2013
Lexington County Community Health Needs Assessment
LexMed.com
Table of Contents Understanding the Community Health Needs Assessment.. . . . . . . . . . . . . . . . . . . . . . . . 1 About Lexington Medical Center. . . . . . . . . . . . . . . . . 3 • Community Medical Centers. . . . . . . . . . . . . . . . 4 • Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 • In the Community. . . . . . . . . . . . . . . . . . . . . . . . . . . 7 • Lexington Medical Center Foundation. . . . . . 9
Lexington County Health Partners. . . . . . . . . . . . . 11 Lexington County Community Profile. . . . . . . . . . 17 Creating the Community Health Needs Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 • Community Survey. . . . . . . . . . . . . . . . . . . . . . . . 30 • One-on-One Interviews. . . . . . . . . . . . . . . . . . . 31 • Focus Groups.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Identified Health Needs. . . . . . . . . . . . . . . . . . . . . . . . . . 35 • Obesity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 • Access to Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 • Mental Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 • Substance Abuse.. . . . . . . . . . . . . . . . . . . . . . . . . 39
Next Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Appendix: Lexington County Community Needs Survey. . . . . . . . . . . . . . . . . . . . . . . 42
Understanding the Community Health Needs Assessment
Lexington Medical Center’s mission is the same as it was when the doors opened in 1971: to provide quality health services that meet the needs of the community. In order to meet those needs, it’s important to understand what they are.
Conducted by Lexington Medical Center and Lexington County Health Partners (LCHP), the Community Health Needs Assessment (CHNA) serves as a vital resource to health care providers in the community as they work together to identify needs, gaps and barriers to wellness and health services. The assessment accounts for the health of the people in the community through evaluating data and trends, interviewing community leaders, and prioritizing the identified health needs for future strategic planning. After extensive analysis and discussion of both qualitative and quantitative data, the 2013 Lexington County CHNA identified a number of health care priorities. The highest concerns identified were obesity, access to care, mental health and substance abuse.
Dr. Henry Marion Lexington Family Practice Northeast
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In fiscal year 2012, Lexington Medical Center admitted 19,077 patients to the main hospital and delivered 3,487 babies.
About Lexington Medical Center
Lexington Medical Center’s 414-bed modern medical complex anchors a vast, countywide network of physicians, medical practices, community-based medical and urgent care centers, an occupational health center, the largest extended care facility in the Carolinas and an Alzheimer’s care center. And that’s just the beginning.
Lexington Medical Center is a an accredited Chest Pain Center, Certified Primary Stroke Center and Bariatric Center of Excellence. Our heart and cancer programs are nationally certified and affiliated with Duke Medicine. We’ve been named Columbia’s “Best Place to Have a Baby,” “Best Hospital” and one of the “Top 25 Best Hospitals to Work for in the U.S.,” honors all made possible by a dedicated, talented team of health care professionals and staff. In 2013, the medical staff was comprised of 595 physicians, including 259 physicians
and 71 mid-level practitioners within the hospital’s network who work in 78 locations throughout Lexington and Richland counties. And the scope of care is extensive. In fiscal year 2012, the hospital cared for 744,116 patients in the physician practice setting, 132,840 patients at the urgent care centers and 103,676 patients in the emergency room. Lexington Medical Center admitted 19,077 patients to the main hospital and delivered 3,487 babies. The hospital also contributed nearly $23 million in charity care.
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COMMUNITY MEDICAL CENTERS The development of community medical centers has been invaluable as Lexington Medical Center strives to reach every corner of the county. These facilities were strategically placed to serve areas with a high need for access to care. The following is a summary of visits at the hospital’s community medical centers.
FY 2012 Community Medical Center Visits
30,364
40,086
LMC L Lexington exington LMC
LMC Batesburg-‐Leesville
LMC Batesburg-‐Leesville LMC Chapin
LMC Chapin LMC Gilbert
25,287 20,718
5,990 4
10,395
LMC ilbert LMC G Swansea
LMC SIrmo LMC wansea
LMC Irmo
Source: Lexington Medical Center, internal data
Chapin
LMC Chapin
Irmo
LMC Irmo Lexington Medical Center
LMC Gilbert
Batesburg-Leesville
Lexington
LMC Lexington Gilbert
LMC Batesburg-Leesville
LMC Swansea
Swansea
Lexington Medical Center Community Medical Center Locations
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SERVICES Lexington Medical Center has long served the needs of Lexington County and surrounding areas with a wide range of services as well as access to advanced technology, state-of-the-art facilities, and physicians and staff who are committed to offering exceptional care.
FEATURED SERVICES
ADDITIONAL PATIENT CARE SERVICES
• Cancer Center
• Alzheimer’s Care
• Imaging
• Heart Center
• Birth Center
• Laboratory & Pathology
• Orthopaedics
• Extended Care
• Occupational Health
• Women’s Services
• Family Medicine
• Weight-loss Surgery
• General Surgery
HEALTH & WELLNESS SERVICES • Community Health Screenings • Health Directions • Lexington Sleep Solutions • Nutrition Therapy
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IN THE COMMUNITY Lexington Medical Center is dedicated to making our health care services available to every person in need. Part of that commitment involves caring for our community by offering free health screenings and assessments, educational wellness presentations, fitness programs and support groups. Lexington Medical Center, also participates in a number of events to increase health education and wellness in the Midlands.
Women’s Night Out Women’s Night Out is an annual awareness and education event that highlights October as National Breast Cancer Awareness Month. Featuring health and wellness exhibits, a silent auction, dinner and keynote address, all proceeds benefit the Lexington Medical Center Foundation’s Cancer Care Fund, which provides cancer services to patients in need.
