed November 17, 2011,
http://publicapps.odh.ohio.gov/oralhealth/default.aspx.
47
Figure 10. Safety-Net Dental Clinics
Lima Dental
Clinic
Logan
County
New Carlisle
Dental Clinic
Mental Health/Substance Abuse
Mental health and substance abuse services in Logan County are planned, monitored, and funded
by the Mental Health, Drug and Alcohol Services Board of Logan and Champaign Counties.
This board’s responsibility includes planning, design, and management of a system of care for
mental health, drug and alcohol prevention, assessment and treatment services. Consolidated
Care provides care to children, adolescents, adults, seniors, and families at locations in
Bellefontaine and West Liberty. Services include mental health, alcohol and drug treatment,
housing, and other support services. There are a few private and other providers that provide
services to individuals covered by Medicaid, but this is not a substantial source of services.
Ten percent of Medicaid enrollees received community mental health services in 2009, and 1.7%
of Medicaid enrollees utilized Ohio Department of Alcohol and Drug Addiction Services during
2009. 48
Pharmacy
There are two Public Health Service Act §340B covered entities in Logan County. Mary Rutan
Hospital is a sole community hospital entity, and the Logan County General Health District is a
tuberculosis entity. There are no retail dispensing §340B pharmacies in Logan County.
Sixty-two percent of Medicaid enrollees had a prescription drug claim in 2009. 49
Health Disparities
48
49
Ibid.
The Centers for Disease Control and Prevention define health disparity as a “type of difference
in health that is closely linked with social or economic disadvantage. Health disparities
negatively affect groups of people who have systematically experienced greater social or
economic obstacles to health. These obstacles stem from characteristics historically linked to
discrimination or exclusion such as race or ethnicity, religion, socioeconomic status, gender,
mental health, sexual orientation.” 50
Leading Causes of Mortality
Table 16 summarizes the mortality rates for the top ten causes of mortality in the United States.
Logan County has higher mortality rates than the United States for the top six causes of
mortality, and has higher mortality rates than the State of Ohio for four of the top six causes of
mortality.
Table 16. Age Adjusted Leading Causes of Mortality 2006 – 2008 Rate per 100,000 51,52
Cause
Logan County State of Ohio
United
States*
Diseases of the Heart
199.4
209.0
190.9
Malignant Neoplasms
209.5
195.9
178.4
Chronic Lower Respiratory Diseases
54.7
50.5
40.8
Cerebrovascular Disease
56.6
44.1
42.2
Accidents/Unintentional Injuries
55.7
40.6
40.0
Alzheimer’s Disease
24.5
28.6
22.7
Diabetes Mellitus
20.2
28.6
22.5
Influenza and Pneumonia
12.9
14.7
16.2
Nephritis, Nephrotic Syndrome, and Nephrosis
10.8
13.7
14.5
Septicemia
4.3
10.2
11.0
*2007
•
Diseases of the Heart: Mortality from diseases of the heart in Logan County is higher
than that of the United States. The 2002 Ohio Behavioral Risk Factor Survey indicates
that 40.7% of Logan County has high cholesterol compared to 34.7% of the State of
Ohio. Figure 11 shows that cardiovascular disease is evenly distributed throughout the
county. Almost 49% of Logan County residents report having been diagnosed with high
blood pressure. 53
50
"Social Determinants of Health," U.S. Department of Health and Human Services Centers for Disease Control and Prevention, accessed
December 2, 2011, http://www.cdc.gov/socialdeterminants/ Definitions.html.
51
"Information Warehouse," Ohio Department of Health, accessed November 18, 2011, http://dwhouse.odh.ohio.gov/datawarehousev2.htm.
52
"National Vital Statistics Reports; Volume 58; Number 19," Centers for Disease Control and Prevention National Center for Health
Statistics, accessed November 18, 2011, last modified May 20, 2010, http://www.cdc.gov/NCHS/data/nvsr/nvsr58/nvsr58_19.pdf.
53
Logan County Needs Assessment 2012, prepublished data
Figure 11. 2008 Cardiovascular Disease 54
The number of hospital discharges in Logan County with heart disease as the principal is
in the worst quartile in the State of Ohio (Figure 12).
Figure 12. 1999-2003 Hospital Discharges with Heart Disease as Principal Diagnosis 55
Logan County
54
"Cardiovascular Disease Atlas," Z-Atlas, accessed November 22, 2011, http://maps.z-atlas.com/DAtlas/ Atlas.aspx.
The Burden of Heart Disease in Ohio, page 49, accessed November 30, 2011,
http://www.odh.ohio.gov/ASSETS/8A86666AAEEC414BB65C2CAE98F21AD7/1-HD%20Burden_FINAL%20Web-file.pdf.
55
•
Malignant Neoplasms: Mortality from Malignant Neoplasms in Logan County is higher
than both the United States and the State of Ohio. Table 17 summarizes the top eight
types of cancer causing mortality in Logan County. The age-adjusted incidence rate of
all types of cancer in Logan County (2003-2007) is 475.9 per 100,000 population which
is slightly higher than the State of Ohio rate of 470.0 per 100,000 population. Late stage
cervical, colon/rectal, lung, melanoma, and prostate cancer diagnoses in Logan County
are all higher than the State of Ohio average for 2003-2007. 56
Table 17. Leading Causes of Cancer Mortality 57
2006-2008 Age
Type
Adjusted Rate Per
100,000 population
Trachea, Bronchus and Lung
Colon, Rectum, and Anus
Pancreas
Liver and Bile Ducts
Breast
Prostate
Leukemia
Non-Hodgkins Lymphoma
64.2
21.9
11.7
10.8
10.7
8.6
8.3
5.7
Lung cancer incidence by census tract is noticeably higher in the census tracts near
Lakeview and Russell’s Point and in the central portion of the City of Bellefontaine
(Figure 13). Colon and rectum cancer rates are highest in the northwest quadrant of the
state and in the central portion of the City of Bellefontaine (Figure 14) as is breast cancer
(Figure 15). The highest rates of prostate cancer are found in the City of Bellefontaine
(Figure 16).
The Susan G. Komen for the Cure Northwest Ohio Affiliate reports that Logan County
has higher breast cancer incidence and prevalence rates than the State of Ohio. 58
Residents of Logan County are less likely than Ohio residents in general to receive cancer
screening including Pap, mammography, colonoscopy/sigmoidscopy, prostate specific
antigen, and digital rectal examination (Table 18). The target population is less likely
than the general population of Logan County to have ever been screened for breast or
colorectal cancer. Schootman et al found that poverty is associated with never having
had a mammogram, a clinical breast examination, or a colonoscopy/sigmoidoscopy. 59
56
Ohio Cancer Facts and Figures 2010, ed. American Cancer Society and Ohio Department of Health, accessed November 21, 2011, The
American Cancer Society; http://www.cancer.org/myacs/Ohio/areahighlights/ohio-cancer-facts-figures.
57
58
Susan G. Komen for the Cure Northwest Ohio Affiliate Community Profile Report 2011 , , accessed November 21, 2011,
http://www.komennwohio.org/assets/grants-documents/ 2011-cp-community-profile-es.pdf.
59
Effect of Area Poverty Rate on Cancer Screening Across US Communities, ed. Mario Schootmanet al., accessed November 21, 2011,
http://jech.bmj.com/content/60/3/202.abstract.
Figure 13. Average Annual Age Adjusted Incidence Rates of Lung and Broncus
Cancer 60
Lakeview and
Russell’s Point
Bellefontaine
Figure 14. Average Annual Age Adjusted Incidence Rates of Colon and Rectum Cancer 61
Ridgeway,
Rushsylvania,
West Mansfield
Bellefontaine
60
Logan County Cancer Profile 2008," The Ohio Department of Health Data and Statistics, accessed November 30, 2011,
http://www.odh.ohio.gov/ASSETS/384F3B9358E246AD912EB56B3FA540A6/ Logan.pdf.
61
Ibid.
Figure 15. Average Annual Age Adjusted Incidence Rates of Breast Cancer 62
Bellefontaine
Ridgeway,
Rushsylvania,
West Mansfield
Figure 16. Average Annual Age Adjusted Incidence Rates of Prostate Cancer 63
Bellefontaine
62
Logan County Cancer Profile 2008," The Ohio Department of Health Data and Statistics, accessed November 30, 2011,
http://www.odh.ohio.gov/ASSETS/384F3B9358E246AD912EB56B3FA540A6/ Logan.pdf.
63
Ibid.
Table 18. 2004-2007 Cancer Screening Behaviors 64
Female Pap in last 3 years(age 18+, intact cervix)
Female Mammogram last 2 years (age 40+)
Colonoscopy/Sigmoidoscopy last 5 years (age 50+)
Male Prostate Specific Antigen in past year (age 50+)
Logan
County
81.1%
74.7%
52.5%
50.8%
Ohio
88.8%
79.1%
55.7%
57.5%
•
Chronic Lower Respiratory Diseases: Mortality from Chronic Lower Respiratory
Diseases in Logan County is higher than both the United States and the State of Ohio.
The mortality rate in Logan County from Chronic Lower Respiratory Diseases dipped
slightly in 2003-2005 before increasing back to earlier levels in 2006-2008. For adults
age 45 and older, the three year average (2006-2008) rate of chronic lower respiratory
disease is 156.9 compared to a state rate of 143.2. The 2002 Ohio Behavioral Risk Factor
Survey reports that 6.5% of Logan County had a current diagnosis of asthma. 65
•
Cerebrovascular Disease: Mortality from Cerebrovascular Disease in Logan County is
higher than both the United States and the State of Ohio. The three year average (20062008) mortality rate from stroke in Logan County was 56.6 per 100,000 population
compared to the State of Ohio rate of 44.1. This is ranked as the “least preferred level”
by the Ohio Department of Health. 66
•
Accidents/Unintentional Injuries: Mortality from Accidents and Unintentional Injuries in
Logan County is higher than both the United States and the State of Ohio. In Logan
County, the primary causes of accidental and unintentional injury deaths are motor
vehicle accidents and accidental poisoning. Mortality from accidental poisoning has risen
significantly since 2000. Mortality from motor vehicle accidents spiked in 2003-2005
before returning to earlier rates (Table 19).
Table 19. Age Adjusted Rate per 100,000 Population 67
Accidental
Motor Vehicle
Time
Poisoning
Accidents
Period
2000-2002
2.1
22.0
2003-2005
9.3
28.9
2006-2008
12.9
21.4
•
64
Alzheimer’s Disease: Mortality from Alzheimer’s Disease in Logan County is higher
than that of the United States.
"Healthy Ohio Community Profiles," Ohio Department of Health, accessed February 14, 2012,
http://www.healthyohioprogram.org/comprofiles/logan.pdf.
65
66
67
Ibid.
Ibid.
•
Diabetes Mellitus: Mortality from Diabetes Mellitus in Logan County is slightly lower
than that of the United States. The 2002 Ohio Behavioral Risk Factor Survey indicates
that 8.9% of Logan County has diabetes compared to 7.7% of the State of Ohio. The
Centers for Disease Control and Prevention reports that figure has now risen to 10.8%,
which is the 12th highest rate in the State of Ohio. 68 The highest rates of diabetes
prevalence are in the northwest corner of the county in the Lakeview and Russell’s Point
area (Figure 17).
Figure 17. Logan County 2009 Diabetes Prevalence 69
Lakeview and
Russell’s Point
Diabetics in Logan County are less likely than diabetics in the United States to receive
appropriate diabetes management as summarized in Table 20.
Table 20. 2004-2007 Diabetes Management 70
Logan
County
United States
(Southwest Ohio
Region)
Annual Dilates Eye Exam
Annual Foot Exam
Annual Doctor Visit
Daily Self Exam of Feet
67.9%
65.7%
84.0%
63.7%
69.4%
68.7%
88.9%
67.9%
The prevalence of diabetes is inversely related to income, with low-income individuals
facing higher rates of diabetes than high-income individuals. Figure 18 summarizes this
disparity in Ohio. It is estimated that the target population for this Needs Assessment
faces diabetes prevalence rates greater than 12.6%.
68
Centers for Disease Control and Prevention. “Diabetes Surveillance System: County Level Estimates,” accessed June 20, 2012,
http://www.cdc.gov.
69
"Diabetes Atlas," Z-Atlas, accessed November 22, 2011, http://maps.z-atlas.com/DAtlas/ Atlas.aspx.
"Healthy Ohio Community Profiles Logan County 2008," Ohio Department of Health, accessed November 22, 2011,
70
Figure 18. Diabetes and Income 71
Diabetes Prevalence by Income
16
14
12
10
8
6
4
2
0
<$15,000
71
$15,000 $24,999
$25,000 $49,999
$50,000 $74,999
> $75,000
•
Influenza and Pneumonia: Mortality from influenza and pneumonia in Logan County is
slightly lower than that of the State of Ohio. The mortality rate has decreased
significantly since 2000-2002 when it was above the State of Ohio rate. The decline in
mortality from pneumonia and influenza since 2000 follows that of the State of Ohio.
The 2002 Ohio Behavioral Risk Factor Survey indicates that 70.4% of adults 65 and over
received a flu shot in the prior 12 months, and 64.8% of adults 65 and over have ever had
a pneumococcal vaccination in Logan County. 72
•
Nephritis, Nephrotic Syndrome, and Nephrosis: Mortality from Nephritis, Nephrotic
Syndrome, and Nephrosis is below that of both the State of Ohio and the United States.
The highest rates of kidney disease are found in the northeast corner of the county
(Figure 19).
•
Septicemia: Mortality from Septicemia is significantly below that of both the State of
Ohio and the United States.
The Burden of Diabetes in Ohio, page 10, accessed November 30, 2011,
http://www.odh.ohio.gov/ASSETS/5001C46467B84CA398CEFC7B89DB3A21/Burden08.pdf.