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Colon Cancer Challenge Each year, Lexington Medical Center hosts the Colon Cancer Challenge, a cycling event that increases awareness of colon cancer and raises funds for screening colonoscopies for patients who are uninsured or underinsured.
Mission South Carolina Mission South Carolina is an annual event in the Midlands to provide dental, medical and vision services to low-income, uninsured adults on a first-come, first-served basis. The South Carolina Hospital Association and several other health partners team with physicians, nurses, dentists, optometrists, pharmacists, lab technicians and volunteers to provide care for thousands of underserved South Carolinians. The event’s goal is to help partner the uninsured with a medical home to promote continuous care and to decrease the use of local emergency rooms. In addition, the event educates patients on some of the most common chronic health conditions. Lexington Medical Center facilitated the Mission 2013 event from August 2–3, 2013. 8
LEXINGTON MEDICAL CENTER FOUNDATION The Lexington Medical Center Foundation works to ensure that quality health services and patient-centered care are available for the people of the Midlands.
Cancer Care The Lexington Medical Center Foundation supports many areas of cancer care at the hospital, including purchasing vital medications and supplies for in-need patients, and providing emergency assistance for other living expenses. In addition to preventive programs such as the Mobile Mammography Van, the Foundation supplies post-surgical kits for mastectomy patients and supports Becky’s Place, a boutique that offers wigs and other prostheses. Through these programs, the Foundation is able to help patients during their most difficult moments.
Women of Hope Women of Hope is an exciting project of the Lexington Medical Center Foundation that brings women together to affect the health of the community. Women of Hope is open to all women throughout the Midlands who want to help patients in need and provide outreach into the community. Through annual events and networking opportunities, Women of Hope builds community among its members and raises awareness of critical health issues affecting women and their families.
Project Prescription Through Project Prescription, the Lexington Medical Center Foundation provides immediate access to prescription medications for people with low-to-moderate income and no insurance. For these patients, this program is the difference between improving or worsening health, returning to work or the hospital, and providing for their families or losing their jobs due to sickness.
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Lexington County Health Partners
LCHP is a group of agency directors and school districts that serve Lexington County with the common purpose of coordinating efforts to address the health needs of the county’s citizens. These partners meet monthly to assess, evaluate and search for ways to enhance communication among agencies and to improve health outcomes for the residents of Lexington County. The following health-related organizations work with Lexington Medical Center to bridge health care gaps in the community.
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Dickerson Center for Children This non-profit organization in Columbia, South Carolina helps children who have been physically or sexually abused.
Eau Claire Cooperative Health Centers The cooperative is a federally qualified, community-based comprehensive medical safety net that provides access to primary health care services for a traditionally underserved population.
First Steps First Steps is the state’s only entity focused exclusively on increasing school-readiness outcomes for all children.
Irmo Chapin Recreation Commission The Irmo Chapin Recreation Commission enhances the quality of life for all citizens of the district through the development of recreation programs that promote a lifestyle of wellness, physical activities and cultural experiences for all ages.
Kids First Dental Kids First Dental provides quality dental care primarily to young people.
Lexington County Community Mental Health Center 12
The center aspires to be the provider of choice for behavioral health and recovery services for the residents of Lexington County.
Lexington County Health Department Services offered at the Lexington County Health Department include immunizations for children and adults, postpartum newborn home visits for infants and mothers, family planning services, STD/HIV testing and treatment, and TB control. Also offered are WIC nutrition services for pregnant women and children through age 5, and a dental clinic for children and adults.
Lexington County Recreation & Aging Commission The commission strives to improve the quality of life for all citizens through creative and meaningful life-enriching experiences.
Lexington Family YMCA The Lexington Family YMCA offers a complete lineup of activities and programs for the whole family: sports; strength and wellness; health screenings; and child care.
Lexington Interfaith Community Services LICS is a local interfaith social services ministry that serves families and individuals struggling to meet their basic needs of food, clothing and shelter as well as emergency financial assistance.
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Lexington/Richland Alcohol and Drug Abuse Commission LRADAC is the designated alcohol- and drug-abuse authority for Lexington and Richland counties that provides a wide array of prevention, intervention and treatment programs in locations convenient to residents of both counties.
Nurse-Family Partnership Nurse-Family Partnership is an evidence-based, community health program that pairs expectant mothers with a registered nurse early in pregnancy to receive ongoing home visits that continue through the child’s second birthday.
Palmetto Healthy Start Serving women, infants, children and families, Palmetto Healthy Start encourages moms-to-be to begin prenatal care as soon as they become pregnant. The program also assists mothers in finding doctors to care for their babies.
Perinatal Awareness for Successful Outcomes PASOs is a community-based organization that helps meet the maternal, child and reproductive health needs of our state’s growing Latino population.
Recovery Works Recovery Works helps men reclaim their lives from the disease of addiction to a life filled with hope, health, happiness and purpose.
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Sexual Trauma Services of the Midlands Sexual Trauma Services of the Midlands is a private, non-profit organization and one of 15 rape crisis centers in South Carolina. STSM provides crisis intervention, advocacy and support services to female and male child, adolescent and adult survivors of sexual assault and abuse, and education about sexual trauma issues.
South Carolina Department of Social Services South Carolina Department of Social Services works to efficiently and effectively serve the citizens of South Carolina by ensuring the safety of children and adults who cannot protect themselves, and assisting families to achieve stability through child support, child care, financial and other temporary benefits while transitioning into employment.
The Free Medical Clinic The Free Medical Clinic provides quality free health care to residents of the community who cannot pay for such services and who have no health insurance.
United Way of the Midlands United Way unites people and resources to improve the quality of life in the Midlands.
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Lexington County Community Profile
The health of the Lexington County community is determined by analyzing the complex relationship between individual health behaviors, the physical environment, socio-economic factors and overall access to health care services. To do this, LCHP relied on the S.C. Department of Health and Environmental Control’s (DHEC) disease prevalence and leading causes of death reports, the Community Need Index (CNI) tool and Robert Wood Johnson Foundation’s County Health Rankings.
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DEMOGRAPHIC DATA The primary service area for the Lexington Medical Center network of care is Lexington County. Located in the Midlands of South Carolina, it is one of the fastest-growing areas in the state and region. The county consists of 16 ZIP codes and 267,129 people (S.C. Office of Research and Statistics). In fiscal year 2012, 56.6% of Lexington Medical Center’s discharges originated from Lexington County. Below is an outlined map of the primary service area with Lexington County ZIP codes identified.
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POPULATION PROJECTION Children and youth ages 0 to 17 make up 24.2% of the population; 8.67% are 18 to 24 years of age, 26.82% are ages 25 to 44; 27.71% are ages 45 to 64; and 12.6% of the population are seniors, 65 years of age and older. Lexington County represents 5.71% of the total population of South Carolina. Based on the 2010 census and population estimates, Lexington County is expected to continue growing to nearly 333,000 residents by 2030, a 20% increase (S.C. Office of Research and Statistics).
Population Projection
POPULATION PROJECTION 350,000 300,000 250,000 200,000
Column1
150,000 100,000 50,000 0
2013
2015
2020
2025
2030
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RACE/ETHNICITY The majority of Lexington County is comprised of White/Caucasian residents at 78.2%, a larger proportion than South Carolina overall at 66.2%. Residents are also more likely to identify with other races or two or more races in Lexington. Residents of Hispanic origin represent 5.9% of the county; Lexington and South Carolina have an almost identical representation. Overall, however, Lexington has a lower minority population than the state (U.S. Census Bureau). Lexington County
South Carolina
Two or More Races Other Race
PaciCic Islander Alone
Lexington County
Asian Alone
American Indian/Alaska Native
Two or More Races
Black Alone
0%
Non Hispanic/Latino
PaciCic Islander Alone
10%
20%
30%
40%
50%
60%
80%
20%
Asian Alone
White Alone
Black Alone
South arolina South C Carolina
White Alone 10% 20% Lexington 30% C40% ounty 50%
Lexington County 0%
Hispanic/Latino
0%
South Carolina
American Indian/Alaska Native Black Alone 0%
20
90%
PaciCic Islander Alone
PERCENT OFAPOPULATION Asian lone
Non Hispanic/Latino
0%
Other Race
70%
American Indian/Alaska Native
Hispanic/Latino
Lexington County
Two or More Races
Other Race
White Alone
South Carolina
20%
40%
60%
80%
PERCENT OF POPULATION
40%
60%
80%
100%
100%
10%
20%
60%
30%
70%
40%
80%
50%
90
60%
EMPLOYMENT Lexington County has a workforce that is recognized as being one of the best in South Carolina. The unemployment rate in Lexington County, reported by the S.C. Department of Employment and Workforce in 2011, was 7.8%; the state unemployment rate was reported at 10.3%. Lexington County continually ranks at the top for reporting the lowest unemployment rates in the state. Currently, 68% of residents are in the labor force, leaving around 30% not in the workforce (U.S. Census Bureau).
EDUCATION Education of at least a high school diploma in Lexington County is 87.8%, somewhat higher than South Carolina at 83.6%. Lexington also outranks the state in residents with higher educational achievement according to U.S. Census Bureau.
LEXINGTON COUNTY
S.C.
Less than 9th Grade
3.6%
5.8%
9 –12th No Diploma
8.6%
10.6%
High School Graduate
28.8%
30.9%
Some College
22.4%
20.1%
Associate Degree
9.3%
8.4%
Bachelor’s Degree
18.0%
15.6%
Graduate Degree
9.3%
8.6%
CATEGORY
Source: 2010 Census, American Community Survey
POVERTY In Lexington County, 30,987 or 11.6% of residents live below the federal poverty line. Of those, 16.9% are under the age of 18. In addition, 36.2% of households with single females and children under age 18 live under the federal poverty line compared to 5.0% of married couples with children under age 18 (U.S. Census Bureau).
INSURANCE Lexington County has a fairly high uninsured population at 17%, affecting more than 45,000 residents. Lexington County Medicaid enrollees make up 18.3% or 48,953 of its residents, with children accounting for the largest portion at 63% of that total (S.C. Health & Human Services).
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DISEASE RATES In spite of the overall reports of good health described by residents of Lexington County, chronic conditions still have a large effect on the health of the county. An estimated 13,871 adults in Lexington County have been diagnosed with diabetes, and that trend has been increasing over the past few years. Insufficient physical activity, overweight adults and smoking have been cited as the leading behavioral risk factors that have contributed to this increased risk of developing some of the most common chronic conditions. The table below demonstrates that the prevalence of diabetes, hypertension, heart disease and stroke in Lexington County is only slightly below the state averages (DHEC Surveillance Data). 40 DISEASE PREVALENCE IN LEXINGTON COUNTY, 2011
35 40 30 35 Population 25 (thousands) 30 20 Population 25 (thousands) 15 20 10 15 5 10 0 5 0
Source: DHEC: Coordinated Chronic Disease Fact Sheet
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Lexington County
SC Lexington County SC
LEADING CAUSES OF DEATH According to DHEC, the top 10 leading causes of death for Lexington County residents are listed below. These causes account for 90% of all deaths in the county and are similar to the leading causes of death in the state.