72
Figure 19. Stage 1 Chronic Kidney Disease 73
Ridgeway and
West Mansfield
Other Health Disparities
•
Infant Mortality: The 2008 infant mortality rate in Logan County was 12.6 per 1,000 live
births compared to a State of Ohio rate of 7.7 per 1,000 live births. The Ohio Department
of Health reports that 59.4 mothers per 100 live births had medical risk factors during
pregnancy compared to the State of Ohio rate of 45.6 per 100 live births. During the
years 2004-2006, 26.7% percent of mothers in Logan County smoked cigarettes during
their pregnancy. 74 The percentage of mothers receiving prenatal care beginning in the
first trimester of pregnancy declined significantly from 2001 to 2008 (Figure 20). 75
Almost 44% of births in 2007 were covered by Medicaid. 76
Figure 20. First Trimester Entry Into Prenatal Care 77
First Trimester Prenatal Care
90
Percent
80
70
60
50
2001 2002 2003 2004 2005 2006 2007 2008
73
"Chronic Kidney Disease Atlas," Z-Atlas, accessed November 22, 2011, http://maps.z-atlas.com/DAtlas/ Atlas.aspx.
75
76
"2009 Job and Family Services Profile; County Overview," Ohio Department of Job and Family Services, accessed February 14, 2012,
77
Ibid.
74
•
Childhood Mortality: The three year average child death rate (2006-2008) for children
ages 1-14 is 26.6 per 100,000 children ages 1-14 compared to the state rate of 18.9. 78
•
Mental Health/Substance Abuse: More than one quarter of Logan County residents
suffer from mental illness. 79
Mortality in Logan County from Suicide in 2006-2008 is slightly below that of the State
of Ohio. At almost 10 per 100,000, the rate has remained fairly consistent for the six
years from 2003-2008.
More than 18% of Logan County residents reported their mental health had prevented
them from performing daily activities on at least one day in the past month. 80 In the
County Health Rankings, the average number of mentally unhealthy days in the past 30
days reported by Logan County residents was 5.3, which compares unfavorably with the
State of Ohio 3.7 days. The national benchmark is 2.3 days. 81
The 2002 Ohio Behavioral Risk Factor Survey indicates that over 12% of Logan County
residents use alcohol consistent with definitions of binge and heavy drinking. The 2009
Logan County per capita alcohol consumption rate of 2.95 bottles per capita is below the
state rate of 3.9 bottles per capita. 82
There were an average of 10.8 prescription drug related deaths per 100,000 population in
Logan County for the period 2004-2008 (Figure 21). 83
78
79
80
81
Ibid
Robert Wood Johnson Foundation, County Health Rankings: 2010 Ohio, accessed December 9, 2010,
http://www.loganhealth.org/documents/CHRR_2010.pdf.
82
"Ohio Department of Alcohol and Drug Addiction Services," State Epidemiological Outcomes Workgroup, accessed November 27, 2011,
http://www.odadas.ohio.gov/SEOW/Counties.aspx.
83
"The Burden of Poisoning in Ohio," The Ohio Department of Health Data and Statistics, accessed November 30, 2011,
http://www.odh.ohio.gov/ASSETS/9CC3AF6D10784E8084215065F6F2ECF4/ Burden%20of%20Poisoning%20Final.pdf.
Figure 21. Logan County 2004-2008 Unintentional Drug/Medication Poisoning Death Rate 84
Logan County
The Ohio Department of Alcohol and Drug Addiction Services reports bath salts, crack
cocaine, heroin, marijuana, powdered cocaine, prescription opioids, sedative-hypnotics,
and Suboxone® are all highly available in the Dayton area of Ohio which includes Logan
County. 85 Opiate use in Logan County has increased substantially in the past decade.
Figure 22 summarizes heroin poisonings in Logan County and the State of Ohio from
2000-2009 and shows an alarming trend of increasing use and consequences. The 20072009 three year average unintentional drug death rate in Logan County is 11.5 per
100,000. 86 This is likely the major contributing factor in the increase in accidental
poisoning mortality summarized in Table 19 on page 24.
Figure 22. Heroin Poisonings 2000-2009 87
84
Ohio Prescription Drug Abuse Task Force Final Report, page 18, accessed November 21, 2011,
http://www.odh.ohio.gov/ASSETS/895B95C591534F7A82A815A69A00011E/OPDATF%20final%20report.pdf.
85
Ohio Substance Abuse Monitoring Network Drug Abuse Trends in the Dayton Area, accessed November 21, 2011,
http://www.odadas.state.oh.us/public/OsamHome.aspx.
86
"Ohio Department of Alcohol and Drug Addiction Services," State Epidemiological Outcomes Workgroup, accessed November 27, 2011,
http://www.odadas.ohio.gov/SEOW/Counties.aspx.
87
Ibid.
Rate per 100,000
Heroin Poisonings
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Logan
County
State of
Ohio
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
88
•
Sexually Transmitted Diseases: Logan County has significantly lower rates of sexually
transmitted diseases than the State of Ohio. There were no cases of syphilis reported
from 2002-2005. Rates of Chlamydia and gonorrhea in Logan County have been
significantly below the State of Ohio for the period 2002-2005.
•
Oral Health: Poor oral health negatively impacts other health conditions including
cardiovascular disease and diabetes as well as pregnancy. The percentage of adults aged
65 and older who have lost all of their natural teeth varies greatly by income level.
During 1998--2009, the percentage of older adults who had no natural teeth was higher
among those in families with low income than in families with higher income as shown
in Figure 23. 88
National Health Interview Survey, "QuickStats," Mprbidity and Mortality Weekly Report 59, no. 50 (December 2010), accessed November
22, 2011, http://www.cdc.gov/mmwr/preview/ mmwrhtml/mm5950a7.htm?s_cid=mm5950a7_w.
Figure 23. Percent of All Adults > 65 Who Have Lost All Their Natural Teeth by Poverty Status
The Ohio Oral Health Surveillance System reports that only 30% of the Medicaid eligible
population ages 18-64 in Logan County had a dental visit in 2009. For adults 65 and
over, this drops to 19%. For all adults age 18-64, 67% had a dental visit during 2008.
For adults 65 and over, this drops to 51%. More than 48% of adults age 18-64 in Logan
County are uninsured for dental services. For adults 65 and over, this increases to more
than 60%. 89
While children below the age of 18 have higher rates of insurance coverage (just 8% are
uninsured for dental services), and have higher rates of dental visits (83% had a dental
visit in 2008), children still face higher rates of untreated decay than the state average. In
2009-2010, 19.5% of Logan County third grade students had untreated decay compared
to 18.7% in the State of Ohio. Nearly 13% reported toothache pain in Logan County
compared with 11.4% in the State of Ohio. Only 29.8% had received one or more dental
sealants compared with 50.4% in the State of Ohio. There are no schools in Logan
County participating in a school-based dental sealant program. 90
•
Obesity: The Trust for America’s Health reports that the adult obesity rate in Ohio is
29%, and the childhood obesity rate is 18.5%. These are the 13th and 12th worst rates in
the United States respectively. 91 In Logan County, almost 35% of adults are overweight
(BMI between 25 and 29.9) and more than 34% are obsese (BMI > 30). For individuals
with an annual income of less than $20,000, the rate of obesity is more than 38%. 92
89
“Ohio Oral Health Surveillance System," Ohio Department of Health, accessed November 22, 2011, p://publicapps.odh.ohio.gov/oralhealth/.
Ibid.
91
"F as in Fat: How Obesity Threatens America's Future 2010," Trust for American's Health, accessed November 22, 2011,
http://healthyamericans.org/reports/obesity2010/.
90
92
The 2004-2005 school year assessment indicated that 31.3% of Logan County thirdgraders were overweight. 93 When considering third graders who are both overweight and
at risk of being overweight, the Logan County rate of 51.5% is the highest in the State of
Ohio (Figure 24).
Figure 24. 2004-2005 Overweight and at Risk Third Graders 94
Logan County
•
Tobacco Use: More than 28% of the population are current cigarette smokers. 95
Core Barriers
The Health Resources and Services Administration considers four core barriers when evaluating
the needs of a given area for Public Health Service Act §330 funding. These barriers are
summarized in Table 21 and wherever possible are measurements related specifically to the
target population (Logan County individuals with income below 200% of the federal poverty
level). Data sources and methodology indicates the independent source of the data, the year of
the data, and a description of any extrapolation methods used.
93
94
"A Report on Body Mass Index of Ohio's Third Graders 2004-2005," The Ohio Department of Health Data and Statistics, accessed
November 30, 2011, http://healthyohioprogram.org/ASSETS/7FBDB7A5C3FB4977A430A1EA46C642D9/bmirept.pdf.
95
Table 21. Core Barriers
Description
Population to One FTE Primary Care
Physician
Percent of Population At or Below
200% of FPL
Logan
County
HRSA-11-017
Points
3073:1
17
100%
20
Percent of the Population Uninsured
10.4%
6
Distance or Travel Time to nearest
primary care provider accepting new
Medicaid Patients and /or uninsured
patients
35 miles
19
Data Source and Methodology
Ohio Department of Health” Logan County, Ohio
Application for a Governor’s Exceptional MUP May
2011”: 4.7 FTE Primary Care Providers; American
Community Survey 2005-2009 Population with income
below 200% FPL: 14,443
By definition the target population is those individuals in
Logan County with income below 200% of the federal
poverty level.
Logan County; 2010; "Primary Care County Profiles," The
Ohio Department of Health Data and Statistics, accessed
November 30, 2011,
http://www.odh.ohio.gov/ASSETS/698EDB7ADF8147F6B
F440C46FE8C2563/logan.pdf.
Dr. Gene Wright CHC in Lima Ohio is the nearest §330
health center without an extensive wait for new patients;
"Find a Health Center," U.S. Department of Health and
Human Services Health Resources and Services
Administration, accessed November 16, 2011,
http://findahealthcenter.hrsa.gov/Search_HCC.aspx?byCou
nty=0.
Core Health Indicators
The Health Resources and Services Administration considers a variety of core health indicators
when evaluating the needs of a given area for Public Health Service Act §330 funding. These
indicators are summarized in Table 22, and wherever possible are measurements related
specifically to the target population (Logan County individuals with income below 200% of the
federal poverty level). Data sources and methodology indicates the independent source of the
data, the year of the data, and a description of any extrapolation methods used.
Table 22. Health Resources and Services Administration Core Health Indicators 96
Description
Logan
National
Severe
County
Benchmark
Benchmark
Diabetes Core Health Indicators
Diabetes short-term
complication
hospital admission
rate
Diabetes long-term
complication
hospital admission
rate
Uncontrolled
diabetes hospital
admission rate
Rate of lowerextremity
amputation among
patients with
diabetes
46.7 per 100,000
82.0 per
100,000
112.6 per
100,000
180.2 per
100,000
27.2 per 100,000
61.1 per
100,000
37.5 per 100,000
65.7 per
100,000
Age adjusted
diabetes
10.2%
6.5%
7.8%
Adult diabetes
prevalence
30.1%
23.0%
24.5%
20.2 per
100,000
26 per 100,000
35 per 100,000
Diabetes Mortality
Rate
Centers for Disease Control and Prevention: National Diabetes Surveillance
System. "County Level Estimates, 2008." Available online at:
http://apps.nccd.cdc.gov/DDTSTRS/def
Centers for Disease Control and Prevention: National Diabetes Surveillance
System. "County Level Estimates, 2008."
Available online at: http://apps.nccd.cdc.gov/DDTSTRS/default.aspx. Retrieved
1/29/201
Logan County age adjusted; 2006-2008; "Information Warehouse," Ohio Department of
Health, accessed November 18, 2011, http://dwhouse.odh.ohio.gov/datawarehousev2.htm.
Cardiovascular Disease Core Health Indicators
Hypertension
hospital admission
rate
Congestive heart
96
43
50.2 per 100,000
99.5 per
100,000
Logan County; 2000 and 2001; "Primary Care County Profiles," The Ohio Department of Health
Data and Statistics, accessed November 30, 2011,
http://www.odh.ohio.gov/ASSETS/698EDB7ADF8147F6BF440C46FE8C2563/logan.pdf.
502.8 per
753.6 per
Logan County; 2000 and 2001; "Primary Care County Profiles," The Ohio Department of Health
“New Access Point Funding Opportunity Announcement," Grants.gov - Find Grant Opportunities, accessed November 28, 2011, https://grants.hrsa.gov/webExternal/
FundingOppDetails.asp?FundingCycleId=450970E7-563E-4D2D-A021-C775F7F614E&ViewMode=EU&GoBack=&PrintMode=&OnlineAvailabilityFlag=&pageNumber=&version=&NC=&Popup=.
Description
failure hospital
admission rate
Angina without
procedure hospital
admission rate
Mortality from
Diseases of the
Heart
Proportion of adults
reporting diagnosis
of high blood
pressure
Logan
County
National
Benchmark
Severe
Benchmark
520
100,000
100,000
82.3 per 100,000
160.3 per
100,000
199.4 per
100,000
240.8 per
100,000
271.0 per
100,000
28.0%
24.8%
27.7%
18.9%
13.8%
16%
25.3%
25.3%
27.8%
Logan County females age 40 and over; 2004-2007 average; ""Healthy Ohio Community Profiles
Logan County 2008," Ohio Department of Health, accessed November 22, 2011,
http://www.healthyohioprogram.org/comprofiles/logan.pdf
75.9%
75.9%
78.3%
Logan County; 1999-2001: "Primary Care County Profiles," The Ohio Department of Health Data
and Statistics, accessed November 30, 2011,
Logan County age adjusted; 2006-2008; "Information Warehouse," Ohio Department of Health,
accessed November 18, 2011, http://dwhouse.odh.ohio.gov/datawarehousev2.htm.
Logan County; 1999-2001; "Primary Care County Profiles," The Ohio Department of Health Data
Cancer
Percent of women
18 and older with no
Pap test in past 3
years
Percent of women
40 and older with no
mammogram in past
3 years
Percent of adults 50
and over with no
fecal occult blood
test within the past 2
years
Logan County female ages 18 and over with an intact cervix; 2004-2007; Healthy Ohio Community
Profiles Logan County 2008," Ohio Department of Health, accessed November 22, 2011,
Prenatal and Perinatal Health Core Health Indicators
Low birth weight
rate (five year
average)
Infant mortality rate
(five year average)
8.54%
6.0%
9.8%
8.02% per
1,000 births
6.9 per 1,000
births
9.1 per 1,000
births
Logan County births < 2500 grams; 2004-2008; "Information Warehouse," Ohio Department of
Logan County; 2004-2008; "Information Warehouse," Ohio Department of Health, accessed
November 30, 2011, http://dwhouse.odh.ohio.gov/datawarehousev2.htm.