Death Statistics for Residents of Lexington County 2011 CAUSE OF DEATH
PERCENT
Cancer (malignant neoplasm)
22.7
Heart disease
22.1
All other diseases (residuals)
19.7
Accidents
6.6
Chronic lower respiratory disease
6.1
Cerebrovascular disease
4.6
Alzheimer’s disease
3.5
Nephritis, nephrotic syndrome and nephrosis
1.9
Suicide (intentional self-harm)
1.7
Diabetes mellitus
1.6
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COMMUNITY NEED INDEX The CNI identifies the severity of health disparities for every ZIP code in the United States and demonstrates the link between community need, access to care and preventable hospitalizations. The ability to pinpoint neighborhoods with significant barriers to health care access is an important advancement for public health advocates and health care providers (Dignity Health, 2013). For each ZIP code, the CNI accounts for the underlying economic and structural barriers that affect overall health and contribute to health disparities. These factors include: income; education; culture/language; insurance; and housing. The CNI was used initially to help identify the ZIP codes in Lexington County with the highest need, gain a better understanding of the county, and assist in analyzing and comparing all the data collected. Scoring consists of a ranking system with 1.0 representing the lowest need and 5.0 representing the highest need. The mean score for Lexington County was 3.0. The two highest scoring ZIP codes were 29006 (Batesburg–Leesville) and 29169 (West Columbia), both receiving a 4.0 rank, which means they have the highest needs in the county. The two lowest scoring ZIP codes were 29036 (Chapin) and 29072 (Lexington), receiving a 1.6 and a 1.8 ranking, respectively.
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COMMUNITY NEED INDEX
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2013 COUNTY HEALTH RANKINGS
RANK
HEALTH OUTCOMES RANK
1
Beaufort
1
Beaufort
a collaboration between Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The County Health Rankings evaluates a variety of health status indicators and ranks each county in the United States in terms of health factors and health outcomes. The health factors measure is comprised of health behaviors, clinical care, social and economic factors, and physical environment. The health outcomes measure is based on mortality and morbidity statistics affected by health factors. In 2013, Lexington County ranked 4th overall in health outcomes and 3rd overall in health factors out of the 46 counties in South Carolina. Lexington has ranked consistently in the top percentage of South Carolina counties; however, its rankings have decreased from 2010 levels of 2nd overall for health outcomes and 1st overall for health factors.
2
York
2
Charleston
3
Edgefield
3
Lexington
4
Lexington
4
Dorchester
5
Greenville
5
Greenville
6
Dorchester
6
Pickens
7
Charleston
7
Richland
8
Richland
8
York
9
Berkeley
9
Anderson
10
Kershaw
10
Edgefield
Source: Robert Wood Johnson Foundation, County Health Rankings
These health rankings signify that Lexington County has continuously ranked number one in social and environmental factors, a subset of health factors. This includes factors such as: education; children in poverty; unemployment; and violent crimes statistics. The county ranked 12th in the state in the 2013 rankings for health behaviors. The health behavior rankings take into consideration adult smoking, adult obesity, physical inactivity, excessive drinking, sexually transmitted infections and teen birth rates. Adult smoking and obesity were both flagged as having an abnormally high prevalence given the demographics of the county.
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HEALTH FACTORS
The County Health Rankings program is
LEXINGTON COUNTY SNAPSHOT: COUNTY HEALTH RANKINGS RANK (OUT OF 46)
HEALTH OUTCOMES
LEXINGTON COUNTY
ERROR MARGIN
SOUTH CAROLINA
NATIONAL BENCHMARK
7,176
6,814–7,538
8,448
5,317
15% 3.1
13–18% 2.6–3.5
16% 3.6
10% 2.6
3.7 8.1%
3.1–4.3 7.8–8.5%
3.6 10.1%
2.3 6.0%
21% 31% 26% 15% 20 373 44
18–24% 28–35% 22–29% 12–17% 18–23
21% 31% 28% 14% 22 573 49
13% 25% 21% 7% 10 92 21
18% 1,722:1 2,827:1 50 85% 69%
17–19%
20% 1,545:1 2,229:1 61 85% 69%
11% 1,067:1 1,516:1 47 90% 73%
74% 58% 10.3% 28% 22% 39% 667
70% 5.0% 14% 14% 20% 66
12.9 2% 9 8% 49%
8.8 0% 16 1% 27%
4 MORTALITY
6
Premature death
MORBIDITY Poor or fair health Poor physical health days Poor mental health days Low birthweight
HEALTH FACTORS
5
3
HEALTH BEHAVIORS Adult smoking Adult obesity Physical inactivity Excess drinking Motor vehicle crash death rate Sexually transmitted infections Teen birth rate
12
CLINICAL CARE
5
Uninsured Primary care physicians Dentists Preventable hospital stays Diabetic screening Mammography screening
SOCIAL & ECONOMIC FACTORS High school graduation Some college Unemployment Children in poverty Inadequate social support Children in single-parent households Violent crime rate PHYSICAL ENVIRONMENT Daily fine particulate matter Drinking water safety Access to recreational facilities Limited access to healthy foods** Fast food restaurants
42–45
47–50 82–89% 66–72%
1 79% 64% 7.8% 21% 17% 32% 385
62–67% 18–25% 14–20% 29–34%
23 13.0 16% 11 6% 51%
12.9–13.1
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An online survey, one-on-one interviews and focus groups were used to collect primary data for the Community Health Needs Assessment.
Creating the Community Health Needs Assessment
In order to create the CHNA, the community health partners collaborated to identify the leading and emerging health issues affecting the community. The committee met monthly to develop the strategy and timeline, and to identify the resources needed to implement the assessment. The assessment needed to provide broad community input from both primary research and an analysis of existing community data, including demographics, socio-economic and health care related statistics from a wide range of internal and external sources. An online survey, one-on-one interviews and focus groups were used to collect primary data. Then the data was prioritized by problem severity, the extent to which the problem was identified and the ability to make an impact. The assessment concluded with a community health summit, where the information was presented to health care stakeholders in the county.
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COMMUNITY SURVEY The South Carolina Hospital Association created the foundation of the community survey to help hospitals complete the CHNA requirement. LCHP customized the survey for Lexington County to solicit input about the health needs from the general community, as well as to gather demographic data. A copy of the survey can be found in Appendix A. The survey was Internet-based; published on January 14, 2013, it was available on the hospital’s website, LexMed.com, until March 11, 2013. LCHP promoted the survey.
A total of 536 surveys were deemed complete for inclusion in the CHNA. The responses were
compared to results from the other methods of data collection. The survey consisted of seven parts: • Part 1: Quality of Life Statements; • Part 2: Community Improvement; • Part 3: Health Information; • Part 4: Personal Health; • Part 5: Access to Care/Family Health; • Part 6: Emergency Preparedness; • Part 7: Demographic Information.
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ONE-ON-ONE INTERVIEWS One-on-one interviews targeted community leaders and representatives from local health organizations with a respectable knowledge of the public health environment in Lexington County. Interviewees were asked a series of five questions. These same questions were used in the assessment three years ago to compare data. The questions included: 1. What are the three most important health needs/issues in Lexington County? 2. Why do you think these three are the most important health needs/issues? 3. Are there underlying causes of these needs and issues that need to be addressed? If so, what are the underlying causes? 4. What is currently being done to address these needs/issues? 5. What additional comments do you have regarding health in Lexington County? Responses to the first question were combined by rank, and questions 2 through 5 were used as supporting qualitative data. The following individuals were interviewed as a broad representation of Lexington County: • J. Mac Bennett, President & CEO, United Way of the Midlands • Michael J. Biediger, President & CEO, Lexington Medical Center •M ary Beth Callais, Assistant Director, Lexington County Recreation & Aging Commission • Katora Campbell, Manager, Midlands Partnership Parish Nurse Program • Dennis Coker, Executive Director, The Free Medical Clinic
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• Michael Crump, MD, Lexington Medical Center Emergency Department • Rhonda DiNovo, Coordinator, Rise Above It Coalition • Jennifer Felkel, Community Roundtable of Chapin, Irmo & Dutch Fork • Deborah Francis, President & CEO, LRADAC • Greg Frohnappel, Director, Lexington County Department of Social Services • Stuart Hamilton, MD, CEO, Eau Claire Cooperative Health Centers • Dr. Venus Holland, Superintendent, Lexington School District Two • Dan Jones, Board Chair, Lexington Medical Center • Laura Jumper, Parish Nurse, Midlands Partnership Parish Nurse Program, Swansea • Lara Lott, Director, Lexington Medical Center • Sheriff Leon Lott, Richland County • Joe Mergo III, Administrator, Lexington County • Sheriff James Metts, Lexington County • James Riddle Jr., Executive Director, Lexington County First Steps • Nikki Setzler, Senator, South Carolina Senate • Ginny Waller, Executive Director, Sexual Trauma Services of the Midlands • Ashley Wierzbicki, Coordinator, Lexington One Community Coalition
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FOCUS GROUPS Due to language and access-to-Internet barriers, LCHP decided that a significant group of individuals may be left out from the data collection process. Focus groups gave these individuals the opportunity to discuss health issues that they thought affected the community and any potential underlying causes. Physicians, nurses, educators, counselors, minorities, senior citizens and community members participated. The location and number of participants for each focus group are identified below. • Saluda Pointe Family Medicine Center (15 participants) • Gilbert Elementary School (6 participants) • English Skills Class, Hispanic Population #1 (15 participants) • English Skills Class, Hispanic Population #2 (12 participants) • Sardis Baptist Church, Senior Group (9 participants) • Swansea First Baptist Church, Senior Group (14 participants)
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Because of rising health care costs, people are choosing to forgo treatments and preventive services they know will benefit their health. This usually ends with the overuse of the Emergency department because people postpone seeking help until their health issues become critical.
Identified Health Needs
The 2013 Lexington County CHNA identified a number of health care concerns in the community and established obesity, access to care, mental health issues and substance abuse as the highest priorities. OBESITY Through primary research, an overwhelming majority identified obesity as the most critical health concern in Lexington County and, more specifically, childhood obesity. Lexington has observed a rapid increase in the number of persons who are overweight or obese. These persons are also at an increased risk of obtaining many other serious health conditions such as high blood pressure, high cholesterol, diabetes and heart disease. Obesity is a complex condition influenced by behavioral, environmental, social and biological factors, making it difficult to target the most appropriate ways to prevent it. Obesity also affects all ages. After reviewing survey responses, some of the major issues mentioned were: barriers to accessibility and affordability of healthy food options; education on how to eat healthily; factors limiting physical activity; and limited access to safe places to be active.
Childhood obesity has been identified as the most critical health concern in Lexington County.
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When asked which health behaviors people in the community needed more information about, respondents indicated eating well/nutrition, stress management, managing weight and exercise/fitness. It was apparent that people were most interested in learning how to lead a healthy lifestyle. When asked about the health services that needed the most improvement, 18% of respondents chose more recreational facilities, healthier food choices and healthy family activities. Also, when asked what topic children need more information about, the number one response was nutrition.