Logan County total births; 2008; "Information Warehouse," Ohio Department of Health, accessed
Description
Logan
County
National
Benchmark
Severe
Benchmark
Births to teenage
mothers (ages 15-19;
percent of all births)
16.5%
6.3% of births
9.2% of births
November 30, 2011, http://dwhouse.odh.ohio.gov/datawarehousev2.htm. Logan County total births
to mothers 15-19; 2008; "Teen Pregnancy," The Ohio Department of Health Data and Statistics,
accessed November 30, 2011,
http://www.odh.ohio.gov/ASSETS/4A31A0352CB6472AA89DCA9E6DA05DA1/teenpreg08.pdf.
Late entry into
prenatal care (Entry
after first trimester;
percent of all births)
27.6%
16%
20%
Cigarette use during
pregnancy (percent
of all pregnancies)
28.2%
10.7%
14.3%
164.6 per
100,000
347.1 per
100,000
Logan County; 2000-2001; "Primary Care County Profiles," The Ohio Department of Health
American Community Survey 2006-2008: Population under 18 ye
http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_08_3YR_B
09001&prodType=tablears. Logan County; 2008; "Childhood Lead Poisoning," The Ohio
Department of Health Data and Statistics, accessed November 30, 2011,
http://www.odh.ohio.gov/ASSETS/E3AC13FD13EB4BF7BEF285B96239
Logan County births with prenatal care after first trimester; 2008; "Information Warehouse," Ohio
Department of Health, accessed November 18, 2011,
http://dwhouse.odh.ohio.gov/datawarehousev2.htm.
Logan County pregnant women; 2010; "CFHS & FP Health Status Profile: Logan County, Ohio,"
The Ohio Department of Health Data and Statistics, accessed November 30, 2011,
http://www.odh.ohio.gov/ASSETS/
C6A677A89A3A41A2834AA76B898DA2BE/Logan%20County.pdf.
Child Health Core Health Indicators
Pediatric asthma
hospital admission
rate
Percent of children
not tested for
elevated blood lead
levels by 36 months
of age
Percent of children
not receiving
recommended
immunizations (4-31-3-3)
140
6.1%
<15%
<7%
25.7%
17.95%
21.4%
State of Ohio 4:3:1:3:3; 2010; "Vaccines and Immunizations," U.S. Department of Health and
Human Services Centers for Disease Control, accessed December 1, 2011,
http://www.cdc.gov/vaccines/stats-surv/nis/data/tables_2010.htm#overall.
Behavioral and Oral Health Core Health Indicators
Depression
prevalence
Suicide
Youth suicide
attempts requiring
medical attention
9.9 per
100,000
9.1%
12.8%
11 per 100,000
16 per 100,000
2.6%
3.6%
Logan County age adjusted per 100,000; 2006-2008; Healthy Ohio Community Profiles Logan
County 2008," Ohio Department of Health, accessed November 22, 2011,
Description
Logan
County
National
Benchmark
Severe
Benchmark
Percent of adults
with mental
disorders not
receiving treatment
Any illicit drug use
in the past month
79.7%
52%
63%
8.25%
9.3%
Heavy alcohol use
4.5%
6.8%
7.5%
25%
30%
56.69%
66%
Medicaid covered individuals age 19-64; 2009; Ohio Oral Health Surveillance System," Ohio
Department of Health, accessed November 22, 2011, p://publicapps.odh.ohio.gov/oralhealth/.
881.6 per
100,000
870 per 100,000
N/A
Logan County; 2004-2006; Healthy Ohio Community Profiles Logan County 2008," Ohio
Department of Health, accessed November 22, 2011,
HIV infection
prevalence
0.03%
0.4%
N/A
and Statistics, accessed
November 30, 2011, http://www.odh.ohio.gov/healthStats/disease/hivdata/hivcov.aspx.
Percent Elderly (65
and older)
Adult asthma
hospital admission
rate
Chronic obstructive
pulmonary disease
hospital admission
rate
Bacterial pneumonia
hospital admission
rate
14.2%
15.2%
N/A
98.4 per 100,000
N/A
Logan County 2010; American Factfinder," U.S. Census Bureau, accessed February 14, 2012,
http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml.
.
377
334.3 per
100,000
N/A
449
503.9 per
100,000
N/A
Homeless with
severe mental illness
Percent without a
dental visit in the
last year
70.3%
Logan County adult residents; 2004-2007; Healthy Ohio Community Profiles Logan County 2008,"
Ohio Department of Health, accessed November 22, 2011,
Other Core Health Indicators
Age adjusted death
rate
Logan County; 2009; "HIV/AIDS Surveillance Data," The Ohio Department of Health Data
113
Description
Three year average
Pneumonia Death
Rate
Logan
County
National
Benchmark
Severe
Benchmark
1.29 per
10,000
1 per 10,000
N/A
Logan County age adjusted pneumonia and influenza mortality rate; 2006-2008; "Information
Warehouse," Ohio Department of Health, accessed November 18, 2011,
http://dwhouse.odh.ohio.gov/datawarehousev2.htm.
Logan County; 2006; "Asthma in Ohio and Logan County," The Ohio Department of Health Data
http://www.odh.ohio.gov/ASSETS/2437EC92EED244A6BE6383A068ED7748/
Logan.pdf.
Logan County; 2006; "Asthma in Ohio and Logan County," The Ohio Department of Health Data
http://www.odh.ohio.gov/ASSETS/2437EC92EED244A6BE6383A068ED7748/
Logan.pdf.
Adult current asthma
prevalence
8.7%
7.6%
N/A
Ever told had
asthma (percent of
all adults)
13.5%
13.2%
N/A
55.7 per
100,000
35 per 100,000
N/A
Logan County residents; 2006-2008; "Information Warehouse," Ohio Department of
<1%
19.6%
N/A
Logan County residents; 2010; American Factfinder," U.S. Census Bureau, accessed February 14,
2012, http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml.
2 years
9 months
N/A
Logan County Metropolitan Housing Authority, 2/14/2012
Unintentional injury
deaths
Percent of
population
linguistically
isolated (percent of
people 5 years and
over who speak a
language other than
English at home)
Waiting time for
public housing
where public
housing exists
Social Determinants of Health
The Centers for Disease Control and Prevention define the social determinants of health as the
“complex, integrated, and overlapping social structures and economic systems that are
responsible for most health inequities. These social structures and economic systems include the
social environment, physical environment, health services, and structural and societal factors.