2012 FACTS & FIGURES • I n Lexington County, 65.9% of adults and 29.6% of high-school-age adolescents were reported as obese or overweight. • Current trends indicate that overweight adolescents have a 70% chance of becoming overweight or obese adults. • DHEC has estimated that expenses associated with obese adults in S.C. have exceeded $1 billion in recent fiscal years. Sources: Eat Smart, Move More, U.S. Census, DHEC
ACCESS TO CARE Despite the median household income of Lexington County residents being similar to the national income level, many residents are without health insurance or other necessary means. These barriers can lead to unmet health needs, which delays residents receiving appropriate care that could potentially prevent a future hospitalization. The three leading underlying 36
causes of access to care issues identified through the primary research of this assessment were lack of transportation, affordability and education on how to properly use the health care system.
Lexington County has many rural communities that lack adequate public transportation.
This hinders individuals and families from receiving basic health care services. For those who do find transportation, the affordability of medications and tests becomes the next leading issue. Because of rising health care costs, people are choosing to forgo treatments and preventive services they know will benefit their health. This usually ends with the overuse of the Emergency department because people are forced to wait until their health issues become critical.
It was also noted that there is a lack of community education on how to properly use the
health care system. Most people do not understand the importance of having a primary care physician who can provide a medical home for more appropriate and cost-effective health care compared to an emergency room.
2012 FACTS & FIGURES • I n Lexington County, 17% of residents were uninsured and 18.3% were enrolled in Medicaid. • T he Free Medical Clinic reported 13,600 visits in fiscal year 2012, and spent $5.15 million on medications and diabetic supplies. • Lexington Medical Center saw 103,676 people in its Emergency department. Sources: Lexington Medical Center, U.S. Census, The Free Medical Clinic
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MENTAL HEALTH In one-on-one interviews, the lack of mental health resources in the county was consistently reported. Responses indicated that this issue affects all ages, but that children and senior citizens’ mental health needs seem to have grown in recent years. Comments also centered on parents being uneducated about mental health; many conditions, especially conditions in children, go undiagnosed and untreated for too long. Numerous health providers noted that there are a limited number of qualified mental health providers as well as a lack of coordination of services around the county.
In the community survey, 16% of respondents reported that a physician or health
care professional told them that they were depressed. In addition, 15% of those surveyed reported that they had felt sad or worried in the past 30 days, which kept them from going about their normal business.
Top diagnoses at the Lexington County Community Mental Health Center (LCCMHC, FY 2012)
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CHILDREN/ADOLESCENTS
ADULTS
1. Attention deficit disorder 2. Conduct disorder 3. Major depression & other mood disorders 4. Autism & development disorders 5. Anxiety disorders
1. Major depression & other mood disorders 2. Schizophrenia 3. Anxiety disorders 4. Other psychotic disorders 5. Dementia disorders
2012 FACTS & FIGURES • LCCMHC served 5,123 residents in FY 2012 (43% male/57% female). • C hildren and adolescents ages 0–17 made up 32% of residents served at LCCMHC. • More than 80% of active clients at LCCMHC reported an annual household income of $10,000 or less. Source: LCCMHC
SUBSTANCE ABUSE Substance abuse can have a major effect on individuals, families and the community. It contributes to social, mental, physical and public health problems. For Lexington County, respondents reported teenage drinking, motor vehicle accidents and domestic violence, all resulting from substance abuse, as top concerns.
Secondary consequences of substance abuse were mentioned as significantly affecting
the quality of life in Lexington County. Costs resulting from health issues and the reallocation of money that could be spent on food or health care were also community concerns. Survey results identified drug abuse as the third most important topic in which children and teenagers need information. Many interviewees noted the current collaboration between alcohol and drug abuse facilities, such as LRADAC, with local police departments, as well as successful initiatives to address these issues countywide.
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2012 FACTS & FIGURES • Marijuana accounted for the majority of adolescent substance abuse treatment admissions at LRADAC. • Twenty-one percent of middle school students reported using alcohol in the previous month. • Thirty-seven percent of high school students reported using alcohol in the previous month. • In Lexington County, 55% of traffic fatalities were related to alcohol or drugs. • Police officers arrested 1,293 people for driving under the influence in Lexington County. Source: LRADAC
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Next Steps
Lexington Medical Center hopes the information provided through its primary research provides a glimpse of the health challenges that families in the community are facing, the needs they have for raising safe and healthy children, and the strengths existing within the community. Through research and analysis, as reported in
Community Mental Health Center (mental health);
this assessment, LCHP identified the leading
and LRADAC (substance abuse).
and emerging health care issues in Lexington
County, enabling all health partners to develop
By working with LCHP to implement strategies
strategic plans now and into the future. After
that examine each of these issues, the hospital
the presentation of the CHNA at the Lexington
looks forward to making a considerable impact
County Community Health Summit on April 26,
on the overall health in the community. Lexington
2013, community leaders and health care
Medical Center will continue to work internally
professionals formed task forces to begin addressing
and with community partners to help develop
identified needs. Four organizations were chosen
strategic initiatives that can be used as a roadmap
to lead the facilitation of these task forces: Eat
to address the CHNA findings countywide.
Collaboration was key throughout this process.
Smart, Move More (obesity); The Free Medical Clinic (access to care); Lexington County
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APPENDIX: Lexington County Community Needs Survey Part 1: Quality of Life Statements 1. H ow do you feel about this statement: “There is good health care in Lexington County”? Consider the cost and quality, number of options, and availability of health care in the county. A. Strongly Disagree B. Disagree C. Neutral
D. Agree E. Strongly Agree
2. H ow do you feel about this statement: “Lexington County is a good place to raise children”? Consider the quality and safety of schools and child care programs, after school programs and places to play in the county. A. Strongly Disagree B. Disagree C. Neutral
D. Agree E. Strongly Agree
3. H ow do you feel about this statement: “Lexington County is a good place to grow old”? Consider the county’s elder-friendly housing, transportation to medical services, recreation and services for the elderly. A. Strongly Disagree B. Disagree C. Neutral
D. Agree E. Strongly Agree
4. H ow do you feel about this statement: “There is plenty of economic opportunity in Lexington County”? Consider the number and quality of jobs, job training/higher education opportunities and availability of affordable housing in the county. A. Strongly Disagree B. Disagree C. Neutral
D. Agree E. Strongly Agree
5. H ow do you feel about this statement: “Lexington County is a safe place to live”? Consider how safe you feel at home, work, school, playgrounds, parks and shopping centers in the county. A. Strongly Disagree B. Disagree C. Neutral
D. Agree E. Strongly Agree
6. H ow do you feel about this statement: “There is plenty of help for people during times of need in Lexington County”? Consider social support in this county: neighbors; support groups; faith community outreach; community organizations; and emergency monetary assistance.
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A. Strongly Disagree B. Disagree C. Neutral
D. Agree E. Strongly Agree
APPENDIX: Lexington County Community Needs Survey Part 2: Community Improvement 7. I n your opinion, which one issue most affects the quality of life in Lexington County? Please choose only one. A. Pollution (air, water, land) H. Lack of community support B. Dropping out of school I. Neglect and abuse C. Low income/poverty J. Elder abuse D. Homelessness K. Child abuse E. Lack of/inadequate health insurance L. Substance abuse F. Hopelessness M. Domestic violence G. Discrimination/racism N. Violent crime (murder, assault, theft, rape) 8. I n your opinion, which one of the following services needs the most improvement in your neighborhood or community? Please choose only one. I. Culturally appropriate health services A. Animal control J. Counseling/mental health/support groups B. Child care options K. Better/more recreational facilities C. Elder care options L. Healthy family activities D. Services for disabled people M. Positive teen activities E. More affordable health services N. Transportation options F. Better/healthier food choices O. Availability of employment G. More affordable housing P. Road maintenance and safety H. Number of health care providers 9. W hat are the three main reasons people in our community are not active outdoors? A. Crime E. Stray dogs B. Not enough sidewalks F. Not enough bike lanes C. No streetlights G. Not enough places to be active D. Traffic H. Other
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APPENDIX: Lexington County Community Needs Survey Part 3: Health Information 10. I n your opinion, which one health behavior do people in your own community need more information about? Please suggest only one. L. Quitting smoking/tobacco use prevention A. Eating well/nutrition M. Child care/parenting B. Exercise/fitness N. Elder care C. Managing weight O. Caring for family members with special needs/disabilities D. Going to a dentist for checkups P. Preventing pregnancy and sexually transmitted diseases E. Going to the doctor for yearly checkups Q. Substance abuse prevention (drugs and alcohol) and screenings R. Suicide prevention F. Getting prenatal care during pregnancy S. Stress management G. Getting flu shots and other vaccines T. Anger management H. Preparing for an emergency/disaster U. Domestic violence I. Using child safety seats V. Crime prevention J. Using seat belts W. Rape/sexual abuse prevention K. Driving safely 11. H ow do you get most of your health-related information? Please choose only one. A. Family and friends F. Child’s school B. Doctor/nurse G. Hospital C. Pharmacist H. Health department D. Church I. Help lines E. Internet J. Books/magazines 12. D o you have children between the ages of 1 and 19 for whom you are the caretaker? Includes stepchildren, grandchildren or other relatives. A. Yes B. No 13. W hich of the following health topics do you think your child/children need(s) more information about? Choose all that apply. A. Dental hygiene H. Sexual activity B. Nutrition I. Alcohol C. Eating disordera J. Drug Abuse D. Asthma management K. Reckless driving/speeding E. Diabetes management L. Mental health issues F. Tobacco M. Suicide prevention G. STDs/HIV & AIDS N. Bullying
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APPENDIX: Lexington County Community Needs Survey Part 4: Personal Health 14. W ould you say that, in general, your health is: A. Excellent D. Fair B. Very Good E. Poor C. Good 15. H ave you ever been told by a doctor, nurse or other health professional that you have any of the following health conditions? Check all that apply. A. Asthma F. Osteoporosis B. Depression or anxiety G. Overweight/obesity C. High blood pressure H. Angina/heart disease D. High cholesterol I. Cancer E. Diabetes (not during pregnancy) J. HIV & AIDS 16. I n the past 30 days, have there been any days when feeling sad or worried kept you from going about your normal business? A. Yes B. No 17. I n the past 30 days, have you had any physical pain or health problems that made it hard for you to do your usual activities, such as driving, working around the house or going to work? A. Yes B. No 18. D uring a normal week, other than in your regular job, do you engage in any physical activity or exercise that lasts at least half an hour? A. Yes B. No 19. W here do you go to exercise or engage in physical activity? Check all that apply. A. YMCA D. Private gym B. Park E. Home C. Public recreation F. Other 20. H ow often do you eat a serving of fruit each day? One serving is equal to 1 cup or a single apple. A. Never C. 3–4 times per day B. 1–2 times per day