Social determinants of health are shaped by the distribution of money, power, and resources
throughout local communities, nations, and the world.” 97
Insurance
In 2004, 15.2% of Logan County adults age 18 and older and 5.6% of children age 17 and
younger did not have health insurance. This compared to 12.5% of Ohio adults and 5.4% of
Ohio children. 98 By 2010 the rate of uninsured adults had increased to 19.2%. 99
In 2004, there was an average Medicaid enrollment of 6,175 individuals in Logan County. Over
half (54%) were children under the age of 18. 100 By 2009 the average Medicaid enrollment in
Logan County had risen almost 19% to 7,337 individuals. This is an increase from just over
13% of the total population to 16% of the total population. 101
Ohio Medicaid provides coverage for all federally required services as well as:
ambulance/ambulette, chiropractic services (children under age 21), community alcohol and drug
addiction treatment, community mental health services, dental services, durable medical
equipment and supplies, home and community based services waivers, hospice care, independent
psychological services for children, intermediate care facility services for people with mental
retardation, occupational therapy, physical therapy, podiatry, prescription drugs, private duty
nursing, speech therapy and vision care including eyeglasses.
There were 8,145 individuals enrolled in Medicare hospital and/or supplemental medical
coverage in 2010. This included 1,137 disabled individuals and 7,008 individuals over the age of
65. 102
Social Services
Social Services are provided by a variety of government and private organizations in Logan
County including:
97
"Social Determinants of Health," U.S. Department of Health and Human Services Centers for Disease Control and Prevention, accessed
December 2, 2011, http://www.cdc.gov/socialdeterminants/ Definitions.html.
98
99
"CFHS & FP Health Status Profile: Logan County, Ohio," The Ohio Department of Health Data and Statistics, accessed November 30, 2011,
http://www.odh.ohio.gov/ASSETS/C6A677A89A3A41A2834AA76B898DA2BE/Logan%20County.pdf.
100
Ohio Medicaid Atlas , The Health Policy Institute of Ohio (Columbus, Ohio, 2008).
101
Ohio Medicaid Atlas 2010 , The Health Policy Institute of Ohio, (Columbus, Ohio, 2010).
"Medicare Enrollment Reports," CMS.gov Centers for Medicare and Medicaid Services, accessed February 14, 2012,
https://www.cms.gov/MedicareEnRpts/Downloads/County2010.pdf.
102
•
•
•
•
•
•
•
•
Logan County Job and Family Services provides child and adult protective services, child
care for families as they strive to become self-sufficient, at risk pregnancy services for
Medicaid-eligible women, income maintenance programs including cash assistance, food
assistance, medical assistance through Medicaid, emergency aid, transportation and elder
care, child support enforcement, and job training.
Logan County Health District provides public health nursing such as adult and child
immunizations, health screenings, Bureau for Children with Medical Handicaps services,
communicable disease programs, HIV/AIDs clinic services, lead case management,
newborn home visitation, and SIDS prevention programming. The Logan County Health
District also operates the Women, Infants, and Children program.
Logan County Children Services provides abuse and neglect services and adoption and
foster care services.
Tri-County Community Action Agency operates transportation, emergency assistance,
weatherization, and senior nutrition programs in Logan County.
Catholic Charities operates a food pantry and provides emergency assistance and
counseling services.
Logan County Friendly Senior Center provides programming for seniors.
Logan County Family and Children First Council provides service coordination, and Help
Me Grow services, and operates the Logan County Drug Free Youth Coalition.
United Way of Logan County provides funding support to a variety of non-profit
organizations including the American Red Cross, Boy Scouts of America, Caring Hearts
Hospice, Catholic Social Services, Consolidated Care, Inc., Discovery Riders, Girl Scouts
of Appleseed Ridge, Green Hills Day Center, Habitat for Humanity, International
Friendship Center, Logan Belle Hand, Logan County Cancer Society, Loving Hands
Adult Day Care Center, Lutheran Community Services, Mary Rutan Medication
Assistance Program, New Directions of CCI, One-on-One, Project Child, Rachel’s
House, Hands on West Central, Safe Haven Community Youth Program, Warm Clothes
for Kids, and the Don M. and Margaret Hilliker YMCA.
Logan County is one of twenty-two Ohio Counties without a domestic violence shelter within the
county. 103
Transportation
In the United States, 20.4% of individuals with income below 100% of the federal poverty level
are without household access to an automobile and 12.4% of individuals with income between
100% and 200% of the federal poverty level are without household access to an automobile. 104
Public transportation in Logan County is coordinated by the Tri-County Community Action
Agency. Scheduled door-to-door transportation is provided Monday through Friday from 6:00
am to 5:45 pm. Fares range from $2.50 to $5.00 within Logan County. Transportation is
provided to nearby larger cities including Columbus, Dayton, Marion, Kenton, Troy, Lima,
103
"Lacking Shelter? Abuse Victims Far Outnumber Available Ohio Safe-House Beds, But Some Advocates Say the Key to Helping Them is
to Arrest More Abusers," Columbus Dispatch, November 27, 2011.
104
Berube, Alan et al. “Socioeconomic Differences in Household Automobile Ownership Rates.” The Brookings Institution, 2006.
http://socrates.berkeley.edu/~raphael/BerubeDeakenRaphael.pdf (November 2010).
Springfield, Sidney, Marysville, Urbana, Jackson Center, and Findlay. Fares to these cities range
from $14.00 to $44.00.
Tri County Community Action Agency completed the Logan County Coordinated Public Transit
Human Service Transportation Plan in 2008. This five year plan evaluated the demographic and
socioeconomic profile of Logan County, identified the most common trip purposes and gaps in
services, conducted a vehicle inventory, and recommended future strategies. This plan found
that most trips take place between 10:00 am and 2:00 pm, and begin and end in the City of
Bellefontaine. The next busiest areas in Logan County are the Indian Lake area (Lakeview and
Russell’s Point) and the DeGraff/Quincy area. The most common out of county destinations are
the cities of Columbus, Dayton, Lima, and Sidney. The most common travel destinations are
health care centers and senior housing. Outreach gathered information from a variety of
stakeholders who identified local and out of county medical trips as the most common purpose
for transportation needs.
Age Distribution
The total population over the age of 65 in Logan County is 6,617 representing 14.2% of the
county’s total population. This is somewhat higher than the size of the senior citizen population
of the State of Ohio which is 13.6%. 105
Gender Distribution
The gender distribution in Logan County matches that of the State of Ohio with 51% of the
population female and 49% of the population male. 106
Employment
Unemployment in Logan County increased significantly in 2009, and remained high in 2010
(Figure 25). This mirrored unemployment trends in the State of Ohio and the United States, but
in 2010, unemployment in Logan County surpassed both state and national levels, reaching
13.3%.
Manufacturing employment in Logan County experienced significant growth from 1989 to 2000,
followed by a decline from 2000-2011 (Table 23). A major loss in employment occurred
between July 2007 and July 2010 as a result of the current recession. This job loss represented
over 1,000 jobs in Logan County. 107
105
"American Community Survey," U.S. Census Bureau American Factfinder, accessed December 3, 2011,
http://factfinder.census.gov/home/saff/main.html?_lang=en.
106
Ibid.
107
Roberto Gallardo, "Cost of Recession: 1.2 Million Rural Jobs," The Daily Yonder; Center for
Rural Strategies, accessed December 5, 2011, http://www.dailyyonder.com/job-loss/2010/09/13/2935.
Figure 25. Unemployment Trends 2000-2010 108
Unemployment Trend
14
12
Percent
10
8
Logan
County
6
State of
Ohio
4
United
States
2
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Table 23. Logan County Manufacturing Employment 1989-2011 109
1989
Number of Manufacturing
55
Establishments
Rank in State (of 88 Counties)
60th
Number of Manufacturing Employees
3,235
Rank in State (of 88 Counties)
64th
Largest Standard Industrial
Classification Groups (in order by
employment)
Industrial and
Commercial Machinery
(SIC 35); Rubber and
Misc. Plastics (SIC 30)
2000
84
2011
75
48th
8,224
40th
54th
3,183
60th
Transportation
Equipment (SIC
37); Electronic
Equipment (SIC36)
Transportation
Equipment (SIC
37); Fabricated
Medal Products
(SIC 34)
Manufacturing employment in Logan County is heavily reliant on Honda of America
Manufacturing, Inc. which opened in 1982 and is physically located in Union County directly to
the east of Logan County. Along the Ohio State Route 33 corridor, significant satellite
companies have opened to support and supply the operations at Honda of America. The
earthquake which struck Japan in March, 2011 significantly reduced production at Honda’s
North American operations. 110 Although there were no layoffs at the Union County Honda plant
itself, manufacturing was reduced to half-day shifts. Production was not expected to normalize
until the end of 2011. 111
108
"Ohio Labor Market Information," Ohio Department of Job and Family Services, accessed December 3, 2011,
http://ohiolmi.com/asp/laus/LAUS.asp.
109
Angela Brown, ed. 1989 Harris Ohio Industrial Directory (Twinsburg, Ohio: Harris Publishing Company, 1988; Frances L. Carlsen, ed.
Harris Ohio Industrial Directory 2000 (Twinsburg, Ohio: HarrisInfoSource, 1999);2011 Harris Ohio Industrial Directory (Twinsburg, Ohio:
HarrisInfoSource a Division of D & B, 2010).
110
Dan Gearino, "No Layoffs, But Quake Slows Honda's Production in Ohio," Columbus Dispatch, April 24, 2011,
http://www.dispatch.com/content/stories/business/2011/04/24/ no-layoffs-but-quake-slows-hondas-production-in-ohio.html.
111
"Update # 14: Earthquake Impact on Honda Operations," www.world.honda.com, accessed December 5, 2011,
http://world.honda.com/investors/pdf/2011/ Update_Earthquake_Impact_on_Honda_Operations_20110502.pdf.
Education and Literacy
There are four public school districts which cover the majority of Logan County: Bellefontaine
City, Benjamin Logan Local, Indian Lake Local, and Riverside Local (Figure 26). In the
Bellefontaine City Schools, almost 52% of the students are economically disadvantaged;
Bellefontaine City Schools also have the highest proportion of disabled students (18.4%). Indian
Lake Local Schools have the lowest graduation rate with only 81% of students graduating.
Student eligibility for free and reduced meal prices ranges from a high of over 50% of students at
Bellefontaine City Schools to a low of just over 26% of students at Benjamin Logan Local
Schools. Table 24 summarizes data on each school district. Fourteen percent of the Logan
County population age 25 and older does not have a high school diploma. 112
Figure 26. Logan County School Districts 113
Indian Lake
Local School
District
Riverside Local
School District
112
Benjamin Logan
Local School
District
Bellefontaine
City School
District
"Ohio County Profiles," Ohio Department of Development Office of Policy, Research and Strategic Planning, accessed February 14, 2012,
http://www.development.ohio.gov/research/files/ s0.htm.
113
“Ohio School Districts and Townships by County," Public Utilities Commission of Ohio, accessed December 3, 2011,
http://www.puco.ohio.gov/pucogis/sd2007_pdf/sd091.pdf.
Table 24. Logan County School Districts 2010-2011 114,115
Bellefontaine
Benjamin
City
Logan Local
Students
2,740
1,825
Economically Disadvantaged
51.6%
26.1%
Students
Students Eligible for Free and
50.19%
26.08%
Reduced Meals
Disabled Students
18.4%
14.2%
Graduation Rate
>95%
>95%
State Indicators Met (of 26 possible)
18
23
Indian Lake
Local
1,838
46.5%
Riverside
Local
727
45.8%
44.78%
46.84%
14.5%
81%
20
13.4%
>95%
21
Prior to the 1950s, Amish children attended public schools. That changed when small rural
schools began to consolidate into large districts and Amish families felt a loss of local control.
The majority of Amish children now attend one or two room schools that are operated by the
Amish community. These schools typically end at the 8th grade, as additional education is
considered unnecessary unless vocational in nature. The curriculum includes reading, arithmetic,
spelling, grammar, penmanship, history, and some geography. Science and sex education are
generally not taught in Amish schools. 116
The 1992 National Adult Literacy Survey indicated that 45% of the population in Logan County
attained only a Level 1 or Level 2 literacy proficiency level, the lowest possible levels. 117 In
2003, the National Assessment of Adult Literacy estimated that 10% of the adult Logan County
population lacked basic prose literacy skills. 118 This assessment also evaluated health literacy,
and found it to be related to poverty level. For individuals with income below the federal
poverty level, the average health literacy score was 205. For individuals with no health
insurance, the average health literacy score was 216, and for individuals covered by Medicaid,
the average health literacy score was 201. At these health literacy levels, individuals would have
difficulty using the information on the label of an over-the-counter medication, reading a
prescription drug label with dependent instructions, and reading common health related charts
such as BMI charts and childhood immunization charts. 119
Nutrition
Almost 15% of Ohio residents were classified as food insecure in 2010. This includes
individuals who report reduced quality, variety, or desirability of diet as well as those with
multiple indications of disrupted eating patterns and reduced food intake. This was a 1.5%
114
"Interactive Local Report Card," Ohio Department of Education, accessed December 3, 2011, http://ilrc.ode.state.oh.us/.
"MR81 - Data for Free and Reduced Price Meal Eligibility," Ohio Department of Health: Learning Supports, accessed December 5, 2011,
ftp://ftp.ode.state.oh.us/MR81/MR81_October_2010/ MR81_Oct_2010_%20Revised%200911.txt.
116
"About Anabaptist and Pietist; Social Organizations; Education," Elizabethtown College -Young Center for Anabaptist and Pietist Studies,
accessed December 5, 2011, http://www2.etown.edu/ amishstudies/Education.asp.
117
"Adult Literacy Estimates," Portland State University; CASAS, accessed December 8, 2011,
http://www2.casas.org/lit/litcode/Search.cfm.
118
“State and County Estimates of Low Literacy," Institute of Education Sciences; National Center for Education Statistics, accessed
December 8, 2011, http://nces.ed.gov/naal/estimates/StateEstimates.aspx.
119
"The Health Literacy of America's Adults; Results from the 2003 National Assessment of Adult Literacy," Institute of Education Sciences;
National Center for Education Statistics, accessed December 8, 2011, http://nces.ed.gov/pubs2006/2006483.pdf.