D. More than 4 times per day
21. H ow often do you eat a serving of vegetables each day? One serving is equal to 1 cup. A. Never C. 3–4 times per day B. 1–2 times per day D. More than 4 times per day
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APPENDIX: Lexington County Community Needs Survey 22. Have you been exposed to secondhand smoke in the past year? A. Yes B. No 23. I f yes, where do you think you are exposed to secondhand smoke most often? Choose only one please. A. Home D. School B. Workplace E. Other C. Restaurants 24. D o you currently smoke? Include regular smoking in social settings. A. Yes
B. No
25. If yes, where would you go for help if you wanted to quit? A. Quitline E. Private counselor/therapist B. Doctor C. Church D. Pharmacy
F. Health department G. I don’t know H. Not applicable; I don’t want to quit
26. During the past 12 months, have you had a seasonal flu vaccine? A. Yes B. No
Part 5: Access to Care/Family Health 27. What is your main form of transportation? A. Car B. Bus C. Walk
D. Bicycle E. Other
28. W here do you go most often when you are sick? Choose only one please. A. Doctor’s office B. Health department C. Hospital
D. Medical clinic/Minute clinic E. Urgent care center F. Other
29. I n the past 12 months, did you have a problem getting the health care you needed for yourself or a family member from any type of health care provider, dentist, pharmacy or other facility? A. Yes B. No
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APPENDIX: Lexington County Community Needs Survey 30. I f you said “yes,” what type of provider did you or your family member have trouble receiving health care? Choose all that apply. A. Dentist B. General practitioner C. Eye care/optometrist/ophthalmologist D. Pharmacy E. Pediatrician F. OB/GYN
G. Health department H. Hospital I. Urgent care center J. Medical clinic K. Specialist L. Other
31. W hich of these problems prevented you or your family member from getting the necessary health care? Choose all that apply. A. No health insurance E. Hospital would not take my/our insurance B. Insurance did not cover what I/we needed C. My/our share of the cost was too high (deductible) D. Doctor would not take my/our insurance or Medicaid
F. G. H. I. J.
Pharmacy would not take my/our insurance or Medicaid Dentist would not take my/our insurance or Medicaid Did not know where to go Could not get an appointment The wait was too long
32. I f a friend or family member needed counseling for a mental health or a drug/alcohol abuse problem, who is the first person you would tell them to talk to? Choose only one. A. Private counselor/therapist E. Minister/religious official B. Support group (AA, Al-Anon) C. School counselor D. Doctor
F. LRADAC – Alcohol and Substance Abuse G. Lexington County Community Mental Health Center H. Do not know
Part 6: Emergency Preparedness 33. Does your household have working smoke and carbon monoxide detectors? A. Yes, smoke detectors only B. Yes, carbon monoxide detectors only
C. Yes, both D. No
34. D oes your family have a basic emergency supply kit? These kits include water, non-perishable food, any necessary prescriptions, first aid supplies, flashlight and batteries, non-electric can opener, blanket, etc. A. Yes B. No 35. If yes, how many days do you have supplies for?
A. 1–3 days B. 3–6 days
C. More than 7 days
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APPENDIX: Lexington County Community Needs Survey 36. W hat would be your main way of getting information from authorities in a large-scale disaster or emergency? Choose only one. A. Television B. Radio C. Internet D. Newspaper
E. Social networking site F. Neighbors G. Text message (emergency alert system) H. Other
37. I f public authorities announced a mandatory evacuation for your neighborhood or community due to a large-scale disaster or emergency, would you evacuate? A. Yes B. No 38. W hat would be the main reason you might not evacuate if asked to do so? Choose only one. A. Lack of transportation F. Concern about leaving pets B. C. D. E.
Lack of trust in public officials Concern about leaving property behind Concern about personal safety Concern about family safety
G. Concern about traffic jams and inability to get out H. Health problems (could not be moved) I. Do not know
Part 7: Demographic Information 39. What is your age? A. 15–19 B. 20–24 C. 25–29 D. 30–34 E. 35–39 40. Are you male or female? A. Male
F. 40–44 G. 45–49 H. 50–54 I. 55–59 J. 60–64
K. 65–69 L. 70–74 M. 75+
B. Female
41. Are you of Hispanic, Latino or Spanish origin? A. Yes B. No 42. W hat is your race? Choose all that apply. A. White B. Black or African American C. American Indian or Alaska Native
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D. Asian Indian E. Pacific Islander including Native Hawaiian, Samoan, Guamanian/Chamorrow F. Other Asian including Japanese, Chinese, Korean, Vietnamese, Filipino/a
APPENDIX: Lexington County Community Needs Survey 43. Do you speak a language other than English at home? A. Yes B. No 44. What is your marital status? A. Never married/single B. Married C. Unmarried partner D. Divorced
E. Separated F. Widowed G. Other
45. What is the highest level of school, college or vocational training that you have finished? A. Less than 9th grade E. Some college (no degree) B. 9–12th grade, no diploma F. Bachelor’s degree C. High school graduate (or GED equivalent) G. Graduate or professional degree D. Associate degree or vocational training
46. What was your total household income last year before taxes? A. Less than $10,000 E. $35,000 to $49,999 B. $10,000 to $14,999 C. $15,000 to $24,999 D. $25,000 to $34,999 47. What is your employment status? A. Employed full-time B. Employed part-time C. Retired D. Armed Forces E. Unemployed for less than 1 year
F. $50,000 to $74,999 G. $75,000 to $99,999 H. $100,000 or more
F. Unemployed for more than 1 year G. Disabled H. Student I. Homemaker J. Self-employed
48. What is your ZIP code? ____________
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2720 Sunset Boulevard, West Columbia, South Carolina 29169
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