115
increase over 2009, and Ohio is tied for 8th for the highest rate of food insecurity in the United
States. For the period 2003-2005, almost 20% of Ohio’s children under the age of 18 were food
insecure. 120,121
The 2010 County Health Rankings indicates that only 46% of Logan County residents have
access to healthy food outlets including grocery stores and produce stands. This compares to
64% of Ohioans, and a national benchmark of 92%. 122
Geography and Climate
Logan County covers 467 square miles and has no interstate highways connecting it to larger
population centers. The largest transportation artery is State Route 33, which runs diagonally
from the northwest corner of the county to the southeast corner of the county. State Route 33
connects Logan County with Honda Manufacturing and related employers in Union County to
the southeast, and in Shelby County to the west. State Route 33 also connects Logan County
with medical services in Columbus to the southeast and Lima to the northwest. State Route 33
varies from four lane limited access to two lane unlimited access along its length.
State Route 68 is a two lane road which runs from north to south through the approximate center
of Logan County, and connects Logan County with the City of Kenton to the North and the City
of Urbana to the south. The remainder of the county is served by smaller two lane state and
county roads.
The average annual precipitation rate in Logan County is 37.4 inches. From late November
through early April when the average monthly low temperature ranges from 15◦ to 28◦, much of
this precipitation is snowfall or sleet. This precipitation and the hilly terrain combine to make
travel in the county difficult throughout the winter season. 123
120
Household Food Security in the United States 2010, accessed December 13, 2011, http://www.ers.usda.gov/Publications/ERR125/.
John T. Cook Ph.D, Child Food Insecurity in the United States: 2003-2005 (n.p.: America's Second Harvest - The Nation's Food Bank
Network, October, 2007).
122
Robert Wood Johnson Foundation, County Health Rankings: 2010 Ohio, accessed December 9, 2010,
http://www.loganhealth.org/documents/CHRR_2010.pdf.
123
U.S. Climate Data, accessed December 13, 2011, http://www.usclimatedata.com/climate.php?location=USOH0070.
121
Figure 27. Transportation Arteries
To
Lima
To
Kenton
To
Columbus
To
Urbana
Conclusions and Recommendations
The preliminary health center service area for planning purposes was defined as Logan County,
Ohio. Logan County includes several distinct areas including the City of Bellefontaine, the
Indian Lake areas of Lakeview and Russell’s Point, and the rural parts of the county. The City of
Bellefontaine has sufficient numbers of low income individuals to support an independent
community health center, but the Indian Lake area is unlikely to be large enough to support the
overhead associated with an independent community health center. The rural areas of the county
are spread over 467 square miles, and other than the City of Bellefontaine and to a lesser extent
the Indian Lake area, there are no other areas with a sufficient population concentration to
warrant either an independent community health center, or a satellite site of a community health
center. It is recommended that the final health center planning service area encompass Logan
County. None of the surrounding counties currently have a safety-net primary care provider, and
12% of current patients at Mad River Family Practice are from outside Logan County, primarily
Champaign County. An influx of patients from outside Logan County should be included in
estimates of the patient population.
The preliminary health center target population for planning purposes was defined as individuals
with income below 200% of the federal poverty level. In the past ten years, these individuals
have gone from living primarily along State Route 33, to being distributed throughout the
county. Special populations are defined as homeless individuals, migrant and seasonal
farmworkers, and/or residents of public housing. This Needs Assessment did not identify any
significant special populations within the service area, and development of a community health
center which primarily serves these special populations is not recommended. This Needs
Assessment did identify a population group with unique cultural characteristics, the local Amish
groups, and development of the community health center should consider the needs of these
groups. It is recommended that the target population remain individuals with income below
200% of the federal poverty level.
The only safety-net primary care provider in Logan County is Mad River Family Practice. This
practice does not offer a sliding fee schedule based on income, and only about 7% of the patients
served are uninsured. A handful of patients travel to Lima, Ohio for services at a Public Health
Service Act §330 funded community health center. Few private physicians accept a significant
number of Medicaid patients, and in August 2011, Logan County was designated as a Medically
Underserved Area. Health center planning should include a safety-net health center which offers
a sliding fee schedule based on income for uninsured patients.
Mary Rutan Hospital provides emergency department care for significant numbers of ambulatory
care sensitive conditions, most notably ear, nose, and throat infections, dental conditions,
cellulitis, kidney/urinary infections, gastroenteritis, and bacterial pneumonia. Health center
planning should include services which will provide an alternative to the emergency department
for treatment of these conditions.
There are no safety-net dental providers in Logan County, and only three dentists accept
Medicaid patients into their practices. The level of use of the emergency department for
treatment of dental conditions is high. Few Medicaid enrollees access mental health and
substance abuse services in Logan County. There are no retail 340B pharmacy programs in
Logan County. Development of a community health center should consider the lack of not only
primary medical care, but also of dental, mental health/substance abuse, and pharmacy programs.
An evaluation of Logan County for Primary Medical Care and Dental Health Professional
Shortage Area designations should be preformed.
Logan County residents have higher mortality rates than the national rates for the top six causes
of mortality which are (in order): diseases of the heart, malignant neoplasms, chronic lower
respiratory disease, cerebrovascular disease, accidents and unintentional injuries, and Alzheimers
Disease. Logan County has high numbers of mothers who begin prenatal care after the first
trimester, high infant mortality rates, high teen pregnancy rates, and high maternal risk factor
rates. High risk behaviors such as substance abuse have resulted in a high unintentional death
rate, particularly heroin poisonings. Other risks include high rates of obesity and tobacco use.
Health center planning should include chronic disease management, cancer screening, prenatal
care, behavioral health, and substance abuse services.
Underlying these health disparities are social determinants of health. Logan County has large
numbers of low income individuals and high rates of individuals without health insurance. The
lack of access to care is coupled with transportation difficulties stemming from low rates of
household access to automobiles caused by poverty, geography of the county, and limited public
transportation. The population has a higher than average percentage of the population over the
age of 65. Unemployment has increased significantly over the past decade. High school
graduation rates are low in some parts of the county, and literacy levels are correspondingly low.
Health center planning should take into consideration income, insurance, transportation, age, and
literacy constraints of the patient population.
It is recommended that community health center plans be of sufficient size to serve a population
of almost 14,500 individuals. A health center of this size may not be realistic at start-up;
however, long term planning should accommodate a patient population of this size.
The distribution of low income individuals indicates that the current location of Mad River
Family Practice is a less than ideal location for the target population. It is recommended that
community health center planning evaluate a location in the City of Bellefontaine, with a
possible satellite office in the Indian Lake area. These locations will provide access to many of
the target population, but the target population that reside in the rural parts of the county may
still have access issues. Planning should include consideration of transportation for rural
residents and/or mobile services. These transportation services should address the barriers to
care faced by the Amish communities living in Logan County.
Given the high numbers of uninsured individuals and individuals covered by Medicaid, it is
unlikely that a health center which is dependent on fee for service reimbursement will generate
sufficient revenue to support operating costs. It is recommended that planning consider cost
based reimbursement models including Rural Health Clinic, Federally Qualified Health Center,
and Federally Qualified Health Center Look Alike models to ensure sustainability.

Logan County Primary Care Planning Needs Assessment

Transcription

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